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Sample records for myelopathy laminectomy laminectomy

  1. Laminectomy

    MedlinePlus

    Lumbar decompression; Decompressive laminectomy; Spine surgery - laminectomy ... problems Bleeding , blood clots , or infection Risks of spine surgery are: Infection in wound or vertebral bones Damage ...

  2. Acute Tetraplegia after Posterior Cervical Laminectomy for Chronic Myelopathy.

    PubMed

    Iorio, Justin A; Jakoi, Andre M; Wetzel, Franklin T

    2015-11-01

    Spinal cord injury (SCI) during revision surgery for persistent multilevel cervical myelopathy (MCM) after an initial anterior procedure is rare. However, the pathophysiology of MCM, even prior to surgery, is a risk-factor for neurological deterioration due to the development of a "sick cord", which reflects pathological changes in the spinal cord that lower the threshold for injury. We report a case of persistent MCM despite a three-level ACDF and corpectomy who developed an incomplete C6 tetraplegia during revision cervical laminectomy and posterior instrumentation. Intraoperative neuromonitoring signal-changes occurred in the absence of mechanical trauma. Postoperative MRI of the cervical spine demonstrated increased T2 hyperintensity and cord expansion at C3 and C4 compared to the pre-laminectomy MRI. The patient has not made improvements in her neurological status at 13 months postoperatively. The pathophysiology of MCM is discussed in addition to perioperative imaging, neuromonitoring, and use of steroids. PMID:26680414

  3. Commentary on article: Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: This is a commentary on the article laminoplasty versus laminectomy and fusion (LF) for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al. Here, the authors utilized seven studies to compare the efficacy of cervical expansive laminoplasty (EL) versus laminectomy and fusion (LF) to address three or more level multilevel cervical spondylotic myelopathy (CSM). Both procedures led to similar degrees of neurological recovery and short-term loss of lordosis, but found that LF led to more favorable long-term results. Methods: For patients with three or more level CSM, laminectomy followed by an instrumented fusion (LF) has major advantages; open bilateral decompression of the nerve roots, while minimizing the risk of inadvertent injury to the cord, and the fusion's maintenance of lordosis. Results: Some would argue that inadvertent cord/root injury is greater utilizing any of the EL techniques; e.g., unilateral, bilateral, or spinous process splitting techniques. In short, why risk cord/root injury by manipulating the compressive posterior/posterolateral elements, which are already threatening neural function. Conclusion: Although the results of EL versus LF appeared comparable in the short-term in these seven articles, LF resulted in better long-term outcomes. Some would also argue that LF, utilizing an open approach offers safer bilateral neural exposure and decompression. PMID:26425397

  4. Arachnoiditis from myelography and laminectomy in experimental animals.

    PubMed

    Johansen, J G; Barthelemy, C R; Haughton, V M; Lipman, B T; Ho, K C

    1984-01-01

    Clinical reports have suggested that myelography and laminectomy may produce more arachnoiditis than myelography alone. The effect of experimental lumbar myelography and laminectomy on arachnoiditis in monkeys was studied. Arachnoiditis was as severe after myelography alone as after myelography and laminectomy. Minimal arachnoiditis was found myelographically and histologically after myelography with metrizamide 300 mg l/ml, and severe arachnoiditis was found after myelography with iophendylate whether or not laminectomy was performed. Laminectomy alone produced insignificant arachnoid changes. Experimental myelography preceding laminectomy did not increase the risk of arachnoiditis. PMID:6421130

  5. Acute Sciatic Neuritis following Lumbar Laminectomy

    PubMed Central

    Hitchon, Patrick; Reddy, Chandan G.

    2014-01-01

    It is commonly accepted that the common cause of acute/chronic pain in the distribution of the lumbosacral nerve roots is the herniation of a lumbar intervertebral disc, unless proven otherwise. The surgical treatment of lumbar disc herniation is successful in radicular pain and prevents or limits neurological damage in the majority of patients. Recurrence of sciatica after a successful disc surgery can be due to many possible etiologies. In the clinical setting we believe that the term sciatica might be associated with inflammation. We report a case of acute sciatic neuritis presented with significant persistent pain shortly after a successful disc surgery. The patient is a 59-year-old female with complaint of newly onset sciatica after complete pain resolution following a successful lumbar laminectomy for acute disc extrusion. In order to manage the patient's newly onset pain, the patient had multiple pain management visits which provided minimum relief. Persistent sciatica and consistent physical examination findings urged us to perform a pelvic MRI to visualize suspected pathology, which revealed right side sciatic neuritis. She responded to the electrical neuromodulation. Review of the literature on sciatic neuritis shows this is the first case report of sciatic neuritis subsequent to lumbar laminectomy. PMID:25024708

  6. The management of pain following laminectomy for lumbar disc lesions.

    PubMed Central

    Martin, G.

    1981-01-01

    Assessment of the results of laminectomy for lumbar disc lesions is unsatisfactory, but it seems that some degree of recurrent pain is virtually inevitable. The clinical features and incidence of the various painful syndromes seen in these patients, including one, the sacro-spinalis insertion syndrome, which has not previously been described, are outlined and the management of each is discussed with reference to two personal series, one of 98 patients consecutively undergoing laminectomy and the other of 35 patients referred because of recurrent pain following laminectomy. Finally, problems of prophylaxis are considered. PMID:6454375

  7. Decompressive Laminectomy for Low Back and Sciatic Pain

    PubMed Central

    Harris, L.

    1970-01-01

    A proportion of patients with lumbar disc syndromes have little in the way of disc protrusion, but have spinal canals, either congenitally narrow, or else narrowed by degenerative changes. These patients require myelography for their assessment and decompression by complete laminectomy for their treatment, as opposed to the more usual practice of discectomy via partial laminectomy and/or fusion. Five such cases with myelographic findings are presented. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5FIG. 6FIG. 7 PMID:4246359

  8. The extent of laminectomy affects pain-related behavior in a rat model of neuropathic pain.

    PubMed

    Kosta, Vana; Kojundzić, Sanja Lovrić; Sapunar, Liana Cambj; Sapunar, Damir

    2009-03-01

    One of the unresolved questions in neuropathic pain research is whether we can prevent or reverse mechanical hyperalgesia by rhizotomy or ganglionectomy. However, one of the obstacles in answering that question is lack of a standardized surgical procedure used in experimental ganglionectomy. We tested the hypothesis that laminectomy performed during ganglionectomy induces lumbar column deformity. We further examined whether spinal deformity is a source of pain-related behavior. Five conditions were studied. Fifth and sixth lumbar (L5 and L6) ganglionectomy were performed in rats using either minimal or extensive laminectomy technique. Two other groups had minimal and extensive laminectomy without ganglionectomies. A final control group had no surgery. Sensory responsiveness of the plantar aspect of the hind paw was repeatedly tested, and a plain radiograph in anteroposterior projection was made to assess the extent of deformity by measurement of deformity angles. Hyperalgesia resulted in groups with extensive laminectomy regardless of performance or absence of ganglionectomy, while in groups with minimal laminectomy there was no increase in pain-related behavior. Lateral deformity of the spine was observed in rats with or without ganglionectomy, confirming that laminectomy can produce deformity. The extent of deformity was more pronounced in rats exposed to the extensive laminectomy. Our results indicate that laminectomy can produce spine deformity and that there is a direct relationship between the extent of laminectomy and the development of mechanical hypersensitivity. The data presented suggest that there is a need for standardization of laminectomy procedure in rat experimental pain models. PMID:18547845

  9. Obtuse-angled Laminotomy as a Modification of Multilevel Laminectomy for Spinal Cord Decompression.

    PubMed

    Jhas, Sumit; Pirouzmand, Farhad

    2016-03-01

    The purpose of this note is to describe an obtuse-angled laminotomy of C7 during cervical decompression that aims to preserve cervicothoracic junction stability and potentially reduce pain. Cervical spondylotic myelopathy can result from degenerative cervical spinal disease including, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multilevel myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Multilevel laminectomy is traditionally used when degenerative changes affect 3 or more levels and when there is primarily dorsal compressive disease. Traditional laminectomy can result in instability and kyphosis. The C7 lamina can be particularly vulnerable given the location at cervicothoracic junction. We describe an obtuse-angled laminotomy for the most caudal lamina in a planned decompression. This lamina is left attached to ligamentum nuchea, adjacent fascia, and paravertebral muscles. Only the base of spinous process and ventral portion of lamina's cortical and cancellous bone are removed in an obtuse angle through the opening. This variation is aimed to preserve as much of the cervical stability while still achieving the goal of decompression. PMID:26889986

  10. Clinical outcomes after decompressive laminectomy for symptomatic ossification of ligamentum flavum at the thoracic spine.

    PubMed

    Zhong, Zhao-Ming; Wu, Qian; Meng, Ting-Ting; Zhu, Yong-Jian; Qu, Dong-Bin; Wang, Ji-Xing; Jiang, Jian-Ming; Lu, Kai-Wu; Zheng, Shuai; Zhu, Si-Yuan; Chen, Jian-Ting

    2016-06-01

    Ossification of the ligamentum flavum (OLF) is a rare disease that causes acquired thoracic spinal canal stenosis and thoracic myelopathy. The aim of this study was to investigate clinical outcomes of symptomatic thoracic OLF treated using posterior decompressive laminectomy. We retrospectively analyzed the medical records of 22 patients who underwent posterior decompressive laminectomy for symptomatic thoracic OLF. The surgical results were evaluated using the modified Japanese Orthopaedic Association (JOA) scoring system and Hirabayashi recovery rate. The intensity of pain was evaluated using a visual analog scale (VAS). The mean duration of follow-up was 35.6months. The mean JOA score was significantly improved at final follow-up (9.18±standard deviation of 1.53 points [range, 6-11 points]) compared with before surgery (5.64±2.04 points [range, 3-9 points]) (P<0.001). The mean Hirabayashi recovery rate was 65.49% (range, 20-100%). Recovery outcomes were excellent in nine patients, good in eight patients, fair in four patients and unchanged in one patient. No patient was classified as deteriorated. The VAS scores were 2.82±3.08 before surgery and 0.59±1.05 at final follow-up (P=0.001). Surgical complications, which resolved after appropriate and prompt treatment, included dural tear in five patients, cerebrospinal fluid leakage in one patient, immediate postoperative neurologic deterioration in one patient, epidural hematoma in one patient, and wound infection in one patient. Our findings suggest that posterior decompressive laminectomy is an effective treatment for symptomatic thoracic OLF and provides satisfactory clinical improvement, but surgery for thoracic OLF is associated with a relatively high incidence of complications. PMID:26898582

  11. Pentoxifylline Inhibits Epidural Fibrosis in Post-Laminectomy Rats

    PubMed Central

    Kelten, Bilal; Erdogan, Hakan; Antar, Veysel; Sanel, Selim; Tuncdemir, Matem; Kutnu, Muge; Karaoglan, Alper; Orki, Tulay

    2016-01-01

    Background The aim of this experimental study was to investigate the effectiveness of intramuscular pentoxifylline in the prevention of postoperative fibrosis. Material/Methods We divided 16 adult Wistar albino rats into 2 equal groups: treatment and control. Both groups underwent L1 vertebral total laminectomy to expose the dura. The intramuscular treatment group received pentoxifylline. Four weeks later, epidural fibrosis was studied in both groups using electron microscopy, light microscopy, histology, biochemistry, and macroscopy. Results The evaluation of epidural fibrosis in the 2 groups according to macroscopic (p<0.01) assessment and light microscopy revealed that epidural scar tissue formation was lower in the treatment group compared to the control group (p<0.001) and the number of fibroblasts was also decreased significantly in the pentoxifylline-treated group (p<0.05). More immature fibers were demonstrated in the treatment group by electron microscopy in comparison with the control group. In biochemical analysis, a statistically significant decrease was detected in hydroxyproline, which indicates fibrosis and myeloperoxidase activity, and shows an inflammatory response (P<0.001). Conclusions Systemic pentoxifylline application prevents postoperative epidural fibrosis and adhesions with various mechanisms. Our study is the first to present evidence of experimental epidural fibrosis prevention with pentoxifylline. PMID:26974057

  12. [Update on prevention of epidural adhesion after lumbar laminectomy].

    PubMed

    Feng, Ming-xuan; Hong, Dun

    2015-11-01

    Postoperative epidural adhesion is one of the most common causes of failed back surgery syndrome (FBSS), which can lead to back and leg pain or neurological deficit. Prevention of epidural adhesion after laminectomy is critical for improving the outcomes of lumbar surgery. The main origins of epidural fibrosis are raw surface of erector muscles and rupture fibers of intervertebral disc. The main current preventive methods for epidural adhesion include the usage of implants, chemicals and low dose radiation. However, most of them are still in experiment period. There are still controversies on the clinic usage of autograft free fat, ADCON-L, and Mitomycin C (MMC). The optimal implants are characteristics of better biocompatibility, degradable absorption and capability of existing for a certain period in body. The optimal medicine should have good effect on anti-desmoplasia, less side effects and long half-life. Besides, the combination of biodegradable medical film and drug and the mixture of two or more medical films are also the research frontlines of epidural adhesion. Further researches are required to explore new materials and drugs with stable and most favorable effect in preventing epidural adhesion. PMID:26757539

  13. Clinical and surgical outcomes after lumbar laminectomy: An analysis of 500 patients

    PubMed Central

    Bydon, Mohamad; Macki, Mohamed; Abt, Nicholas B.; Sciubba, Daniel M.; Wolinsky, Jean-Paul; Witham, Timothy F.; Gokaslan, Ziya L.; Bydon, Ali

    2015-01-01

    Background: The objective of this study is to determine the clinical and surgical outcomes following lumbar laminectomy. Methods: We retrospectively reviewed medical records of neurosurgical patients who underwent first-time, bilateral, 1-3 level laminectomies for degenerative lumbar disease. Patients with discectomy, complete facetectomy, and fusion were excluded. Results: Five hundred patients were followed for an average of 46.79 months. Following lumbar laminectomy, patients experienced statistically significant improvement in back pain, neurogenic claudication, radiculopathy, weakness, and sensory deficits. The rate of intraoperative durotomy was 10.00%; however, 1.60% experienced a postoperative cerebrospinal fluid leak. The risk of experiencing at least one postoperative complication with a lumbar laminectomy was 5.60%. Seventy-two patients (14.40%) required reoperations for progression of degenerative disease over a mean of 3.40 years. The most common symptoms prior to reoperation included back pain (54.17%), radiculopathy (47.22%), weakness (18.06%), sensory deficit (15.28%), and neurogenic claudication (19.44%). The relative risk of reoperation for patients with postoperative back pain was 6.14 times higher than those without postoperative back pain (P < 0.001). Of the 72 patients undergoing reoperations, 55.56% underwent decompression alone, while 44.44% underwent decompression and posterolateral fusions. When considering all-time reoperations, the lifetime risk of requiring a fusion after a lumbar laminectomy based on this study (average follow-up of 46.79 months) was 8.0%. Conclusion: Patients experienced statistically significant improvements in back pain, neurogenic claudication, radiculopathy, motor weakness, and sensory deficit following lumbar laminectomy. Incidental durotomy rate was 10.00%. Following a first-time laminectomy, the reoperation rate was 14.4% over a mean of 3.40 years. PMID:26005583

  14. Comparison of hemilaminectomy and dorsal laminectomy for thoracolumbar intervertebral disc extrusion in dachshunds.

    PubMed

    Muir, P; Johnson, K A; Manley, P A; Dueland, R T

    1995-08-01

    Neurological improvement after decompressive surgery, without routine therapeutic or prophylactic disc fenestration, was evaluated retrospectively in a consecutive series of 93 dachshunds with thoracolumbar disc extrusion. In 24 per cent of procedures, deep pain sensation was not elicited in at least one hind paw before surgery. Median neurological status one to seven days after surgery, at the time of discharge, was significantly improved after hemilaminectomy compared with dorsal laminectomy (P < 0.05). After hemilaminectomy, deep pain sensation was not elicited in one or both hind paws of 8 per cent of dogs in which pain sensation was elicited before surgery, compared with 21 per cent after dorsal laminectomy (P > 0.05). Improvement in neurological grade at follow-up examination two to 12 weeks after hemilaminectomy was not significantly different compared with dorsal laminectomy (P > 0.05). Of dogs which were unable to walk before surgery, 83 per cent regained the ability to walk after hemilaminectomy, compared with 74 per cent after dorsal laminectomy (P > 0.05). In both groups, 50 per cent of dogs in which deep pain sensation was abnormal before surgery eventually regained the ability to walk after surgery (P = 1). One to two years after the first operation, a second laminectomy was performed in only 5 per cent of dogs because of extrusion of a different intervertebral disc which had not been fenestrated. PMID:8558868

  15. Tisseel does not reduce postoperative drainage, length of stay, and transfusion requirements for lumbar laminectomy with noninstrumented fusion versus laminectomy alone

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: Typically, fibrin sealants (FSs) and fibrin glues (FGs) are used to strengthen dural repairs during spinal surgery. In 2014, Epstein demonstrated that one FS/FG, Tisseel (Baxter International Inc., Westlake Village, CA, USA) equalized the average times to drain removal and length of stay (LOS) for patients with versus without excess bleeding (e.g. who did not receive Tisseel) undergoing multilevel laminectomies with 1-2 level noninstrumented fusions (LamF).[6] Methods: Here Tisseel was utilized to promote hemostasis for two populations; 39 patients undergoing average 4.4 level lumbar laminectomies with average 1.3 level noninstrumented fusions (LamF), and 48 patients undergoing average 4.0 level laminectomies alone (Lam). We compared the average operative time, estimated blood loss (EBL), postoperative drainage, LOS, and transfusion requirements for the LamF versus Lam groups. Results: The average operative times, EBL, postoperative drainage, LOS, and transfusion requirements were all greater for LamF versus Lam patients; operative times (4.1 vs. 3.0 h), average EBL (192.3 vs. 147.9 cc), drainage (e.g. day 1; 199.6 vs. 167.4 cc; day 2; 172.9 vs. 63.9 cc), average LOS (4.6 vs. 2.5 days), and transfusion requirements (11 LamF patients; 18 Units [U] RBC versus 2 Lam patients; 3 U RBC). Conclusions: Utilizing Tisseel to facilitate hemostasis in LamF versus Lam still resulted in greater operative times, EBL, postoperative average drainage, LOS, and transfusion requirements for patients undergoing the noninstrumented fusions. Although Tisseel decreases back bleeding within the spinal canal, it does not reduce blood loss from LamF decorticated transverse processes. PMID:26005579

  16. Effects of Lateral Mass Screw Rod Fixation to the Stability of Cervical Spine after Laminectomy

    NASA Astrophysics Data System (ADS)

    Rosli, Ruwaida; Kashani, Jamal; Kadir, Mohammed Rafiq Abdul

    There are many cases of injury in the cervical spine due to degenerative disorder, trauma or instability. This condition may produce pressure on the spinal cord or on the nerve coming from the spine. The aim of this study was, to analyze the stabilization of the cervical spine after undergoing laminectomy via computational simulation. For that purpose, a three-dimensional finite element (FE) model for the multilevel cervical spine segment (C1-C7) was developed using computed tomography (CT) data. There are various decompression techniques that can be applied to overcome the injury. Usually, decompression procedures will create an unstable spine. Therefore, in these situations, the spine is often surgically restabilized by using fusion and instrumentation. In this study, a lateral mass screw-rod fixation was created to stabilize the cervical spine after laminectomy. Material properties of the titanium alloy were assigned on the implants. The requirements moments and boundary conditions were applied on simulated implanted bone. Result showed that the bone without implant has a higher flexion and extension angle in comparison to the bone with implant under applied 1Nm moment. The bone without implant has maximum stress distribution at the vertebrae and ligaments. However, the bone with implant has maximum stress distribution at the screws and rods. Overall, the lateral mass screw-rod fixation provides stability to the cervical spine after undergoing laminectomy.

  17. Predicting Discharge Placement and Health Care Needs After Lumbar Spine Laminectomy

    PubMed Central

    Kanaan, Saddam F; Yeh, Hung-Wen; Waitman, Russell L; Burton, Douglas C; Arnold, Paul M; Sharma, Neena K

    2015-01-01

    Objective To explore factors associated with discharge placement (DP) and need for skilled assistance after patients are discharged to home following lumbar Laminectomy Methods A retrospective analysis of 339 patients who underwent lumbar laminectomy was conducted. We used multivariable logistic regression analysis to identify significant covariates and to construct two regression models: a primary model to predict DP, home versus inpatient rehabilitation/skilled nursing facility (IR/SNF), and a secondary model to predict the need for skilled assistance once patients are discharged to home. Results Sample included 48.7% females, 68.2% married, 56.3% independent in daily activities, and 85.2% discharged to home. Subjects were 56.06±12.75 years old and had 31.35±6.2 BMI. Of those discharged to home, 17.7% needed skilled assistance. Patients stayed 4.41±3.55 days in the hospital and walked 203.38±144.87 feet during hospital stay. Age, distance walked during hospital stay, and length of hospital stay (LOS) were significant positive predictors for discharge to home versus IR/SNF, whereas single living status, diminished prior level of function, and longer LOS were predictors of need for skilled assistance after discharge to home. Conclusion Age, mobility, marital status, prior level of function and LOS are key variables in determining healthcare needs following lumbar Laminectomy. PMID:24925036

  18. Incidence and management of cerebrospinal fluid fistulas in 336 multilevel laminectomies with noninstrumented fusions

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: The incidence (e.g., 3–27%) and the types of cerebrospinal fluid (CSF) fistulas occurring during multilevel lumbar laminectomy with noninstrumented spinal fusions varies. Methods: From 2000 to 2015, we retrospectively evaluated the incidence/etiologies of CSF fistulas occurring for 336 patients undergoing average 4.7 laminectomies with average 1.4 level noninstrumented fusions over a 15 year period. The varied etiologies of CSF leaks included; ossification of the yellow ligament (OYL) extending through the dura, postoperative surgical scar, iatrogenic traumatic leak, epidural steroid injections (ESI), resection of synovial cysts, and the removal of intradural tumors. Techniques for primary repairs included combinations of; 7-0 Gore-Tex (Newark, Delaware, USA) sutures, micro-dural staples, muscle patch/other (e.g., bovine pericardial) grafts, fibrin sealants/glues (e.g., Tisseel; Baxter International Inc., Westlake Village, CA, USA), and Duragen (Integra LifeSciences, Hawthorne, NY, USA) including both the thin and suturable types. Results: The etiologies of CSF fistulas in descending order included: Epidural spinal injections (ESI) (7 patients), synovial cysts (6 patients), OYL (5 patients), and equally for postoperative scar and intradural tumors (3 patients). CSF fistulas occurred in 24 (7.14%) of 336 patients; this frequency was reduced to 4.2% when ESI and intradural tumors were excluded. Conclusion: CSF fistulas occurred in 7.14% of 336 patients undergoing average 4.7 multilevel laminectomies with average 1.4 level noninstrumented fusions attributed to a lumbar stenosis with mild/moderate instability. The dural repair addressed seven prior ESI, six synovial cysts, five OYL, and operative scarring and intradural tumors (three apiece). Knowing the pathologies contributing to CSF fistulas should help the surgeon to better anticipate and treat these fistulas. PMID:26605107

  19. Minimally Invasive Drainage of a Post-Laminectomy Subfascial Seroma with Cervical Spinal Cord Compression.

    PubMed

    Kitshoff, Adriaan Mynhardt; Van Goethem, Bart; Cornelis, Ine; Combes, Anais; Dvm, Ingeborgh Polis; Gielen, Ingrid; Vandekerckhove, Peter; de Rooster, Hilde

    2016-01-01

    A 14 mo old female neutered Doberman pinscher was evaluated for difficulty in rising, a wide based stance, pelvic limb gait abnormalities, and cervical pain of 2 mo duration. Neurologic examination revealed pelvic limb ataxia and cervical spinal hyperesthesia. Spinal reflexes and cranial nerve examination were normal. The pathology was localized to the C1-C5 or C6-T2 spinal cord segments. Computed tomography (CT) findings indicated bony proliferation of the caudal articular processes of C6 and the cranial articular processes of C7, resulting in bilateral dorsolateral spinal cord compression that was more pronounced on the left side. A limited dorsal laminectomy was performed at C6-C7. Due to progressive neurological deterioration, follow-up CT examination was performed 4 days postoperatively. At the level of the laminectomy defect, a subfacial seroma had developed, entering the spinal canal and causing significant spinal cord compression. Under ultrasonographic guidance a closed-suction wound catheter was placed. Drainage of the seroma successfully relieved its compressive effects on the spinal cord and the patient's neurological status improved. CT was a valuable tool in assessing spinal cord compression as a result of a postoperative subfascial seroma. Minimally invasive application of a wound catheter can be successfully used to manage this condition. PMID:27008321

  20. Effects of a Temperature-Sensitive, Anti-Adhesive Agent on the Reduction of Adhesion in a Rabbit Laminectomy Model

    PubMed Central

    Park, Jeong Woo; Cho, Tae Koo; Chun, Hyoung-Joon; Ryu, Je Il

    2016-01-01

    Objective A common cause of failure in laminectomy surgery is when epidural, peridural, or perineural adhesion occurs postoperatively. The purpose of this study is to examine the efficacy of a temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG®, as a mechanical barrier for the prevention or reduction of peridural scar adhesion in a rabbit laminectomy model. Methods Twenty-six mature rabbits were used for this study. Each rabbit underwent two separate laminectomies at lumbar vertebrae L3 and L6, left empty (the control group) and applied 2 mL of the TSAA agent (the experimental group), respectively. Invasive scar formation or inflammation after laminectomy was quantitatively evaluated by measuring the thickness of the dura, the distance from the surface of dura to the scar tissues, the number of inflammatory cells in the scar tissues at the laminectomy site, and the concentration of collagen in histological sections. Results At 6 weeks postsurgery, the dura was significantly thinner and the distance from the surface of dura to the scar tissues was greater in the experimental group than in the control group (p=0.04 and p=0.01). The number of inflammatory cells was not significantly different in the two groups (p=0.08), although the mean number of inflammatory cells was relatively lower in the experimental group than in the control group. Conclusion The current study suggests that the TSAA agent, Guardix-SG®, could be useful as an interpositional physical barrier after laminectomy for the prevention or reduction of adhesion. PMID:27226857

  1. Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

    PubMed Central

    Tuli, Surendra Mohan; Kapoor, Varun; Jain, Anil K; Jain, Saurabh

    2011-01-01

    Background: Iatrogenic instability following laminectomy occurs in patients with degenerative lumbar canal stenosis. Long segment fusions to obviate postoperative instability result in loss of motion of lumbar spine and predisposes to adjacent level degeneration. The best alternative would be an adequate decompressive laminectomy with a nonfusion technique of preserving the posterior ligament complex integrity. We report a retrospective analysis of multilevel lumbar canal stenosis that were operated for posterior decompression and underwent spinaplasty to preserve posterior ligament complex integrity for outcome of decompression and iatrogenic instability. Materials and Methods: 610 patients of degenerative lumbar canal stenosis (n=520) and development spinal canal stenosis (n=90), with a mean age 58 years (33–85 years), underwent multilevel laminectomies and spinaplasty procedure. At followup, changes in the posture while walking, increase in the walking distance, improvement in the dysesthesia in lower limb, the motor power, capability to negotiate stairs and sphincter function were assessed. Forward excursion of vertebrae more than 4 mm in flexion–extension lateral X-ray of the spine as compared to the preoperative movements was considered as the iatrogenic instability. Clinical assessment was done in standing posture regarding active flexion–extension movement, lateral bending and rotations Results: All patients were followed up from 3 to 10 years. None of the patients had neurological deterioration or pain or catch while movement. Walking distance improved by 5–10 times, with marked relief (70–90%) in neurogenic claudication and preoperative stooping posture, with improvement in sensation and motor power. There was no significant difference in the sagittal alignment as well as anterior translation. Two patients with concomitant scoliosis and one with cauda equine syndrome had incomplete recovery. Two patients who developed disc protrusion, underwent a second operation for a symptomatic disc prolapse. Conclusion: Spinaplasty following posterior decompression for multilevel lumbar canal stenosis is a simple operation, without any serious complications, retaining median structures, maintaining the tension band and the strength with least disturbance of kinematics, mobility, stability and lordosis of the lumbar spine. PMID:21886919

  2. The Effect of Gabapentin Plus Celecoxib on Pain and Associated Complications After Laminectomy

    PubMed Central

    Vasigh, Aminolah; Jaafarpour, Molouk; Khani, Ali

    2016-01-01

    Introduction Prevention and treatment of postoperative pain is a major challenge in postoperative care and well-being of the surgical patient. The multimodal analgesic method has been recommended as an alternative treatment for the management of postoperative pain. Aim To assess the comparative effect of gabapentin versus gabapentin plus celecoxib on pain and associated complications after laminectomy. Materials and Methods In this randomized double- blind clinical trial, 114 patients scheduled for elective laminectomy received gabapentin (n=38, 900 mg daily), gabapentin plus celecoxib (n=38, 200 mg celecoxib plus 300mg gabapentin twice a day), and placebo (n=38, capsule containing starch). Visual Analog Scale (VAS) was used to determine the severity of pain. Complications after surgery, anxiety scores before surgery and patient’s satisfaction 24 hour after surgery were recorded. Results The mean pain sevenity score and morphine consumption in the gabapentin plus celecoxib group were less compared to the placebo and gabapentin group respectively at various intervals (p < 0.001). The mean anxiety score, shivering, nausea, vomiting and pruritus in the gabapentin group were significantly lower compared to the placebo and gabapentin plus celecoxib groups respectively (p < 0.001, p < 0.05). The frequencies of drowsiness (42.1%) in the gabapentin group were significantly high compared to the placebo and gabapentin plus celecoxib group respectively (p <0.001, p< 0.05). In the gabapentin plus celecoxib group patient satisfaction was significantly higher compared to the placebo and gabapentin group (p< 0.05). Conclusion Combination of 300 mg gabapentin plus 200 mg celecoxib twice a day is a good alternative in multimodal analgesia, effective in pain control with lesser side effects seen with gabapentin alone. PMID:27134973

  3. The effect of interspinous ligament integrity on adjacent segment instability after lumbar instrumentation and laminectomy--an experimental study in porcine model.

    PubMed

    Chen, Lih-Huei; Lai, Po-Liang; Tai, Ching-Lung; Niu, Chi-Chien; Fu, Tsai-Sheng; Chen, Wen-Jer

    2006-01-01

    Eight fresh porcine lumbar spines received a posterior instrumentation at L4-L5 using pedicle screw-rod system. Each specimen was tested utilizing laminectomies of varying extent. Group A (Integrity) preserved the spinous process and interspinous ligament; Group B (Partial laminectomy) removed the inferior portion of L4 spinous process and preserved the interspinous ligament of L3-L4; Group C (Complete laminectomy) removed the entire L4 spinous process. Hydraulic testing machine was used to generate an increasing moment up to 8400 N mm in flexion and extension. The intervertebral displacement on the superior adjacent disc between L3-L4 was measured using an extensometer. Under extension, no significant difference in the intervertebral displacement was observed among three different models of laminectomy. However, under flexion, the intervertebral displacement on adjacent disc with complete laminectomy was statistically larger than those of integrity and partial laminectomies (P=0.000976 and P=0.0363, respectively). No difference was found between integrity and partial laminectomy groups (P>0.05). This study implies that an instrumented spine with integrity of posterior complex is less likely to develop adjacent instability than a spine with destruction of the anchoring point for supraspinous ligament. PMID:16971744

  4. Surgical decompression of a caudal vertebral disc extrusion by dorsal laminectomy.

    PubMed

    Potanas, C P; Grange, A; Casale, S A

    2012-01-01

    A 3.5-year-old female spayed Beagle cross was presented to our emergency and referral facility for the complaint of acute onset paralysis of the tail. A full physical and neurological examination was performed which confirmed the absence of motor function in the tail. Signs of superficial and deep pain sensation to the tail remained intact. Orthogonal view survey radiographs identified mineralization superimposed over the intervertebral foramen of the first and second caudal vertebrae. A dorsal laminectomy was performed for surgical decompression of the caudal nerve roots. On the fourth postoperative day, the patient exhibited good motor function of the tail. Neurological improvement continued and 11 days postoperatively the patient demonstrated normal neurological function, free range-of-motion of the tail, and it did not exhibit any signs of pain. Follow-up examination was performed 76 days after surgery, at which time the patient exhibited normal neurological function and signs of a pain-free range-of-motion on manipulation of its tail. PMID:21976157

  5. An Experimental Novel Study: Angelica sinensis Prevents Epidural Fibrosis in Laminectomy Rats via Downregulation of Hydroxyproline, IL-6, and TGF-β1

    PubMed Central

    Kong, Xiaohong; Zhao, Xuechao; Zhou, Xianhu; Su, Yanhua; Sharma, Hari S.; Feng, Shiqing

    2013-01-01

    With laminectomy being widely accepted as the treatment for lumbar disorders, epidural fibrosis (EF) is a common complication for both the patients and the surgeons alike. Currently, EF is thought to cause recurrent postoperative pain after laminectomy or after discectomy. Angelica sinensis is a traditional Chinese medicine which has shown anti-inflammatory, antifibrotic, and antiproliferative properties. The object of this study was to investigate the effects of Angelica sinensis on the prevention of post-laminectomy EF formation in a rat model. A controlled double-blinded study was conducted in sixty healthy adult Wistar rats that underwent laminectomy at the L1-L2 levels. They were divided randomly into 3 groups according to the treatment method, with 20 in each group: (1) Angelica sinensis treatment group, (2) saline treatment group, and (3) sham group (laminectomy without treatment). All rats were euthanized humanely 4 weeks after laminectomy. The hydroxyproline content, Rydell score, vimentin cells density, fibroblasts density, inflammatory cells density, and inflammatory factors expressions all suggested better results in Angelica sinensis group than the other two groups. Topical application of Angelica sinensis could inhibit fibroblasts proliferation and TGF-β1 and IL-6 expressions and prevent epidural scar adhesion in postlaminectomy rat model. PMID:24069047

  6. Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study

    PubMed Central

    Nerland, Ulf S; Jakola, Asgeir S; Solheim, Ole; Weber, Clemens; Rao, Vidar; Lønne, Greger; Solberg, Tore K; Salvesen, Øyvind; Carlsen, Sven M; Nygaard, Øystein P

    2015-01-01

    Objective To test the equivalence for clinical effectiveness between microdecompression and laminectomy in patients with central lumbar spinal stenosis. Design Multicentre observational study. Setting Prospective data from the Norwegian Registry for Spine Surgery. Participants 885 patients with central stenosis of the lumbar spine who underwent surgery at 34 Norwegian orthopaedic or neurosurgical departments. Patients were treated from October 2006 to December 2011. Interventions Laminectomy and microdecompression. Main outcome measures The primary outcome was change in Oswestry disability index score one year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), perioperative complications, and duration of surgical procedures and hospital stays. A blinded biostatistician performed predefined statistical analyses in unmatched and propensity matched cohorts. Results The study was powered to detect a difference between the groups of eight points on the Oswestry disability index at one year. 721 patients (81%) completed the one year follow-up. Equivalence between microdecompression and laminectomy was shown for the Oswestry disability index (difference 1.3 points, 95% confidence interval −1.36 to 3.92, P<0.001 for equivalence). Equivalence was confirmed in the propensity matched cohort and full information regression analyses. No difference was found between groups in quality of life (EQ-5D) one year after surgery. The number of patients with complications was higher in the laminectomy group (15.0% v 9.8%, P=0.018), but after propensity matching for complications the groups did not differ (P=0.23). The duration of surgery for single level decompression was shorter in the microdecompression group (difference 11.2 minutes, 95% confidence interval 4.9 to 17.5, P<0.001), but after propensity matching the groups did not differ (P=0.15). Patients in the microdecompression group had shorter hospital stays, both for single level decompression (difference 1.5 days, 95% confidence interval 1.7 to 2.6, P<0.001) and two level decompression (0.8 days, 1.0 to 2.2, P=0.003). Conclusion At one year the effectiveness of microdecompression is equivalent to laminectomy in the surgical treatment of central stenosis of the lumbar spine. Favourable outcomes were observed at one year in both treatment groups. Trial registration ClinicalTrials.gov NCT02006901. PMID:25833966

  7. Prognostic Factors of Surgical Outcome after Spinous Process-Splitting Laminectomy for Lumbar Spinal Stenosis

    PubMed Central

    Tachibana, Toshiya; Inoue, Shinichi; Arizumi, Fumihiro; Yoshiya, Shinichi

    2015-01-01

    Study Design A retrospective case review. Purpose To assess the clinical and radiographic outcomes and identify the predictive factors associated with poor clinical outcomes after lumbar spinous process-splitting laminectomy (LSPSL) for lumbar spinal stenosis (LSS). Overview of Literature LSPSL is an effective surgical treatment for LSS. Special care should be taken in patients with degenerative lumbar scoliosis (DLS). Methods A consecutive retrospective case review of patients undergoing LSPSL for LSS with a minimum 2-year follow-up was performed. Mild DLS and mild degenerative spondylolisthesis (DS) were included in the study. The Japanese Orthopedic Association (JOA) score and recovery rate were reviewed. Poor clinical outcome was defined as a recovery rate <50% using Hirabayashi's method. Results A total of 52 patients (mean age, 72 years) met the inclusion criteria and had a mean follow-up of 2.6 years (range, 2-4.5 years). The preoperative diagnosis was LSS in 19, DS in 19, and DLS in 14 cases. The mean JOA score significantly increased from 14.6 to 23.2 at the final follow-up. The overall mean recovery rate was 60.1%. Thirteen patients (25%) were assigned to the poor outcome group. A higher rate of pre-existing DLS was observed in the poor outcome (poor) group (good, 15%; poor, 62%; p=0.003) than in the good outcome (good) group. None of the patient factors examined were associated with a poor outcome. A progression of slippage ≥5 mm was found in 8 of 24 patients (33%) in the DS group. A progression of curvature ≥5° was found in 5 of 14 patients (36%) in the DLS group. The progression of scoliosis and slippage did not influence the clinical outcome. Conclusions The clinical and radiographic outcomes of LSPSL for LSS were favorable. Pre-existing DLS was significantly associated with poor clinical outcome. PMID:26435788

  8. Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study

    PubMed Central

    2010-01-01

    Background To assess safety, risk factors and clinical outcomes in elderly patients with spinal stenosis after decompressive laminectomy. Methods A prospective cohort of patients 70 years and older with spinal stenosis undergoing conventional laminectomy without fusion (n = 101) were consecutively enrolled from regular clinical practice and reassessed at 3 and 12 months. Primary outcome was change in health related quality of life measured (HRQL) with EuroQol-5 D (EQ-5D). Secondary outcomes were safety assessment, changes in Oswestry disability index (ODI), Visual Analogue Scale (EQ-VAS) score for self reported health, VAS score for leg and back pain and patient satisfaction. We used regression analyses to evaluate risk factors for less improvement. Results The mean EQ-5 D total score were 0.32, 0.63 and 0.60 at baseline, 3 months and 12 months respectively, and represents a statistically significant (P < 0.001) improvement. Effect size was > 0.8. Mean ODI score at baseline was 44.2, at 3 months 25.6 and at 27.9. This represents an improvement for all post-operative scores. A total of 18 (18.0%) complications were registered with 6 (6.0%) classified as major, including one perioperative death. Patients stating that the surgery had been beneficial at 3 months was 82 (89.1%) and at 12 months 73 (86.9%). The only predictor found was patients with longer duration of leg pain had less improvement in ODI (P < 0.001). Increased age or having complications did not predict a worse outcome in any of the outcome variables. Conclusions Properly selected patients of 70 years and older can expect a clinical meaningful improvement of HRQL, functional status and pain after open laminectomy without fusion. The treatment seems to be safe. However, patients with longstanding leg-pain prior to operation are less likely to improve one year after surgery. PMID:21092227

  9. Spinous Process splitting Laminectomy: Clinical outcome and Radiological analysis of extent of decompression

    PubMed Central

    Srikantha, Umesh

    2015-01-01

    Introduction Spinous process splitting laminectomy (SPSL) is a useful technique in achieving adequate decompression for lumbar canal stenosis, has the advantage of simultaneously decompressing multiple levels and minimising injury to the paraspinal muscles. Some concern has been expressed over the efficacy of this technique in decompressing lateral recesses. This study was undertaken to assess the clinical outcome of SPSL technique and radiologically assess the extent of decompression. Patients and Methods Thirty-nine consecutive patients treated by SPSL for degenerative lumbar spinal stenosis were methodically assessed for demographic data, clinical findings, Pre- and post-op VAS, JOA scores and spinal canal dimensions on imaging. Surgical technique for SPSL is described. Results The mean age of the patients was 66.9 yrs. The mean follow-up was 7.3 months. The mean pre- and post-operative VAS scores were 7.8 and 3.7, respectively. The mean pre- and post-operative JOA scores were 6.3 and 11.2, respectively. The mean JOA recovery rate was 57.3%. 77% of the patients were in the ‘good’ or ‘excellent’ McNab's grades at follow-up. Radiologic results were assessed separately at the 118 levels decompressed by the SPSL technique. The ratio increase for the spinal canal dimensions on post-operative images were as follows – Interfacet distance–116.6%; Effective AP distance–67.6%; Right lateral recess depth–165.1%; Right lateral recess angle–145.5%; Left lateral recess depth–149.3%; Left lateral recess angle–133.6%; Cross-sectional spinal canal area–163.8%. There was no worsening of pre-existing degenerative listhesis or scoliosis in any case. Conclusion SPSL achieves effective central and lateral recess decompression, at the same time minimising injury to the paraspinal muscles thus reducing post-operative pain and aiding in quicker mobilisation and recovery. It is an effective tool to treat multiple level spinal stenosis, especially in elderly patients who have pre-existing spinal deformities which can precipitate into frank instability after conventional procedures. PMID:26114089

  10. Radicular Pain due to Subsidence of the Nitinol Shape Memory Loop for Stabilization after Lumbar Decompressive Laminectomy.

    PubMed

    Son, Byung-Chul; Kim, Deog-Ryeong

    2015-01-01

    A number of dynamic stabilization systems have been used to overcome the problems associated with spinal fusion with rigid fixation recently and the demand for an ideal dynamic stabilization system is greater for younger patients with multisegment disc degeneration. Nitinol, a shape memory alloy of nickel and titanium, is flexible at low temperatures and regains its original shape when heated, and the Nitinol shape memory loop (SML) implant has been used as a posterior tension band mostly in decompressive laminectomy cases because the Nitinol implant has various characteristics such as high elasticity and a tensile force, flexibility, and biological compatibility. The reported short-term outcomes of the application of SMLs as posterior column supporters in cervical and lumbar decompressive laminectomies seem to be positive, and complications are minimal except for the rare occurrence of pullout and fracture of the SML. However, there was no report of neurological complications related to neural compression in spite of the use of the loop of SML in the epidural space. The authors report a case of delayed development of radiating pain caused by subsidence of the SML resulting epidural compression. PMID:25674347

  11. Comparative effectiveness of microdecompression and laminectomy for central lumbar spinal stenosis: study protocol for an observational study

    PubMed Central

    Nerland, Ulf S; Jakola, Asgeir S; Solheim, Ole; Weber, Clemens; Rao, Vidar; Lønne, Greger; Solberg, Tore K; Salvesen, Øyvind; Carlsen, Sven M; Nygaard, Øystein P; Gulati, Sasha

    2014-01-01

    Introduction This observational study is designed to test the equivalence between the clinical effectiveness of microdecompression and laminectomy in the surgical treatment of central lumbar spinal stenosis. Lumbar spinal stenosis is the most frequent indication for spinal surgery in the elderly, and as the oldest segment of the population continues to grow its prevalence is likely to increase. However, data on surgical outcomes are limited. Open or wide decompressive laminectomy, often combined with medial facetectomy and foraminotomy, was formerly the standard treatment. In recent years a growing tendency towards less invasive decompressive procedures has emerged. At present, many spine surgeons perform microdecompression for central lumbar spinal stenosis. Methods and analysis Prospectively registered treatment and outcome data are obtained from the Norwegian Registry for Spine Surgery. The primary outcome measure is change in Oswestry disability index between baseline and 12-month follow-up. Secondary outcome measures are changes in health-related quality of life measured by the Euro-Qol-5D between baseline and 12-month follow-up, perioperative complications, and duration of surgical procedures and length of hospital stay. Ethics and dissemination The study has been evaluated and approved by the regional committee for medical research in central Norway and all participants provided written informed consent. The findings of this study will be disseminated through peer-reviewed publications. Trial registration number Clinicaltrials.gov (NCT02006901). PMID:24650809

  12. Radicular Pain due to Subsidence of the Nitinol Shape Memory Loop for Stabilization after Lumbar Decompressive Laminectomy

    PubMed Central

    Kim, Deog-ryeong

    2015-01-01

    A number of dynamic stabilization systems have been used to overcome the problems associated with spinal fusion with rigid fixation recently and the demand for an ideal dynamic stabilization system is greater for younger patients with multisegment disc degeneration. Nitinol, a shape memory alloy of nickel and titanium, is flexible at low temperatures and regains its original shape when heated, and the Nitinol shape memory loop (SML) implant has been used as a posterior tension band mostly in decompressive laminectomy cases because the Nitinol implant has various characteristics such as high elasticity and a tensile force, flexibility, and biological compatibility. The reported short-term outcomes of the application of SMLs as posterior column supporters in cervical and lumbar decompressive laminectomies seem to be positive, and complications are minimal except for the rare occurrence of pullout and fracture of the SML. However, there was no report of neurological complications related to neural compression in spite of the use of the loop of SML in the epidural space. The authors report a case of delayed development of radiating pain caused by subsidence of the SML resulting epidural compression. PMID:25674347

  13. Comparing Gabapentin and Celecoxib in Pain Management and Complications After Laminectomy: A Randomized Double-Blind Clinical Trial

    PubMed Central

    Vasigh, Aminolah; Najafi, Fatemeh; Khajavikhan, Javaher; Jaafarpour, Molouk; Khani, Ali

    2016-01-01

    Background Complications and postoperative pain are major care problems that can affect the quality of health care plan. Objectives According to the use of multimodal therapy the current study aimed to compare the efficacy of gabapentin and celecoxib in pain management and complications after laminectomy at Ilam University of Medical Sciences, Ilam, Iran, in 2015. Patients and Methods In this randomized double-blind clinical trial, 114 patients scheduled for elective laminectomy with simple random sampling design received gabapentin (n = 38, 900 mg/day), celecoxib (n = 38, 600 mg/day) and placebo (n = 38, capsule contain starch). Visual analog scale (VAS) was used to determine the intensity of pain. Complications after surgery, anxiety scores before surgery and patient’s satisfaction 24 hours after the surgery were recorded. Results The mean pain intensity in the gabapentin group was lower compared to those of the placebo and celecoxib groups respectively at different time durations (P < 0.001). The means of morphine consumption were 11.9 mg, 22.8 mg and 30.1 mg in the gabapentin, celecoxib and placebo groups, respectively (P < 0.001). The prevalence of shivering, nausea, vomiting and pruritus were 10.5%, 12.8%, 10.3% and 18.4% in the gabapentin group vs 31.5%, 29.8%, 32.4% and 28.9% in the celecoxib group and 42.1%, 44.7%, 39.5% and 44.7% in the placebo group (P < 0.001). The mean anxiety score in the gabapentin group was 2.4 vs those of the celecoxib group 3 and placebo group 3.6 (P < 0.001). The frequencies of drowsiness were 42.1%, 13.2% and 5.3% in the gabapentin, celecoxib and placebo groups, respectively (P < 0.001). In the gabapentin group, patient satisfaction was significantly higher compared to those of the placebo and celecoxib groups (P < 0.05). Conclusions According to the effect of gabapentin on pain management, complications after laminectomy and increased patients satisfaction, it can be regarded as an alter native in multimodal analgesia. PMID:27195145

  14. Microsurgical excision of symptomatic sacral perineurial cyst with sacral recapping laminectomy : a case report in technical aspects.

    PubMed

    Seo, Dae-Hyun; Yoon, Kyeong-Wook; Lee, Sang Koo; Kim, Young-Jin

    2014-02-01

    Perineurial cysts (Tarlov cysts) are lesions of the nerve root that are often observed in the sacral area. There is debate about whether symptomatic perineurial cysts should be treated surgically. We presented three patients with symptomatic perineurial cyst who were treated surgically, and introduced sacral recapping laminectomy. Patients complained of low back pain and hypesthesia on lower extremities. We performed operations with sacral recapping technique for all three. The outcome measure was baseline visual analogue score and post operative follow up magnetic resonance images. All patients were completely relieved of symptoms after operation. Although not sufficient to address controversies, this small case series introduces successful use of a particular surgical technique to treat sacral perineural cyst, with resolution of most symptoms and no sequelae. PMID:24653808

  15. Microsurgical Excision of Symptomatic Sacral Perineurial Cyst with Sacral Recapping Laminectomy : A Case Report in Technical Aspects

    PubMed Central

    Seo, Dae-Hyun; Yoon, Kyeong-Wook; Lee, Sang Koo

    2014-01-01

    Perineurial cysts (Tarlov cysts) are lesions of the nerve root that are often observed in the sacral area. There is debate about whether symptomatic perineurial cysts should be treated surgically. We presented three patients with symptomatic perineurial cyst who were treated surgically, and introduced sacral recapping laminectomy. Patients complained of low back pain and hypesthesia on lower extremities. We performed operations with sacral recapping technique for all three. The outcome measure was baseline visual analogue score and post operative follow up magnetic resonance images. All patients were completely relieved of symptoms after operation. Although not sufficient to address controversies, this small case series introduces successful use of a particular surgical technique to treat sacral perineural cyst, with resolution of most symptoms and no sequelae. PMID:24653808

  16. Finite Element Analysis for Comparison of Spinous Process Osteotomies Technique with Conventional Laminectomy as Lumbar Decompression Procedure

    PubMed Central

    Kim, Ho-Joong; Chun, Heoung-Jae; Kang, Kyoung-Tak; Lee, Hwan-Mo; Chang, Bong-Soon; Lee, Choon-Ki

    2015-01-01

    Purpose The purpose of this study was to evaluate and compare the biomechanical behavior of the lumbar spine after posterior decompression with the spinous process osteotomy (SPiO) technique or the conventional laminectomy (CL) technique using a finite element (FE) model. Materials and Methods Three validated lumbar FE models (L2-5) which represented intact spine and two decompression models using SPiO and CL techniques at the L3-4 segment were developed. In each model, the ranges of motion, the maximal von Mises stress of the annulus fibrosus, and the intradiscal pressures at the index segment (L3-4) and adjacent segments (L2-3 and L4-5) under 7.5 Nm moments were analyzed. Facet contact forces were also compared among three models under the extension and torsion moments. Results Compared to the intact model, the CL and SPiO models had increased range of motion and annulus stress at both the index segment (L3-4) and the adjacent segments under flexion and torsion. However, the SPiO model demonstrated a reduced range of motion and annulus stress than the CL model. Both CL and SPiO models had an increase of facet contact force at the L3-4 segment under the torsion moment compared to that of the intact model. Under the extension moment, however, three models demonstrated a similar facet contact force even at the L3-4 model. Conclusion Both decompression methods lead to postoperative segmental instability compared to the intact model. However, SPiO technique leads to better segmental stability compared to the CL technique. PMID:25510758

  17. Risk factors for early post-operative neurological deterioration in dogs undergoing a cervical dorsal laminectomy or hemilaminectomy: 100 cases (2002-2014).

    PubMed

    Taylor-Brown, F E; Cardy, T J A; Liebel, F X; Garosi, L; Kenny, P J; Volk, H A; De Decker, S

    2015-12-01

    Early post-operative neurological deterioration is a well-known complication following dorsal cervical laminectomies and hemilaminectomies in dogs. This study aimed to evaluate potential risk factors for early post-operative neurological deterioration following these surgical procedures. Medical records of 100 dogs that had undergone a cervical dorsal laminectomy or hemilaminectomy between 2002 and 2014 were assessed retrospectively. Assessed variables included signalment, bodyweight, duration of clinical signs, neurological status before surgery, diagnosis, surgical site, type and extent of surgery and duration of procedure. Outcome measures were neurological status immediately following surgery and duration of hospitalisation. Univariate statistical analysis was performed to identify variables to be included in a multivariate model. Diagnoses included osseous associated cervical spondylomyelopathy (OACSM; n = 41), acute intervertebral disk extrusion (IVDE; 31), meningioma (11), spinal arachnoid diverticulum (10) and vertebral arch anomalies (7). Overall 54% (95% CI 45.25-64.75) of dogs were neurologically worse 48 h post-operatively. Multivariate statistical analysis identified four factors significantly related to early post-operative neurological outcome. Diagnoses of OACSM or meningioma were considered the strongest variables to predict early post-operative neurological deterioration, followed by higher (more severely affected) neurological grade before surgery and longer surgery time. This information can aid in the management of expectations of clinical staff and owners with dogs undergoing these surgical procedures. PMID:26542365

  18. Investigation of Efficacy of Mitomycin-C, Sodium Hyaluronate and Human Amniotic Fluid in Preventing Epidural Fibrosis and Adhesion Using a Rat Laminectomy Model

    PubMed Central

    Bolat, Elif; Kocamaz, Erdoğan; Kulahcilar, Zeki; Yilmaz, Ali; Topcu, Abdullah; Coskun, Mehmet Erdal

    2013-01-01

    Study Design A retrospective study. Purpose The aim of this study was to evalute the effects of mitomycin-C, sodium hyaluronate and human amniotic fluid on preventing spinal epidural fibrosis. Overview of Literature The role of scar tissue in pain formation is not exactly known, but it is reported that scar tissue causes adhesions between anatomic structures. Intensive fibrotic tissue compresses on anatomic structures and increases the sensitivity of the nerve root for recurrent herniation and lateral spinal stenosis via limiting movements of the root. Also, neuronal atrophy and axonal degeneration occur under scar tissue. Methods The study design included 4 groups of rats: group 1 was the control group, groups 2, 3, and 4 receieved antifibrotic agents, mitomycin-C (group 2), sodium hyaluronate (group 3), and human amniotic fluid (group 4). Midline incision for all animals were done on L5 for total laminectomy. Four weeks after the surgery, the rats were sacrificed and specimens were stained with hematoxylin-eosin and photos of the slides were taken for quantitive assesment of the scar tissue. Results There was no significant scar tissue in the experimental animals of groups 2, 3, and 4. It was found that there was no significant difference between drug groups, but there was a statistically significant difference between the drug groups and the control group. Conclusions This experimental study shows that implantation of mitomycin-C, sodium hyaluronate and human amniotic fluid reduces epidural fibrosis and adhesions after spinal laminectomy in rat models. Further studies in humans are needed to determine the complications of the agents researched. PMID:24353840

  19. Myelopathy due to multilevel cervical canal stenosis with Forestier disease: case report.

    PubMed

    Koizumi, Shinichiro; Yamaguchi-Okada, Mitsuo; Namba, Hiroki

    2010-01-01

    A 56-year-old woman presented with multilevel myelopathy associated with Forestier disease (FD). The patient was hospitalized for dysphagia, bilateral shoulder pain, and progressive gait disturbance. The diagnosis was confirmed by radiography and magnetic resonance imaging which demonstrated coalescent anterior osteophyte formation extending from C2 to C7 with atlanto-axial dislocation and persistence of mobility at C3-4, and a hyperintense area in the spinal cord at the C1 and C3-4 levels on T(2)-weighted images. Dynamic radiography showed no instability at the C1 and C3-4 levels. Decompressive laminectomy of the atlas, dome-like laminectomy, and facet fusion at C3-4 were performed, resulting in symptomatic improvement. Myelopathy is very rare in patients with FD and is due to mechanical stress at the level where mobility persists. Strategic intervention should be considered based on evaluation of mobile levels and stenotic lesions. PMID:21030813

  20. Operative Techniques for Cervical Radiculopathy and Myelopathy

    PubMed Central

    Moran, C.; Bolger, C.

    2012-01-01

    The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970's. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review. PMID:22195284

  1. Ossification of ligamentum flavum, a rare cause of myelopathy: First case report of a Lebanese patient.

    PubMed

    El Helou, Antonios; Alaywan, Moussa; Tarabay, Antonio; Nachanakian, Antoine

    2016-01-01

    Ossification of ligamentum flavum (OLF) is a well-known pathology causing myelopathy, although it is a rare disease. The most commonly affected population is from the Far East and mainly Japanese. However, few reports and studies have shown the prevalence of the disease all over the world. We report the case of a 33-year-old man presenting with signs of progressive myelopathy. Magnetic resonance imaging (MRI) showed Th2-Th11 OLF with severe narrowing and intramedullary hypersignal at the level Th2-Th3. This is the first Lebanese case reported in the literature. A decompressive laminectomy with flavectomy was done. This case adds to the previous reported cases on the occurrence of the disease in different populations. PMID:27057241

  2. Ossification of ligamentum flavum, a rare cause of myelopathy: First case report of a Lebanese patient

    PubMed Central

    El Helou, Antonios; Alaywan, Moussa; Tarabay, Antonio; Nachanakian, Antoine

    2016-01-01

    Ossification of ligamentum flavum (OLF) is a well-known pathology causing myelopathy, although it is a rare disease. The most commonly affected population is from the Far East and mainly Japanese. However, few reports and studies have shown the prevalence of the disease all over the world. We report the case of a 33-year-old man presenting with signs of progressive myelopathy. Magnetic resonance imaging (MRI) showed Th2-Th11 OLF with severe narrowing and intramedullary hypersignal at the level Th2-Th3. This is the first Lebanese case reported in the literature. A decompressive laminectomy with flavectomy was done. This case adds to the previous reported cases on the occurrence of the disease in different populations. PMID:27057241

  3. Acute Myelopathy Caused by a Cervical Synovial Cyst

    PubMed Central

    Kim, Dong Shin; Cho, Yong Jun; Kang, Suk Hyung

    2014-01-01

    Synovial cysts of the cervical spine, although they occur infrequently, may cause acute radiculopathy or myelopathy. Here, we report a case of a cervical synovial cyst presenting as acute myelopathy after manual stretching. A 68-year-old man presented with gait disturbance, decreased touch senses, and increased sensitivity to pain below T12 level. These symptoms developed after manual stretching 3 days prior. Computed tomography scanning and magnetic resonance imaging revealed a 1-cm, small multilocular cystic lesion in the spinal canal with cord compression at the C7-T1 level. We performed a left partial laminectomy of C7 and T1 using a posterior approach and completely removed the cystic mass. Histological examination of the resected mass revealed fibrous tissue fragments with amorphous materials and granulation tissue compatible with a synovial cyst. The patient's symptoms resolved after surgery. We describe a case of acute myelopathy caused by a cervical synovial cyst that was treated by surgical excision. Although cervical synovial cysts are often associated with degenerative facet joints, clinicians should be aware of the possibility that these cysts can cause acute neurologic symptoms. PMID:25289127

  4. Recurrence of cervical myelopathy secondary to a strut graft fracture 20 years after anterior decompression and fusion: a case report.

    PubMed

    Kida, Kazunobu; Takaya, Shogo; Tadokoro, Nobuaki; Kumon, Masashi; Kiyasu, Katsuhito; Kato, Tomonari; Takemasa, Ryuichi; Ikeuchi, Masahiko; Tani, Toshikazu

    2015-08-01

    This study reports on a 70-year-old man with recurrent cervical myelopathy 20 years after anterior decompression and fusion of C4-7 using a free vascularised strut graft. The recurrent myelopathy was secondary to a kyphotic deformity of a fractured graft and residual ossification of the posterior longitudinal ligament with stenosis at C3/4. Intraoperative spinal cord-evoked potentials indicated that spinal cord traction secondary to progressive kyphosis of the cervical spine after the graft fracture was the cause. The patient underwent laminoplasty at C3 and laminectomy at C4 to decompress the stenosis at C3/4 as well as posterior cervical spinal fusion at C3-7 with pedicle screws and a lateral mass screw and a bone graft to prevent further progression of the kyphosis. At postoperative 18 months, the patient's Japanese Orthopaedic Association score had improved to 14 from 8, and he could walk without support. PMID:26321562

  5. Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy

    PubMed Central

    Singhal, Udit; Jain, Manoj; Jaiswal, Awadhesh K; Behari, Sanjay

    2009-01-01

    High cervical ossified ligamentum flavum (OLF) is rare and may cause progressive quadriparesis and respiratory failure. Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring). The first patient had a linear and nodular OLF with calcification within tectorial membrane, C2–3 fusion and unilateral C2-facetal hypertrophy; and the second patient, a lateral, linear OLF with loss of lordosis and C3–6 spondylotic changes. A decompressive laminectomy using “posterior floating and enbloc resection” brought significant relief in myelopathy. Histopathology showed mature bony trabeculae, bone marrow and ligament tissue. The coexisting mobile cervical vertebral segment above and congenitally fused or spondylotic rigid segment below the level of LF may have led to abnormal strain patterns within resulting in its unilateral ossification. In dealing with cervical OLF, carefully preserving facets during laminectomy or laminoplasty helps in maintaining normal cervical spinal curvature. PMID:19838355

  6. Cervical Spondylotic Myelopathy Secondary to Dropped Head Syndrome: Report of a Case and Review of the Literature

    PubMed Central

    Soufiani, Housain F.; Rahimizadeh, Saghayegh

    2016-01-01

    The dropped head syndrome (DHS) is a disabling condition caused by severe weakness of the neck extensor muscles causing progressive reducible kyphosis of the cervical spine and the inability to hold the head up. Weakness can occur in isolation or in association with a generalized neuromuscular disorder. Isolated cases are owed to the late onset of noninflammatory myopathy designated as INEM, where persistent chin to chest deformity may gradually cause or aggravate preexisting degenerative changes of the cervical spine and ultimately result in myelopathy. In review of the literature, we could find only 5 cases, with no unique guidelines to address the management of these two concomitant pathologies. Herein, a 69-year-old man who had developed cervical myelopathy 2 years after being affected by isolated dropped head syndrome is presented. Chin to chest deformity and cervical myelopathy were managed through three-level anterior cervical discectomy and fusion (ACDF) combined with decompressive cervical laminectomy and stabilization with C2 to C7 pedicle screw-rod construct. At 4-month follow-up, despite recovery in patient's neurological status, flexion deformity reappeared with recurrence of dropped head due to C7 pedicle screws pull-out. However, this was successfully managed with extension of the construct to the upper thoracic levels. PMID:27034870

  7. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy.

    PubMed

    Hirabayashi, K; Watanabe, K; Wakano, K; Suzuki, N; Satomi, K; Ishii, Y

    1983-10-01

    Although the operative results have been improving since the air drill was introduced for cervical laminectomy instead of an ordinary rongeur, post-laminectomy complications, such as postoperative fragility of the cervical spine to acute neck trauma, posterior spur formation at the vertebral body, and malalignment of the lateral curvature have still remained as unsolved problems. In order to avoid these disadvantages, a new surgical technique called "expansive open-door laminoplasty" was devised by the author in 1977, which is relatively easier, safer, and better than the ordinary laminectomy from the standpoint of structural mechanics of the cervical spine. The operative procedure is described in detail. Operative results in the patients with cervical OPLL, spondylosis, and canal stenosis were satisfactory, and optimal widening of the AP diameter of the spinal canal is considered to be over 4 mm. From this procedure a bilateral, open-door laminoplasty has been devised for extensive exploration at the intradural space. PMID:6420895

  8. Two Cases of Klippel-Feil Syndrome with Cervical Myelopathy Successfully Treated by Simple Decompression without Fixation

    PubMed Central

    Kim, Jin Bum; Lee, Young Seok; Nam, Taek Kyun; Park, Yong Sook; Kim, Young Baeg

    2015-01-01

    Klippel-Feil syndrome (KFS) is a congenital developmental disorder of cervical spine, showing short neck with restricted neck motion, low hairline, and high thoracic cage due to multilevel cervical fusion. Radiculopathy or myelopathy can be accompanied. There were 2 patients who were diagnosed as KFS with exhibited radiological and physical characteristics. Both patients had stenosis and cord compression at C1 level due to anterior displacement of C1 posterior arch secondary to kyphotic deformity of upper cervical spine, which has been usually indicative to craniocervical fixation. One patient was referred due to quadriparesis detected after surgery for aortic arch aneurysmal dilatation. The other patient was referred to us due to paraparesis and radiating pain in all extremities developed during gynecological examinations. Decompressive C1 laminectomy was done for one patient and additional suboccipital craniectomy for the other. No craniocervical fixation was done because there was no spinal instability. Motor power improved immediately after the operation in both patients. Motor functions and spinal stability were well preserved in both patients for 2 years. In KFS patients with myelopathy at the C1 level without C1-2 instability, a favorable outcome could be achieved by a simple decompression without spinal fixation. PMID:26512291

  9. Cervical Spondylotic Myelopathy (CSM)

    MedlinePlus

    ... whether these treatments help in the long run. Surgery to reduce the compression of the spinal cord ... cervical spondylotic myelopathy. Are there side effects? Can surgery help cervical spondylotic myelopathy? Source Cervical Spondylotic Myelopathy: ...

  10. Radiation myelopathy.

    PubMed Central

    Sanyal, B; Pant, G C; Subrahmaniyam, K; Agrawal, M S; Mohanty, S

    1979-01-01

    Five cases of radiation myelopathy were found in a total of 10,000 cases given radiotherapy from 1968 to 1977. The clinical presentation and treatment details including the total dose, treatment volume, number of fractionations, overall time, and the RET value at the spinal cord were calculated and compared with other reports on this subject. The total number of fractionations ranged from 20 to 26 with an overall time of 32 days to 37 days. The dose received by four patients ranged from 1030 to 1900 RET, a little higher than the tolerance level of the spinal cord as compared to reported values. Two patients in this series had high blood pressure. The incidence of radiation myelopathy, already acceptably low, could possibly be reduced further by meticulous planning of radiation. PMID:448380

  11. Syphilitic myelopathy.

    PubMed

    Silber, M H

    1989-10-01

    Whether the clinical pattern of neurosyphilis has changed since the introduction of penicillin is controversial. This study describes the clinical, laboratory and radiological features of nine patients with syphilitic myelopathy, to assess whether the disease pattern has changed in this subgroup. Four patterns based on clinical course and radiological findings were identified: three patients presented with subacute paraparesis, four with prodromal backache and/or mild leg weakness followed by sudden paraplegia, one patient developed slowly progressive weakness over 4 years and one patient who progressed over one month was shown to have dural thickening on myelography. All patients showed CSF pleocytosis with positive CSF VDRL in seven patients. Despite therapy the prognosis for recovery was not good. Compared with pre-penicillin era studies, the clinical pattern has not significantly changed. Greater alertness to the diagnosis might result in earlier therapy and thus possibly lead to improved prognosis. PMID:2583718

  12. Perioperative Risks Associated with Cervical Spondylotic Myelopathy Based on Surgical Treatment Strategies

    PubMed Central

    Macagno, Angel; Liu, Shian; Marascalchi, Bryan J; Yang, Sun; Boniello, Anthony J; Bendo, John A; Lafage, Virginie C

    2015-01-01

    Background Few studies have provided nationwide estimates of patient characteristics and procedure-related complications, or examined postsurgical outcomes for patients with cervical spondylotic myelopathy (CSM) comparatively with respect to surgical approach. The objective of this study is to identify patients at risk for morbidity and mortality directly related with the selected approach, report an overall nation-wide complication rate for each approach against which surgeons can compare themselves, and direct future research to improve patient outcomes. Methods Patients surgically treated for CSM were retrospectively identified using ICD-9-CM codes from the Nationwide Inpatient Sample (NIS) database. Four cohorts were compared for demographics and hospital system-related data: anterior (ACDF, ACCF), posterior decompression without fusion, decompression with posterior fusion, and combined anterior-posterior. Multivariate analysis was also used to determine the odds ratio of morbidity and mortality among the cohorts. Results 54,416 discharges were identified between 2001 and 2010: 34,400 anterior, 9,014 decompression procedures without fusion, 8,741 decompression procedures with posterior fusion, and 2,261 combined anterior-posterior. Groups were statistically different with respect to age, length of hospital stay, mortality, and complications. Groups were statistically different for Deyo score except between posterior decompression only and combined approaches. Using multivariate analysis and adjusting for covariates, the combined (2.74[2.18-3.44]) and laminectomy (1.22[1.04-1.44]) cohorts had an increased risk of mortality when compared to anterior alone. Conclusion These findings are the first to determine the rates and odds of perioperative risks directly related to combined anterior-posterior procedures. This study provides clinically useful data for surgeons to educate patients and direct future research to improve patient outcomes. PMID:26196031

  13. Diabetes and cervical myelopathy.

    PubMed

    Houten, John K; Lenart, Christopher

    2016-05-01

    Diabetes may affect the typical physical findings associated with cervical spondylotic myelopathy, as coexisting diabetic neuropathy may dampen expected hyperreflexia and also produce non-dermatomal extremity numbness. Most large studies of surgically treated diabetic patients with cervical spondylotic myelopathy have focused upon infection rates rather than exploring any differences in the presenting physical signs. We conducted a retrospective study of the pattern of presenting neurological signs and symptoms and of the clinical outcomes in 438 patients surgically treated for cervical spondylotic myelopathy, 79 of whom had diabetes. Compared with non-diabetic patients, those with diabetes were slightly older and had lower preoperative modified Japanese Orthopaedic Association (mJOA) scores. Those with diabetes also had a significantly higher incidence of hyporeflexia and a higher incidence of a positive Babinski sign, but there was no difference in the appearance of the Hoffman sign. The magnitude of mJOA improvement after surgery was comparable. We conclude that diabetes may alter the typical signs and symptoms of cervical spondylotic myelopathy and suggest that knowledge of the differences may aid in securing a prompt and accurate diagnosis. PMID:26747704

  14. ACR Appropriateness Criteria Myelopathy.

    PubMed

    Roth, Christopher J; Angevine, Peter D; Aulino, Joseph M; Berger, Kevin L; Choudhri, Asim F; Fries, Ian Blair; Holly, Langston T; Kendi, Ayse Tuba Karaqulle; Kessler, Marcus M; Kirsch, Claudia F; Luttrull, Michael D; Mechtler, Laszlo L; O'Toole, John E; Sharma, Aseem; Shetty, Vilaas S; West, O Clark; Cornelius, Rebecca S; Bykowski, Julie

    2016-01-01

    Patients presenting with myelopathic symptoms may have a number of causative intradural and extradural etiologies, including disc degenerative diseases, spinal masses, infectious or inflammatory processes, vascular compromise, and vertebral fracture. Patients may present acutely or insidiously and may progress toward long-term paralysis if not treated promptly and effectively. Noncontrast CT is the most appropriate first examination in acute trauma cases to diagnose vertebral fracture as the cause of acute myelopathy. In most nontraumatic cases, MRI is the modality of choice to evaluate the location, severity, and causative etiology of spinal cord myelopathy, and predicts which patients may benefit from surgery. Myelopathy from spinal stenosis and spinal osteoarthritis is best confirmed without MRI intravenous contrast. Many other myelopathic conditions are more easily visualized after contrast administration. Imaging performed should be limited to the appropriate spinal levels, based on history, physical examination, and clinical judgment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26653797

  15. Pathology of radiation myelopathy

    PubMed Central

    Burns, R. J.; Jones, A. N.; Robertson, J. S.

    1972-01-01

    After nothing the rarity of papers describing the pathology of delayed radiation necrosis of the spinal cord, the clinical and pathological findings from four cases are presented. The main pathological features are asymmetric demyelination of the lateral columns and to a lesser degree the posterior and anterior columns of white matter, with coagulative necrosis at the level of irradiation which affected the grey matter to a lesser degree. There is ascending and descending secondary tract degeneration, and poor glial response in the lesions themselves. Vascular changes, mainly hyalilne thickening of arteriolar walls, are present, but not in degree sufficient to explain the primary lesion. The discussion of the pathogenesis of the myelopathy weighs the merits of a primary vascular lesion against those of a primary effect of the radiation on neural tissue. The latter is favoured. Images PMID:4647860

  16. Acute transverse myelopathy complicating systemic lupus erythematosus.

    PubMed Central

    Propper, D J; Bucknall, R C

    1989-01-01

    A sixteen year old girl with systemic lupus erythematosus developed acute transverse myelopathy. She was treated with high dose steroids, cyclophosphamide, and plasma exchange and regained partial neurological function. Previous descriptions of transverse myelopathy complicating systemic lupus erythematosus are reviewed, with particular reference to the efficacy of high dose steroid treatment. PMID:2662918

  17. Complete paraplegia resulting from surfer's myelopathy.

    PubMed

    Takakura, Tomokazu; Yokoyama, Osamu; Sakuma, Fujiko; Itoh, Ryousuke; Romero, Ray R

    2013-09-01

    Three patients with diagnoses of surfer's myelopathy (24-31 yrs old; two men, one woman) were admitted to our rehabilitation hospital. All three patients were novice surfers and had a typical clinical course of onset: rapid progression of paraplegia after back pain while taking surfing lessons. Despite months of rehabilitation at our hospital, in all three patients, complete paraplegia (T9-T12) and bladder-bowel dysfunction remained. Our case profiles suggest that the neurologic outcome of surfer's myelopathy is potentially catastrophic, as has been suggested in previous reports. Surfer's myelopathy has been estimated to be an ischemic thoracic myelopathy. From our case profiles and review of the literature, not only the prolonged prone hyperextended posture of paddling but also the repetitive mechanical stress caused by flexion-extension of the spinal column may be related to its pathogenesis. To prevent surfer's myelopathy and to avoid progressive deterioration of neurologic function, increased education and awareness are essential. PMID:22257974

  18. Mechanical and cellular processes driving cervical myelopathy

    PubMed Central

    Dolan, Roisin T; Butler, Joseph S; O’Byrne, John M; Poynton, Ashley R

    2016-01-01

    Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment. Despite advances in surgical technology and treatment innovations, there are limited neuro-protective treatments for cervical myelopathy, which reflects an incomplete understanding of the pathophysiological processes involved in this disease. The aim of this review is to provide a comprehensive overview of the key pathophysiological processes at play in the development of cervical myelopathy. PMID:26807352

  19. Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone.

    PubMed

    Fox, M W; Onofrio, B M; Onofrio, B M; Hanssen, A D

    1996-11-01

    One hundred twenty-four patients with degenerative lumbar stenosis underwent decompression with fusion (32 patients) and without fusion (92 patients) during a 30-month period between 1986 and 1988. Patient-reported satisfaction at a mean follow-up period of 5.8 years (range 4.6-6.8 years) revealed a 79% good or fair outcome and a 21% poor outcome (26 patients). Seven patients (6%) developed lumbar instability, three patients (2%) developed new stenosis at an adjacent unoperated level, and three patients (2%) developed a new disc herniation between 2 and 5 years after surgery. Progressive postoperative spondylolisthesis occurred in 31% of patients with normal preoperative alignment (mean 7.8 mm, range 2-20 mm) and in 73% of patients with preoperative subluxation (mean 5.1 mm, range 2-13 mm) in whom fusion was not attained. Radiological progression did not correlate well with patient-reported outcome. The major conclusions from this study are the following: 1) the majority of patients respond well to this surgery, but complication (22%) and late deterioration (10%) rates are not insignificant; 2) radiological instability is common after decompression for degenerative lumbar spinal stenosis, but this correlates poorly with clinical outcome; 3) there are no definitive clinical or radiological factors that preoperatively predict patients at risk for a poor outcome; 4) post-operative radiological instability is more likely to occur when the following criteria are present: preoperative spondy-degenerated L-4 or a markedly degenerated L-3 disc; and when a radical and extensive decompression greater than one level is planned; and 5) the group at greatest risk for a poor outcome consists of those patients with normal preoperative alignment who do not suffer slippage following surgery. PMID:8893716

  20. [A child case of surfer's myelopathy].

    PubMed

    Sugiyama, Nobuyoshi; Yokoyama, Jun-iIchi; Ikegami, Mariko; Matsuda, Shin-ichi; Miyashita, Yoshihiro

    2016-01-01

    We report a case of so-called "surfer's myelopathy" involving a 15-year-old girl. Preceding episodes of vaccination and infection were absent. She experienced back pain during a surfing class for beginners, followed by weakness in both legs, which progressed to paraperesis. Then, 2 days later, sensory disturbance and bladder/rectal disturbance also developed. Spinal MRI revealed a ischemic lesion compatible with anterior spinal cord syndrome. A combination of methylprednisolone pulse therapy and high-dose intravenous immunoglobulin therapy was effective leaving no residual dysfunction. The acute onset during the surfing class and characteristic MRI findings led to the diagnosis of surfer's myelopathy. Although rarely reported, warnings are warranted to prevent surfer's myelopathy and avoid the progressive deterioration of neurological dysfunction. PMID:27012110

  1. Pathogenesis of cervical spondylotic myelopathy.

    PubMed Central

    Levine, D N

    1997-01-01

    OBJECTIVE: To determine whether either of two mechanical theories predicts the topographic pattern of neuropathology in cervical spondylotic myelopathy (CSM). The compression theory states that the spinal cord is compressed between a spondylotic bar anteriorly and the ligamenta flava posteriorly. The dentate tension theory states that the spinal cord is pulled laterally by the dentate ligaments, which are tensed by an anterior spondylotic bar. METHODS: The spinal cord cross section, at the level of a spondylotic bar, is modelled as a circular disc subject to forces applied at its circumference. These forces differ for the two theories. From the pattern of forces at the circumference the distribution of shear stresses in the interior of the disc-that is, over the transverse section of the spinal cord-is calculated. With the assumption that highly stressed areas are most subject to damage, the stress pattern predicted by each theory can be compared to the topographic neuropathology of CSM. RESULTS: The predicted stress pattern of the dentate tension theory corresponds to the reported neuropathology, whereas the predicted stress pattern of the compression theory does not. CONCLUSIONS: The results strongly favour the theory that CSM is caused by tensile stresses transmitted to the spinal cord from the dura via the dentate ligaments. A spondylotic bar can increase dentate tension by displacing the spinal cord dorsally, while the dural attachments of the dentate, anchored by the dural root sleeves and dural ligaments, are displaced less. The spondylotic bar may also increase dentate tension by interfering locally with dural stretch during neck flexion, the resultant increase in dural stress being transmitted to the spinal cord via the dentate ligaments. Flexion of the neck increases dural tension and should be avoided in the conservative treatment of CSM. Both anterior and posterior extradural surgical operations can diminish dentate tension, which may explain their usefulness in CSM. The generality of these results must be tempered by the simplifying assumptions required for the mathematical model. Images PMID:9120444

  2. Operative Outcomes for Cervical Myelopathy and Radiculopathy

    PubMed Central

    Galbraith, J. G.; Butler, J. S.; Dolan, A. M.; O'Byrne, J. M.

    2012-01-01

    Cervical spondylotic myelopathy and radiculopathy are common disorders which can lead to significant clinical morbidity. Conservative management, such as physical therapy, cervical immobilisation, or anti-inflammatory medications, is the preferred and often only required intervention. Surgical intervention is reserved for those patients who have intractable pain or progressive neurological symptoms. The goals of surgical treatment are decompression of the spinal cord and nerve roots and deformity prevention by maintaining or supplementing spinal stability and alleviating pain. Numerous surgical techniques exist to alleviate symptoms, which are achieved through anterior, posterior, or circumferential approaches. Under most circumstances, one approach will produce optimal results. It is important that the surgical plan is tailored to address each individual's unique clinical circumstance. The objective of this paper is to analyse the major surgical treatment options for cervical myelopathy and radiculopathy focusing on outcomes and complications. PMID:22046575

  3. Activ C cervical disc replacement for myelopathy

    PubMed Central

    McGonagle, L.; Cadman, S.; Chitgopkar, S. D.; Canavan, L.; O’Malley, M.; Shackleford, I. M.

    2011-01-01

    Background: Cervical disc replacement is becoming an increasingly popular treatment option for cervical myelopathy. It retains motion at the affected segment, unlike anterior cervical discectomy and fusion. The aim of this study is to assess the outcomes of a series of patients who underwent Activ C disc replacement for cervical myelopathy. Materials and Methods: A series of patients at the above Trust with clinical and radiological evidence of cervical myelopathy who were suitable for cervical disc replacement from 2007 to 2009 were included. Implants were inserted by one of two consultant surgeons {IMS, MO’M}. Patients were assessed preoperatively and at six, 12 and 24 months, postoperatively, with a visual analogue score (VAS) for neck and arm pain severity and frequency, the Neck Disability Index questionnaire (NDI) and the Centre for Epidemiologic Studies Depression questionnaire (CES-D). Results: Ten patients underwent surgery between May 2007 and July 2009, 6 women, and 4 men. Average age was 54 years (40-64). Disc levels replaced were: four at C4-5; eight at C5-6; seven at C6-7. Three patients had one disc replaced, five patients had two discs replaced, and two patients had three discs replaced. The VAS for neck pain improved from 5.9 pre-operatively to 1.4-24 months postoperatively and the VAS arm pain improved from 5.4 to 2.6. The NDI improved from 51% preoperatively to 26.8% at 24 months postoperatively. The CES-D showed a slight increase from 19.5 preoperatively to 21.7 at 24 months, postoperatively. Conclusion: Cervical decompression and disc replacement improves pain and function in patients with cervical myelopathy. This benefit is maintained at 24 months post op, with no cases requiring revision. PMID:23125494

  4. Skeletal fluorosis causing high cervical myelopathy.

    PubMed

    Kumar, Hrishikesh; Boban, Marina; Tiwari, Mona

    2009-06-01

    Skeletal fluorosis is endemic in some parts of the world and is the result of life-long ingestion of high amounts of fluoride in drinking water. Its clinical presentation is characterized mostly by bone and dental changes with later ossification of many ligaments and interosseous membranes. We present a rare case of high cervical myelopathy caused by ossification of the posterior longitudinal ligament and ligamentum flavum in a patient from an area endemic for skeletal fluorosis. The clinical presentation of skeletal fluorosis and treatment options are discussed. PMID:19286383

  5. Acute transverse myelopathy: association with body position.

    PubMed

    Merli, G J; Staas, W E

    1985-05-01

    The syndrome of acute transverse myelopathy (ATM) has been described in the medical literature for decades. Despite the clinical descriptions, ATM continues to be poorly understood etiologically. Current thinking associates the syndrome with viral infections, multiple sclerosis, vascular disease, and malignancy. Three cases of ATM seen since 1972 are reported. All three patients described unusual stressful body posturing immediately preceding the onset of neurologic deficit. This presentation focuses on vascular compromise associated with stressful body positioning as another possible etiologic factor for ATM. PMID:4004523

  6. Sensitivity of Pyramidal Signs in Patients with Cervical Spondylotic Myelopathy

    PubMed Central

    2016-01-01

    Study Design This was a retrospective study. Purpose The purpose of this study was to study the relationship between prevalence of pyramidal signs and the severity of cervical myelopathy. The study is focused on patients having increased signal intensity in T2-weighted magnetic resonance imaging. Overview of Literature Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in elderly population. It is the consequence of spondylotic changes leading to cervical cord injury with resulting clinical deficits. Diagnosis in such patients is made based on clinical and radiographic features. A patient must have both symptoms and signs consistent with cervical cord injury as well as radiographic evidence of damage to spondylotic cord. Methods Forty-six patients with complaint of cervical spondylotic myelopathy with increased signal intensity in T2-weighted magnetic resonance imaging were included in the study. The neurological finding of the patients was reviewed for the presence of pyramidal signs. The prevalence of each pyramidal sign was calculated and correlated to severity of cervical myelopathy. The motor function scores of the upper and lower extremities for cervical myelopathy set by the Japanese Orthopedic Association (motor Japanese Orthopaedic Association score, m-JOA) scores were used to assess severity of myelopathy. Results The most prevalent signs were hyperreflexia (89.1%), Hoffmann reflex (80.4%), Babiniski sign (56.5%), and ankle clonus (39.1%). Babiniski sign, ankle clonus, and Hoffmann reflex showed significant association with the lower m-JOA score. Conclusions In patients with cervical myelopathy, hyperreflexia exhibited highest sensitivity whereas ankle clonus demonstrated lowest sensitivity. The prevalence of the pyramidal signs is correlated with increasing severity of myelopathy. PMID:26949460

  7. Acute compressive myelopathy due to vertebral haemangioma

    PubMed Central

    Macki, Mohamed; Bydon, Mohamad; Kaloostian, Paul; Bydon, Ali

    2014-01-01

    A 47-year-old woman with a history of anaemia presented to the emergency room with an acute onset of leg weakness. Physical examination of the bilateral lower extremities was significant for 0/5 muscle strength in all muscle groups with decreased pinprick and temperature sensation. A sensory level at the umbilicus was appreciated. Fine touch and proprioception were preserved. Bowel and bladder function were intact. CT revealed several thoracic, vertebral haemangiomatas. An MRI was suggestive of an epidural clot at the T8–T10-weighted posterior epidural space. At the level of the lesion, the cerebrospinal fluid space was completely effaced, and the flattened spinal cord exhibited signs of oedema and compressive myelopathy. The patient immediately underwent surgical decompression of the spinal cord. An epidural clot and vessel conglomeration were identified. A postoperative spinal angiogram confirmed the diagnosis of vertebral haemangioma. At 1-month follow-up, the patient regained strength and sensation. PMID:24777075

  8. Expansion Duroplasty Improves Intraspinal Pressure, Spinal Cord Perfusion Pressure, and Vascular Pressure Reactivity Index in Patients with Traumatic Spinal Cord Injury: Injured Spinal Cord Pressure Evaluation Study

    PubMed Central

    Phang, Isaac; Werndle, Melissa C.; Saadoun, Samira; Varsos, Georgios; Czosnyka, Marek; Zoumprouli, Argyro

    2015-01-01

    Abstract We recently showed that, after traumatic spinal cord injury (TSCI), laminectomy does not improve intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), or the vascular pressure reactivity index (sPRx) at the injury site sufficiently because of dural compression. This is an open label, prospective trial comparing combined bony and dural decompression versus laminectomy. Twenty-one patients with acute severe TSCI had re-alignment of the fracture and surgical fixation; 11 had laminectomy alone (laminectomy group) and 10 had laminectomy and duroplasty (laminectomy+duroplasty group). Primary outcomes were magnetic resonance imaging evidence of spinal cord decompression (increase in intradural space, cerebrospinal fluid around the injured cord) and spinal cord physiology (ISP, SCPP, sPRx). The laminectomy and laminectomy+duroplasty groups were well matched. Compared with the laminectomy group, the laminectomy+duroplasty group had greater increase in intradural space at the injury site and more effective decompression of the injured cord. In the laminectomy+duroplasty group, ISP was lower, SCPP higher, and sPRx lower, (i.e., improved vascular pressure reactivity), compared with the laminectomy group. Laminectomy+duroplasty caused cerebrospinal fluid leak that settled with lumbar drain in one patient and pseudomeningocele that resolved completely in five patients. We conclude that, after TSCI, laminectomy+duroplasty improves spinal cord radiological and physiological parameters more effectively than laminectomy alone. PMID:25705999

  9. Cervical Synovial Cyst Causing Cervical Radiculomyelopathy: Case Report and Review of the Literature

    PubMed Central

    Corredor, Jos A.; Quan, Gerald

    2014-01-01

    Study Design?Case report. Objective?Synovial cysts in the subaxial cervical spine are rare and are most commonly reported at the cervicothoracic junction. Only six cases of symptomatic C5C6 synovial cysts have been reported in the literature; the condition is usually treated with decompressive laminectomy. We present a patient with a synovial cyst arising from the C5C6 facet joint, associated with spondylolisthesis, and causing radiculomyelopathy. The patient was treated with a posterior excision of the cyst, decompressive laminectomy, and fusion. Methods?A 67-year-old man had vertebral canal stenosis at C5C6 secondary to a synovial cyst and spondylolisthesis with symptoms and signs of radiculopathy and myelopathy. Surgical management involved C5C6 posterior decompressive laminectomy and excision of the cyst and C4C6 instrumented fusion with lateral mass screws and rods. A literature review of symptomatic cervical synovial cysts is presented. Results?The imaging studies identified grade I spondylolisthesis and a 3.3??4.3-mm extradural lentiform-like mass associated with focal compression of the spinal cord and exiting the C6 nerve root. After the surgery, the patient had an immediate full recovery and was asymptomatic by the 6-month examination. No operative complications were reported. The histologic report confirmed the presence of a synovial cyst. Conclusions?C5C6 is an unusual localization for symptomatic synovial cysts. Similar cases reported in the literature achieved excellent results after cyst excision and decompressive laminectomy. Because spondylolisthesis plus laminectomy are risk factors for segmental instability in the cervical spine, we report a case of a C5C6 facet synovial cyst successfully treated with posterior laminectomy and C4C6 fusion. PMID:26225291

  10. Cervical Myelopathy Caused by Injections into the Neck

    PubMed Central

    Ralph, Jeffrey W.; Layzer, Robert B.

    2015-01-01

    Three cases of longitudinally extensive cervical myelopathies temporally associated with neck injections are presented. The spinal cord injury was similar radiographically, despite a number of different needle approaches and substances injected. In recent years, there have been reports of an acute cervical myelopathy immediately following an injection procedure in the neck. Various explanations have been offered for this unfortunate complication, including (1) direct injection into the cord leading to traumatic injury, (2) injection of particulate matter into the arterial supply of the cord causing microvascular embolism and spinal cord infarction, and (3) intraneural injection of the chemical with centripetal spread of the injectant from the nerve trunk to the substance of the cord. The merits of each of these 3 mechanisms in explaining these cases are discussed. Albeit rare, acute cervical myelopathy should be considered a potential complication from any deep injection of chemicals into the neck. PMID:26425248

  11. [Acute non-traumatic myelopathy in children and adolescents].

    PubMed

    Arroyo, Hugo A

    2013-09-01

    The term 'acute myelopathies'--referred to a spinal cord dysfunction--represent a heterogeneous group of disorders with distinct etiologies, clinical and radiologic features, and prognoses. The objective of this review is to discuss the non-traumatic acute myelopathies. Acute myelopathy can be due to several causes as infective agents or inflammatory processes, such as in acute myelitis, compressive lesions, vascular lesions, etc. The clinical presentation is often dramatic with tetraparesis or paraparesis, sensory disturbances and bladder and/or bowel dysfunction. History and physical examination are used to localize the lesion to the root or specific level of the cord, which can guide imaging. Different syndromes are recognized: complete transverse lesion, central grey matter syndrome, anterior horn syndrome, anterior spinal artery syndrome, etc). The first priority is to rule out a compressive lesion. If a myelopathy is suspected, a gadolinium-enhanced MRI of the spinal cord should be obtained as soon as possible. If there is no structural lesion such as epidural blood or a spinal mass, then the presence or absence of spinal cord inflammation should be documented with a lumbar puncture. The absence of pleocytosis would lead to consideration of non inflammatory causes of myelopathy such as arteriovenous malformations, fibrocartilaginous embolism, or possibly early inflammatory myelopathy. In the presence of an inflammatory process (defined by gadolinium enhancement, cerebrospinal fluid pleocytosis, or elevated cerebrospinal fluid immunoglobulin index), one should determine whether there is an inflammatory or an infectious cause. Different virus, bacterias, parasites and fungi have to be considered as autoimmune and inflammatory diseases that involve the central nervous system. PMID:23897140

  12. Heterotopic ossification associated with myelopathy following cervical disc prosthesis implantation.

    PubMed

    Wenger, Markus; Markwalder, Thomas-Marc

    2016-04-01

    This case report presents a 37-year-old man with clinical signs of myelopathy almost 9years after implantation of a Bryan disc prosthesis (Medtronic Sofamor Danek, Memphis, TN, USA) for C5/C6 soft disc herniation. As demonstrated on MRI and CT scan, spinal cord compression was caused by bony spurs due to heterotopic ossification posterior to the still moving prosthesis. The device, as well as the ectopic bone deposits, had to be removed because of myelopathy and its imminent aggravation. Conversion to anterior spondylodesis was performed. PMID:26633091

  13. Gait Analysis in Cervical Spondylotic Myelopathy

    PubMed Central

    Endo, Kenji; Suzuki, Hidekazu; Tanaka, Hidetoshi; Shishido, Takaaki; Yamamoto, Kengo

    2015-01-01

    Study Design Gait analysis of patients with cervical spondylotic myelopathy (CSM) by using a sheet-type gait analysis system. Purpose The aim of this study was to compare the gait patterns of patients with CSM, evaluated by the Nurick grades, and to determine the threshold values of gait parameters predicting the occurrence of a fall by using a gait recorder. Overview of Literature Gait disorder due to CSM may progress to severe paraplegia, following even a minor trauma such as a fall. The indications for the surgery of CSM without severe paralysis remain controversial. The quantitative gait analysis and the decision for decompressive surgery in patients with CSM are important in order to prevent severe paraplegia from a fall. Methods One hundred thirty-two subjects (normal, 34; CSM, 98) underwent gait analysis by using a sensor sheet. Measurements of gait cycle parameters included the step and stride length, step width, foot angle, swing phase, and stance phase. CSM was assessed by Nurick grade. Results Although the clinical symptoms were lacking, Nurick grade 1 had significant abnormalities in the parameters of velocity, step length, and step angle (p<0.05). Regarding the Nurick grade and walking phase, the length of the stance phase was increased to more than 70% of the entire walking cycle in Nurick grade 4. Conclusions Gait analysis was an objective tool for evaluating the gait stability. Our results suggested that when the percentage of the stance phase in the gait cycle increases to above 70%, the CSM patients have an increased fall risk. PMID:26097646

  14. Diagnosis and Treatment of Cervical Radiculopathy and Myelopathy.

    PubMed

    Leveque, Jean-Christophe A; Marong-Ceesay, Bintu; Cooper, Teresa; Howe, Chris R

    2015-08-01

    This article is a guideline covering a wide array of cervical conditions seen in the workers' compensation, as well as the nonworkers' compensation, population. The guideline is intended to provide a diagnostic and treatment algorithm to commonly seen cervical conditions such as single-level and multilevel radiculopathies and myelopathies. PMID:26231961

  15. Imaging features and differentials in surfer's myelopathy: a case report.

    PubMed

    Teixeira, Stephanie; Moser, Franklin; Kotton, Ryan H

    2016-02-01

    Surfer's myelopathy is a rare non-traumatic cause of myelopathy found in novice surfers. We present a case of a 23-year-old female who developed acute and rapidly progressive bilateral lower extremity paraplegia, paresthesia, and anesthesia, accompanied by lower back discomfort and bowel and bladder dysfunction after surfing for the first time. She had a past history of auto-resolved lower extremity weakness that could be related to anatomy variation of spinal cord vascular supply. This individual variation could have increased the risk for ischemic myelopathy after prolonged prone position with back hyperextension on the surf board. We discuss radiological findings of acute spinal cord infarct and longitudinal extensive transverse myelitis (LETM) as possible differentials in this case. The diagnosis of surfer's myelopathy relies on a first time surfing history since the clinical and radiological presentations can be similar to other entities in some cases. Thus, we highlight the importance of a full clinical report and efficient communication between referring clinicians and radiologists for a precise and early diagnosis. PMID:26394636

  16. Treatment of Portosystemic Shunt Myelopathy with a Stent Graft Deployed through a Transjugular Intrahepatic Route

    SciTech Connect

    Jain, Deepak Arora, Ankur; Deka, Pranjal; Mukund, Amar Bhatnagar, Shorav; Jindal, Deepti Kumar, Niteen Pamecha, Viniyendra

    2013-08-01

    A case of surgically created splenorenal shunt complicated with shunt myelopathy was successfully managed by placement of a stent graft within the splenic vein to close the portosystemic shunt and alleviate myelopathy. To our knowledge, this is the first report of a case of shunt myelopathy in a patient with noncirrhotic portal fibrosis without cirrhosis treated by a novel technique wherein a transjugular intrahepatic route was adopted to deploy the stent graft.

  17. Arachnoiditis Ossificans – A Rare Cause of Progressive Myelopathy

    PubMed Central

    Steel, Christopher J; Abrames, Erik L; O’Brien, William T

    2015-01-01

    Arachnoiditis ossificans is a rare cause of chronic, progressive myelopathy. In contrast to the more common benign causes of meningeal calcification, arachnoiditis ossificans results in replacement of portions of the spinal arachnoid by bone as an end-stage complication of adhesive arachnoiditis. It is usually the sequela of prior trauma or interventional procedures. Prognosis and treatment options depend upon the location and degree of spinal stenosis with thoracic involvement being more common and more severe than lumbar spine involvement. The imaging findings on magnetic resonance imaging may be confusing; however, the findings of intraspinal ossification on computed tomography are characteristics and diagnostic. We present a classic case of arachnoiditis ossificans in an elderly man who presented with progressive myelopathy and a recent fall, along with a review of the literature. The imaging in this case not only identified the characteristic findings of arachnoiditis ossificans but also identified secondary findings of the underlying causative etiology. PMID:26401174

  18. Cytokine expression of macrophages in HIV-1-associated vacuolar myelopathy.

    PubMed

    Tyor, W R; Glass, J D; Baumrind, N; McArthur, J C; Griffin, J W; Becker, P S; Griffin, D E

    1993-05-01

    Macrophages are frequently present within the periaxonal and intramyelinic vacuoles that are located primarily in the posterior and lateral funiculi of the thoracic spinal cord in HIV-associated vacuolar myelopathy. But the role of these macrophages in the formation of the vacuoles is unclear. One hypothesis is that cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor (TNF)-alpha, are produced locally by macrophages and have toxic effects on myelin or oligodendrocytes. The resulting myelin damage eventually culminates in the removal of myelin by macrophages and vacuole formation. We studied thoracic spinal cord specimens taken at autopsy from HIV-positive (+) and HIV-negative individuals. The predominant mononuclear cells present in HIV+ spinal cords are macrophages. They are located primarily in the posterior and lateral funiculi regardless of the presence or absence of vacuolar myelopathy. Macrophages and microglia are more frequent in HIV+ than HIV-negative individuals and these cells frequently stain for class I and class II antigens, IL-1, and TNF-alpha. Activated macrophages positive for IL-1 and TNF-alpha are great increased in the posterior and lateral funiculi of HIV+ individuals with and without vacuolar myelopathy, suggesting they are present prior to the development of vacuoles. Cytokines, such as TNF-alpha, may be toxic for myelin or oligodendrocytes, leading to myelin damage and removal by macrophages and vacuole formation. PMID:8492917

  19. Non-compressive myelopathy: clinical and radiological study.

    PubMed

    Prabhakar, S; Syal, P; Singh, P; Lal, V; Khandelwal, N; Das, C P

    1999-12-01

    Fifty seven patients (42 males and 15 females) with non-compressive myelopathy were studied from 1997 to 1999. Acute transverse myelitis (ATM) was the commonest (31) followed by Vit B12 deficiency myelopathy (8), primary progressive multiple sclerosis (5), hereditary spastic paraplegia (3), tropical spastic paraplegia (2), subacute necrotising myelitis (1), radiation myelitis (1), syphilitic myelitis (1) and herpes zoster myelitis (1). 4 cases remained unclassified. In the ATM group, mean age was 30.35 years, antecedent event was observed in 41.9% case, 25 cases had symmetrical involvement and most of the cases had severe deficit at onset. CSF study carried out in 23 patients of ATM revealed rise in proteins (mean 147.95mg%, range 20-1200 mg/dL) and pleocytosis (mean 20.78/cumm, range 0-200 mm3). Oligoclonal band (OCB) was present in 28% of cases of ATM. The most common abnormality detected was a multisegment hyperintense lesion on T2W images, that occupied the central area on cross section. In 6 patients hyperintense signal was eccentric in location. MRI was normal in 4 cases of ATM. Thus ATM is the leading cause of non-compressive myelopathy. Clinical features combined with MRI findings are helpful in defining the cause of ATM. PMID:10625902

  20. Lumbar congestive myelopathy mimicking neoplasia without concurrent vascular malformation.

    PubMed

    Tsutsumi, Satoshi; Abe, Yusuke; Yasumoto, Yukimasa; Ito, Masanori

    2009-07-01

    A 78-year-old male presented with congestive myelopathy manifesting as progressive gait disturbance following conservative therapy for lumbar spinal canal stenosis, with suspected spinal cord tumor in the conus medullaris. His past medical history was unremarkable and he was not aware of any traumatic injury in the back or infectious disease. On admission, he had clumsy hand, moderate paraparesis, significant sensory disturbance below the L5 level, and severe vesicorectal dysfunction. The deep tendon reflex was promoted in the upper extremities, but poorly induced in the lower extremities. Blood examination found no abnormalities including values of tumor markers. Cerebral, cervical, and thoracic magnetic resonance (MR) imaging revealed no contributory pathology without spondylotic change at the C3-C6 levels. Lumbar MR imaging showed fusiform swelling of the cord from the T10 to T12-L1 levels, with rimlike enhancement at the T12-L1 levels by gadolinium. The patient underwent surgery. Intraoperatively, the dorsal surface of the affected cord was pale, not swollen, and sparsely vascularized without tortuous vessels. Midline myelotomy caused escape of creamy material that was identified as necrotic neural tissue. A collapsed vessel, located on the surface of the cord, was histologically identified as a thrombosed vein. The histological findings were compatible with spinal infarction caused by congestive myelopathy. Whole craniospinal and iliac angiography performed postoperatively failed to reveal any dural and paraspinal vascular malformation. His paraparesis, sensory disturbance, and vesicorectal dysfunction improved significantly after surgery. Congestive myelopathy may be caused by various angiographically occult etiologies other than dural arteriovenous fistula. PMID:19633406

  1. Current techniques in the management of cervical myelopathy and radiculopathy.

    PubMed

    Gerard, Carter S; O'Toole, John E

    2014-04-01

    Posterior decompressive procedures are a fundamental component of the surgical treatment of symptomatic cervical degenerative disease. Posterior approaches have the appeal of avoiding complications associated with anterior approaches such as esophageal injury, recurrent laryngeal nerve paralysis, dysphagia, and adjacent-level disease after fusion. Although open procedures are effective, the extensive subperiosteal stripping of the paraspinal musculature leads to increased blood loss, longer hospital stays, and more postoperative pain, and potentially contributes to instability. Minimally invasive access has been developed to limit approach-related morbidity. This article reviews current techniques in minimally invasive surgical management of cervical myelopathy and radiculopathy. PMID:24703445

  2. Clustered clinical findings for diagnosis of cervical spine myelopathy

    PubMed Central

    Cook, Chad; Brown, Christopher; Isaacs, Robert; Roman, Matthew; Davis, Samuel; Richardson, William

    2010-01-01

    Cervical spine myelopathy (CSM) is a clinical diagnosis made with imaging confirmation. At present, most clinical tests used to identify CSM are specific and no clusters of tests have proven more beneficial than stand alone tests in guiding treatment decision making. This study endeavored to produce a cluster of predictive clinical findings for a sample of patients using a clinical diagnosis/imaging confirmation as the reference standard for cervical spine myelopathy. Data from 249 patients with various conditions associated with cervical spine dysfunction were analyzed to determine which clinical tests and measures, when clustered together, were most diagnostic for CSM. Using multivariate regression analyses and calculations for sensitivity, specificity, and positive and negative likelihood ratios, a definitive cluster was identified. Thirteen clinical findings were investigated for capacity to diagnosis CSM. Five clinical: (1) gait deviation; (2) +Hoffmann’s test; (3) inverted supinator sign; (4) +Babinski test; and (5) age >45 years, were demonstrated the capacity when clustered into one of five positive tests to rule out CSM (negative likelihood ratio = 0.18; 95% CI = 0.12–0.42), and when clustered into three of five positive findings to rule in CSM (positive likelihood ratio = 30.9; 95% CI = 5.5–181.8). This study found clustered combinations of clinical findings that could rule in and rule out CSM. These clusters may be useful in identifying patients with this complex diagnosis in similar patient populations. PMID:22131790

  3. Progressive myelopathy mimicking subacute combined degeneration after intrathecal chemotherapy.

    PubMed

    Yi, Youbin; Kang, Hyung Jin; Shin, Hee Young; Kim, Keewon

    2015-02-01

    Intrathecal chemotherapy including methotrexate is well documented for neurotoxicity of diverse clinical manifestation. Acute or chronic leukoencephalopathy is the most common type of methotrexate-induced neurotoxicity, and subacute myelopathy is rare. Although its pathogenesis is not fully understood, it is postulated that direct damage of methotrexate to the central nervous system plays a major part and elevated levels of homocysteine and its excitatory amino acid neurotransmitter metabolites (homocysteic acid and cysteine sulfinic acid) could mediate, in part, MTX-associated neurotoxicity. On the while, subacute combined degeneration is a progressive degeneration of the dorsal and lateral columns of the spinal cord, mostly due to vitamin B12 deficiency. The authors report a case of a 15-year-old boy with Burkitt leukemia who developed progressive myelopathy after intrathecal triple therapy (methotrexate, cytarabine, and hydrocortisone) whose clinical and radiologic features were compatible with subacute combined degeneration. The pathogenic mechanism could be explained by biochemical alteration by methotrexate and a possible treatment strategy was discussed. PMID:24659737

  4. Impact of dynamic alignment, motion, and center of rotation on myelopathy grade and regional disability in cervical spondylotic myelopathy.

    PubMed

    Liu, Shian; Lafage, Renaud; Smith, Justin S; Protopsaltis, Themistocles S; Lafage, Virginie C; Challier, Vincent; Shaffrey, Christopher I; Radcliff, Kris; Arnold, Paul M; Chapman, Jens R; Schwab, Frank J; Massicotte, Eric M; Yoon, S Tim; Fehlings, Michael G; Ames, Christopher P

    2015-12-01

    OBJECT Cervical stenosis is a defining feature of cervical spondylotic myelopathy (CSM). Matsunaga et al. proposed that elements of stenosis are both static and dynamic, where the dynamic elements magnify the canal deformation of the static state. For the current study, the authors hypothesized that dynamic changes may be associated with myelopathy severity and neck disability. This goal of this study was to present novel methods of dynamic motion analysis in CSM. METHODS A post hoc analysis was performed of a prospective, multicenter database of patients with CSM from the AOSpine North American study. One hundred ten patients (34%) met inclusion criteria, which were symptomatic CSM, age over 18 years, baseline flexion/extension radiographs, and health-related quality of life (HRQOL) questionnaires (modified Japanese Orthopaedic Association [mJOA] score, Neck Disability Index [NDI], the 36-Item Short Form Health Survey Physical Component Score [SF-36 PCS], and Nurick grade). The mean age was 56.9 12 years, and 42% of patients were women (n = 46). Correlations with HRQOL measures were analyzed for regional (cervical lordosis and cervical sagittal vertical axis) and focal parameters (kyphosis and spondylolisthesis between adjacent vertebrae) in flexion and extension. Baseline dynamic parameters (flexion/extension cone relative to a fixed C-7, center of rotation [COR], and range of motion arc relative to the COR) were also analyzed for correlations with HRQOL measures. RESULTS At baseline, the mean HRQOL measures demonstrated disability and the mean radiographic parameters demonstrated sagittal malalignment. Among regional parameters, there was a significant correlation between decreased neck flexion (increased C2-7 angle in flexion) and worse Nurick grade (R = 0.189, p = 0.048), with no significant correlations in extension. Focal parameters, including increased C-7 sagittal translation overT-1 (slip), were significantly correlated with greater myelopathy severity (mJOA score, Flexion R = -0.377, p = 0.003; mJOA score, Extension R = -0.261, p = 0.027). Sagittal slip at C-2 and C-4 also correlated with worse HRQOL measures. Reduced flexion/extension motion cones, a more posterior COR, and smaller range of motion correlated with worse general health SF-36 PCS and Nurick grade. CONCLUSIONS Dynamic motion analysis may play an important role in understanding CSM. Focal parameters demonstrated a significant correlation with worse HRQOL measures, especially increased C-7 sagittal slip in flexion and extension. Novel methods of motion analysis demonstrating reduced motion cones correlated with worse myelopathy grades. More posterior COR and smaller range of motion were both correlated with worse general health scores (SF-36 PCS and Nurick grade). To our knowledge, this is the first study to demonstrate correlation of dynamic motion and listhesis with disability and myelopathy in CSM. PMID:26315953

  5. Intraoperative computed tomography for cervicomedullary decompression of foramen magnum stenosis in achondroplasia: two case reports.

    PubMed

    Arishima, Hidetaka; Tsunetoshi, Kenzo; Kodera, Toshiaki; Kitai, Ryuhei; Takeuchi, Hiroaki; Kikuta, Ken-Ichiro

    2013-01-01

    The authors report two cases of cervicomedullary decompression of foramen magnum (FM) stenosis in children with achondroplasia using intraoperative computed tomography (iCT). A 14-month-old girl with myelopathy and retarded motor development, and a 10-year-old girl who had already undergone incomplete FM decompression was presented with myelopathy. Both patients underwent decompressive sub-occipitalcraniectomy and C1 laminectomy without duraplasty using iCT. It clearly showed the extent of FM decompression during surgery, which finally enabled sufficient decompression. After the operation, their myelopathy improved. We think that iCT can provide useful information and guidance for sufficient decompression for FM stenosis in children with achondroplasia. PMID:24140778

  6. Cervical degenerative intraspinal cyst: a case report and literature review involving 132 cases

    PubMed Central

    Machino, Masaaki; Yukawa, Yasutsugu; Ito, Keigo; Kato, Fumihiko

    2012-01-01

    Intraspinal and extradural cysts in the cervical spine are rare disorders that may cause myelopathy or radiculopathy. A synovial cyst or ganglion derived from the facet joint and that from a ligamentum flavum have been reported. We report a surgical case of degenerative intraspinal cyst, causing cervical myelopathy. MRI of a case revealed cystic lesion at C45. Spinal cord was compressed by cyst and symptoms of myelopathy were also observed. The patient with cervical spinal canal stenosis underwent laminoplasty and excision of the cyst. The patient recovered well immediately after the surgery. Literature review showed that 133 patients have been reported, including the present case. Previous reports indicated that most cysts occurred in old patients and at the atlantoaxial or C7T1 junction, and laminectomy or laminoplasty with excision of the cyst gave good results in most cases. PMID:23195823

  7. Intraoperative Computed Tomography for Cervicomedullary Decompression of Foramen Magnum Stenosis in Achondroplasia: Two Case Reports

    PubMed Central

    Arishima, Hidetaka; Tsunetoshi, Kenzo; Kodera, Toshiaki; Kitai, Ryuhei; Takeuchi, Hiroaki; Kikuta, Ken-ichiro

    2013-01-01

    The authors report two cases of cervicomedullary decompression of foramen magnum (FM) stenosis in children with achondroplasia using intraoperative computed tomography (iCT). A 14-month-old girl with myelopathy and retarded motor development, and a 10-year-old girl who had already undergone incomplete FM decompression was presented with myelopathy. Both patients underwent decompressive sub-occipitalcraniectomy and C1 laminectomy without duraplasty using iCT. It clearly showed the extent of FM decompression during surgery, which finally enabled sufficient decompression. After the operation, their myelopathy improved. We think that iCT can provide useful information and guidance for sufficient decompression for FM stenosis in children with achondroplasia. PMID:24140778

  8. Paroxysmal Chorea as a Relapse of Myelopathy in a Patient with Neuromyelitis Optica

    PubMed Central

    Lee, Sang-Soo; Han, Ho-Sung; Shin, Dong-Ick

    2009-01-01

    Movement disorders secondary to intrinsic spinal cord disease are rare. Paroxysmal chorea has not yet been reported in the neuromyelitis optica (NMO). We report a 43-year-old woman with relapsing-remitting cervical myelopathy who developed paroxysmal chorea during clinical exacerbation of NMO. MRI scan of the cervical spine revealed a long segmental enhancing lesion, but brain MRI did not show any responsible abnormalities. Acute exacerbation of recurrent myelopathy in NMO may be associated with transient movement disorder. PMID:24868362

  9. Advances in MR Imaging for Cervical Spondylotic Myelopathy

    PubMed Central

    Ellingson, Benjamin M.; Salamon, Noriko; Holly, Langston T.

    2016-01-01

    Cervical spondylosis is the most common cause of nontraumatic spinal cord injury and is the most common cause of spinal cord dysfunction in the elderly. Magnetic resonance imaging (MRI) is an invaluable tool for the diagnosis and assessment of cervical spondylosis due to its sensitivity to soft tissues; however, standard MR techniques have some limitations in predicting neurological impairment and response to intervention. Therefore, there is great interest in novel MR techniques including diffusion tensor imaging (DTI) and MR spectroscopy (MRS) as imaging biomarkers for neurological impairment and tools for understanding spinal cord physiology. This review outlines the pathogenesis of cervical spondylotic myelopathy (CSM), the correlative abnormalities observed on standard MRI, the biological implications and current status of DTI and MRS as clinical tools, and future directions of MR technology in the management of CSM patients. PMID:23917647

  10. Effect of posterior decompression extent on biomechanical parameters of the spinal cord in cervical ossification of the posterior longitudinal ligament.

    PubMed

    Khuyagbaatar, Batbayar; Kim, Kyungsoo; Park, Won Man; Kim, Yoon Hyuk

    2016-06-01

    Ossification of the posterior longitudinal ligament is a common cause of the cervical myelopathy due to compression of the spinal cord. Patients with ossification of the posterior longitudinal ligament usually require the decompression surgery, and there is a need to better understand the optimal surgical extent with which sufficient decompression without excessive posterior shifting can be achieved. However, few quantitative studies have clarified this optimal extent for decompression of cervical ossification of the posterior longitudinal ligament. We used finite element modeling of the cervical spine and spinal cord to investigate the effect of posterior decompression extent for continuous-type cervical ossification of the posterior longitudinal ligament on changes in stress, strain, and posterior shifting that occur with three different surgical methods (laminectomy, laminoplasty, and hemilaminectomy). As posterior decompression extended, stress and strain in the spinal cord decreased and posterior shifting of the cord increased. The location of the decompression extent also influenced shifting. Laminectomy and laminoplasty were very similar in terms of decompression results, and both were superior to hemilaminectomy in all parameters tested. Decompression to the extents of C3-C6 and C3-C7 of laminectomy and laminoplasty could be considered sufficient with respect to decompression itself. Our findings provide fundamental information regarding the treatment of cervical ossification of the posterior longitudinal ligament and can be applied to patient-specific surgical planning. PMID:26951839

  11. Cervical Laminoplasty: The History and the Future

    PubMed Central

    KUROKAWA, Ryu; KIM, Phyo

    Cervical laminoplasty was developed as an alternative to cervical laminectomy for treatment of cervical myelopathy, in which hinges are created to lift the lamina. Various techniques of laminoplasty have since been developed after two prototype techniques: Hirabayashi’s open-door laminoplasty and Kurokawa’s spinous process splitting (double-door) laminoplasty. Several in vitro studies report superior biomechanical stability of the cervical spine after laminoplasty compared with laminectomy. In clinical situation, randomized control studies are scarce and superiority of one procedure over another is not uniformly shown. Lack of hard evidence supporting the purported advantages of laminoplasty over laminectomy, that is, reduced rate of postoperative instability and kyphosis development, while preserving range of motion (ROM), has been a weak selling point. Currently, laminoplasty is performed by majority of spine surgeons in Japan, but is rarely performed in the United States and Europe. Recent development in laminoplasty is preservation of muscle attachment, which enabled dynamic stabilization of the cervical spine by neck extensor muscles. After treatment with new laminoplasty techniques with active postoperative neck ROM exercises, postoperative instability, kyphosis, axial neck pain, and loss of ROM seems minimal. Well-designed clinical trials to show the effectiveness and long-term outcome of this surgical procedure are warranted. PMID:26119898

  12. Phosphorylated neurofilament subunit levels in the serum of cervical compressive myelopathy patients.

    PubMed

    Kato, So; Chikuda, Hirotaka; Ohya, Junichi; Hayakawa, Kentaro; Takeshita, Katsushi; Tanaka, Sakae; Ogata, Toru

    2015-10-01

    We investigated the serum levels of the phosphorylated form of the high molecular weight neurofilament subunit (pNF-H) in patients with cervical compressive myelopathy. pNF-H is becoming increasingly recognized as a biomarker for axonal injury, however, it remains unclear whether serum pNF-H is elevated in chronic spinal cord compression. We examined 26 patients who underwent surgery for cervical compressive myelopathy. Peripheral blood samples were obtained both preoperatively and 1 week after surgery to evaluate the serum pNF-H levels using an enzyme-linked immunosorbent assay. A history of recent aggravation of myelopathy was also investigated. Of the 26 myelopathy patients, the preoperative serum pNF-H level was negative in 20 patients and moderately elevated in six. Patients who were positive for pNF-H were more likely to have had a recent aggravation of myelopathy compared with the pNF-H negative patients (83 versus 25%; p=0.02). All patients who were positive for pNF-H before surgery remained positive after surgery. Two patients who became positive after surgery demonstrated a neurologic deterioration associated with the surgery. In conclusion, the serum pNF-H level was negative in the majority of patients with cervical compressive myelopathy. Our results suggest that an elevated serum level of pNF-H is associated with an acute worsening of myelopathy and that a positive conversion of pNF-H after surgery is a marker of perioperative neural damage. PMID:26195334

  13. Human neuropathological and animal model evidence supporting a role for Fas-mediated apoptosis and inflammation in cervical spondylotic myelopathy.

    PubMed

    Yu, Wen Ru; Liu, Tianyi; Kiehl, Tim-Rasmus; Fehlings, Michael G

    2011-05-01

    Although cervical spondylotic myelopathy is a common cause of chronic spinal cord dysfunction in humans, little is known about the molecular mechanisms underlying the progressive neural degeneration characterized by this condition. Based on animal models of cervical spondylotic myelopathy and traumatic spinal cord injury, we hypothesized that Fas-mediated apoptosis and inflammation may play an important role in the pathobiology of human cervical spondylotic myelopathy. We further hypothesized that neutralization of the Fas ligand using a function-blocking antibody would reduce cell death, attenuate inflammation, promote axonal repair and enhance functional neurological outcomes in animal models of cervical spondylotic myelopathy. We examined molecular changes in post-mortem human spinal cord tissue from eight patients with cervical spondylotic myelopathy and four control cases. Complementary studies were conducted using a mouse model of cervical spondylotic myelopathy (twy/twy mice that develop spontaneous cord compression at C2-C3). We observed Fas-mediated apoptosis of neurons and oligodendrocytes and an increase in inflammatory cells in the compressed spinal cords of patients with cervical spondylotic myelopathy. Furthermore, neutralization of Fas ligand with a function-blocking antibody in twy/twy mice reduced neural inflammation at the lesion mediated by macrophages and activated microglia, glial scar formation and caspase-9 activation. It was also associated with increased expression of Bcl-2 and promoted dramatic functional neurological recovery. Our data demonstrate, for the first time in humans, the potential contribution of Fas-mediated cell death and inflammation to the pathobiology of cervical spondylotic myelopathy. Complementary data in a murine model of cervical spondylotic myelopathy further suggest that targeting the Fas death receptor pathway is a viable neuroprotective strategy to attenuate neural degeneration and optimize neurological recovery in cervical spondylotic myelopathy. Our findings highlight the possibility of medical treatments for cervical spondylotic myelopathy that are complementary to surgical decompression. PMID:21490053

  14. Preliminary documentation of the comparable efficacy of vitoss versus NanOss bioactive as bone graft expanders for posterior cervical fusion

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: Laminectomies with posterior cervical instrumented fusions often utilize bone graft expanders to supplement cervical lamina/iliac crest autograft/bone marrow aspirate (BMA). Here we compared posterior fusion rates utilizing two graft expanders; Vitoss (Orthovita, Malvern, PA, USA) vs. NanOss Bioactive (Regeneration Technologies Corporation [RTI: Alachua, FL, USA]). Methods: Two successive prospective cohorts of patients underwent 1-3 level laminectomies with 5-9 level posterior cervical fusions to address cervical spondylotic myelopathy (CSM) and/or ossification of the posterior longitudinal ligament (OPLL). The first cohort of 72 patients received Vitoss, while the second cohort or 20 patients received NanOss. Fusions were performed utilizing the Vertex/Rod/Eyelet System (Medtronic, Memphis, TN, USA) with braided titanium cables through the base of intact spinous processes (not lateral mass screws) cephalad and caudad to laminectomy defects. Fusion was documented by an independent neuroradiologist blinded to the study design, utilizing dynamic X-rays and two dimensional computed tomography (2D-CT) studies up to 6 months postoperatively, or until fusion or pseudarthrosis was confirmed at 1 year. Results: Vitoss and NanOss resulted in comparable times to fusion: 5.65 vs. 5.35 months. Dynamic X-ray and CT-documented pseudarthrosis developed in 2 of 72 Vitoss patients at one postoperative year (e.g. bone graft resorbed secondary to early deep wound infections), while none occurred in the 20 patients receiving NanOss. Conclusion: In this preliminary study combining cervical laminectomy/fusions, the time to fusion (5.65 vs. 5.35 months), pseudarthrosis (2.7% vs. 0%), and infection rates (2.7% vs. 0%) were nearly comparable sequentially utilizing Vitoss (72 patients) vs. NanOss (20 patients) as bone graft expanders. PMID:26005578

  15. Progression rate of myelopathy in X-linked adrenoleukodystrophy heterozygotes.

    PubMed

    Habekost, Clarissa Troller; Pereira, Fernanda Santos; Vargas, Carmen Regla; Coelho, Daniella Moura; Torrez, Vitor; Oses, Jean Pierre; Portela, Luis Valmor; Schestatsky, Pedro; Felix, Vitor Torres; Matte, Ursula; Torman, Vanessa Leotti; Jardim, Laura Bannach

    2015-10-01

    X-linked adrenoleukodystrophy heterozygote women can present adult onset myeloneuropathy and little is known about its natural history. We aimed to describe the progression rate of the neurological impairment in the prospective follow-up of our cohort and to look for prognostic factors. The neurological scales Japanese Orthopaedic Association (JOA) and Severity Score System for Progressive Myelopathy (SSPROM) were applied at baseline in 29 symptomatic carriers and in follow-up visits. Age at onset, disease duration, X inactivation pattern, determination of the allele expressed, plasma levels of the very long chain fatty acids and of the neuron-specific enolase, and somato-sensory evoked potentials, were taken at baseline. The slope of the linear regression of both JOA and SSPROM versus disease duration since the first symptom was estimated using mixed modeling. JOA and SSPROM decreased 0.42 and 1.87 points per year, respectively (p < 0.001). None of the parameters under study influenced these rates. We estimated that the number of carriers per arm needed in a future 12 month trial with 80% power and a 50% reduction in disease progression would be 225 women for JOA and 750 for SSPROM. The progression rates of the studied neurological scales were small, did not depend on any modifier factor known, and reflected the characteristically slow worsening of symptoms in X-ALD heterozygotes. Better biomarkers are still necessary for future studies. PMID:25920484

  16. Regorafenib-induced transverse myelopathy after stereotactic body radiation therapy.

    PubMed

    Tian, Sibo; Nissenblatt, Michael; Goyal, Sharad

    2014-12-01

    Stereotactic body radiation therapy (SBRT) delivers large doses of radiation with great accuracy, but is known to have deleterious effects on the vascular compartment of irradiated tissues. Combining SBRT with targeted anti-angiogenesis agents, while able to increase therapeutic efficacy, may unexpectedly precipitate vascular-based toxicities. In this report, we describe a patient with colon cancer who developed transverse myelopathy from regorafenib 2 years after receiving SBRT for three metastatic liver lesions. Regorafenib (Stivarga), formerly BAY 73-4506, (Bayer HealthCare Pharmaceuticals, Montville, NJ) is a multiple receptor tyrosine kinase inhibitor with anti-angiogenic effects used in metastatic colon cancer. Its most common side effects are fatigue, diarrhea and hypertension. However, severe neurologic toxicity has not been previously recognized. Here, we illustrate a case in which the patient developed hyperalgesia and radicular pain 2 weeks after starting regorafenib. Several studies report an increased neurological toxicity when angiogenesis inhibitors are given after radiation therapy, and we postulate that the angioinhibitory effects of regorafenib accelerated subclinical microvascular injury from SBRT. This unexpected toxicity may be clinically relevant when giving targeted angiogenesis inhibitors after SBRT. PMID:25436137

  17. Regorafenib-induced transverse myelopathy after stereotactic body radiation therapy

    PubMed Central

    Tian, Sibo; Nissenblatt, Michael

    2014-01-01

    Stereotactic body radiation therapy (SBRT) delivers large doses of radiation with great accuracy, but is known to have deleterious effects on the vascular compartment of irradiated tissues. Combining SBRT with targeted anti-angiogenesis agents, while able to increase therapeutic efficacy, may unexpectedly precipitate vascular-based toxicities. In this report, we describe a patient with colon cancer who developed transverse myelopathy from regorafenib 2 years after receiving SBRT for three metastatic liver lesions. Regorafenib (Stivarga), formerly BAY 73-4506, (Bayer HealthCare Pharmaceuticals, Montville, NJ) is a multiple receptor tyrosine kinase inhibitor with anti-angiogenic effects used in metastatic colon cancer. Its most common side effects are fatigue, diarrhea and hypertension. However, severe neurologic toxicity has not been previously recognized. Here, we illustrate a case in which the patient developed hyperalgesia and radicular pain 2 weeks after starting regorafenib. Several studies report an increased neurological toxicity when angiogenesis inhibitors are given after radiation therapy, and we postulate that the angioinhibitory effects of regorafenib accelerated subclinical microvascular injury from SBRT. This unexpected toxicity may be clinically relevant when giving targeted angiogenesis inhibitors after SBRT. PMID:25436137

  18. Maple Syrup Urine Disease Complicated with Kyphoscoliosis and Myelopathy.

    PubMed

    Hou, Jia-Woei

    2014-01-29

    Maple syrup urine disease (MSUD) is an autosomal recessive aminoacidopathy secondary to an enzyme defect in the catabolic pathway of the branched-chain amino acids (BCAAs: leucine, isoleucine, and valine). Accumulation of their corresponding keto-acids leads to encephalopathy if not treated in time. A newborn male patient was suspected to have MSUD after tandem mass study when he presented symptoms and signs suggestive neonatal sepsis, anemia, and diarrhea. Food restriction of BCAAs was started; however, acrodermatitis enteropathica-like skin eruptions occurred at age 2 months. The skin rashes resolved after adding BCAAs and adjusting the infant formula. At age 7 months, he suffered from recurrent skin lesions, zinc deficiency, osteoporosis, and kyphosis of the thoracic spine with acute angulation over the T11-T12 level associated with spinal compression and myelopathy. After supplementation of zinc products and pamidronate, skin lesions and osteopenia improved gradually. Direct sequencing of the DBT gene showed a compound heterozygous mutation [4.7 kb deletion and c.650-651insT (L217F or L217fsX223)]. It is unusual that neurodegeneration still developed in this patient despite diet restriction. Additionally, brain and spinal magnetic resonance imaging, bone mineral density study, and monitoring of zinc status are suggested in MSUD patients. PMID:24486081

  19. Development of a functional scoring system for rheumatoid arthritis patients with cervical myelopathy.

    PubMed Central

    Casey, A T; Bland, J M; Crockard, H A

    1996-01-01

    OBJECTIVE: To be able to measure disability objectively in rheumatoid arthritis complicated by cervical myelopathy. METHODS: The responses to the Stanford health assessment questionnaire disability index were recorded from 250 consecutive patients (group 1) referred to our unit for spinal surgery. Using principal components analysis the questionnaire was reduced from 20 questions to 10 questions. In the second part of the study, the results of the questionnaire for those patients undergoing surgery from the original group of 250 patients were analysed with respect to outcome. RESULTS: The reduction in the number of questions results in no significant loss of information, reliability (internal consistency Cronbach's alpha = 0.968) or sensitivity. The new scale, the myelopathy disability index, measures only one dimension (Eigen value 6.97) and may be more finely tuned to the measurement of disability in these myelopathic patients. When administered to the 194 patients undergoing cervical spine (group 2) surgery the myelopathy disability index was an accurate predictor of neurological and functional outcome, as well as survival following surgery (P < 0.0001). CONCLUSIONS: The myelopathy disability index provides a much needed objective and reliable means of assessing disability in patients with rheumatoid involvement of the cervical spine and also in predicting outcome following surgical intervention. It also provides information for both the patient and surgeon alike, on what to realistically expect from surgery. Its adoption should facilitate comparisons between different forms of surgical intervention. PMID:9014584

  20. Idiopathic Ventral Spinal Cord Herniation: An Increasingly Recognized Cause of Thoracic Myelopathy

    PubMed Central

    Berg-Johnsen, Jon; Ilstad, Eivind; Kolstad, Frode; Züchner, Mark; Sundseth, Jarle

    2014-01-01

    Idiopathic spinal cord herniation (ISCH), where a segment of the spinal cord has herniated through a ventral defect in the dura, is a rarely encountered cause of thoracic myelopathy. The purpose of our study was to increase the clinical awareness of this condition by presenting our experience with seven consecutive cases treated in our department since 2005. All the patients developed pronounced spastic paraparesis or Brown-Séquard syndrome for several years (mean, 4.7 years) prior to diagnosis. MRI was consistent with a transdural spinal cord herniation in the mid-thoracic region in all the cases. The patients underwent surgical reduction of the herniated spinal cord and closure of the dural defect using an artificial dural patch. At follow-up, three patients experienced considerable clinical improvement, one had slight improvement, one had transient improvement, and two were unchanged. Two of the four patients with sphincter dysfunction regained sphincter control. MRI showed realignment of the spinal cord in all the patients. ISCH is probably a more common cause of thoracic myelopathy than previously recognized. The patients usually develop progressive myelopathy for several years before the correct diagnosis is made. Early diagnosis is important in order to treat the patients before the myelopathy has become advanced. PMID:25336997

  1. Myelopathy Caused by Soft Cervical Disc Herniation : Surgical Results and Prognostic Factors

    PubMed Central

    Kim, Young-Jin; Yi, Hyeong-Joong; Kim, Young-Soo; Ko, Yong; Oh, Suck Jun

    2007-01-01

    Objective The purpose of this study was to investigate the surgical results and prognostic factors for patients with soft cervical disc herniation with myelopathy. Methods During the last 7 years, 26 patients with cervical discogenic myelopathy were undertaken anterior discectomy and fusion. Clinical and radiographic features were reviewed to evaluate the surgical results and prognostic factors. The clinical outcome was judged using two grading systems (Herkowitz's scale and Nurick's grade). Results Male were predominant (4:1), and C5-6 was the most frequently involved level. Gait disturbance, variable degree of spasticity, discomfort in chest and abdomen, hand numbness were the most obvious signs. Magnetic resonance(MR) images showed that central disc herniation was revealed in 16 cases, and accompanying cord signal changes in 4. Postoperatively, 23 patients showed favorable results (excellent, good and fair) according to Herkowitz's scale. Conclusion Anterior cervical discectomy and fusion effectively reduced myelopathic symptoms due to soft cervical disc herniation. The authors assured that the shorter duration of clinical attention, the lesser the degree of myelopathy and better outcome in discogenic myelopathy. PMID:19096586

  2. Vertebral Arteriovenous Fistula Presenting as Cervical Myelopathy: A Rapid Recovery with Balloon Embolization

    SciTech Connect

    Modi, Manish; Bapuraj, J. Rajiv; Lal, Anupam; Prabhakar, S.; Khandelwal, N.

    2010-12-15

    A 24-year-old male presented with progressive cervical myelopathy of 2 months' duration. Magnetic resonance imaging of the cervical spine and angiography revealed a large arteriovenous fistula arising from the left vertebral artery. The present case highlights the clinical features and dramatic recovery following endovascular balloon occlusion of a giant cervical arteriovenous fistula.

  3. Posterior C1-C2 calcium pyrophosphate dihydrate crystal deposition disease.

    PubMed

    Ng, Isaac Bing-Yi; Arkun, Knarik; Riesenburger, Ron I

    2016-01-01

    Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease rarely occurs in the posterior aspect of the craniocervical junction (CCJ). To the best of our knowledge, there have been only 2 previously reported cases of patients with posterior CPPD lesions in this region that have led to cervical myelopathy. We report the case of a 70-year-old man presenting with neck pain and cervical myelopathy with multilevel stenosis from C1-C6. The stenosis was worst at C1-C2, secondary to compression by a CPPD lesion posterior to the spinal cord. The patient underwent a C2-C6 laminectomy and fusion with resection of the CPPD lesion. In this report, we discuss the patient and present a novel theory to explain the preponderance of CPPD lesions in the CCJ occurring anteriorly and not posteriorly to the spinal cord. PMID:26976840

  4. Subacute myelo‑optic neuropathy, beriberi, and HTLV‑I‑associated myelopathy: elucidation of some neurological diseases in Japan.

    PubMed

    Igata, Akihiro

    2012-01-01

    Personal experience of the discovery of the cause, pathophysiology, and treatment as well as prevention of subacute myelo‑optic neuropathy, beriberi, and HTLV‑I‑associated myelopathy were described. PMID:23222550

  5. Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications

    PubMed Central

    Ross, Ruth E.; Shade-Zeldow, Yvonne; Kostas, Konstantinos; Morrissey, Mary; Elias, Dean A.; Shepard, Alan

    2007-01-01

    Some patients with fibromyalgia also exhibit the neurological signs of cervical myelopathy. We sought to determine if treatment of cervical myelopathy in patients with fibromyalgia improves the symptoms of fibromyalgia and the patients’ quality of life. A non-randomized, prospective, case control study comparing the outcome of surgical (n = 40) versus non-surgical (n = 31) treatment of cervical myelopathy in patients with fibromyalgia was conducted. Outcomes were compared using SF-36, screening test for somatization, HADS, MMPI-2 scale 1 (Hypochondriasis), and self reported severity of symptoms 1 year after treatment. There was no significant difference in initial clinical presentation or demographic characteristics between the patients treated by surgical decompression and those treated by non-surgical means. There was a striking and statistically significant improvement in all symptoms attributed to the fibromyalgia syndrome in the surgical patients but not in the non-surgical patients at 1 year following the treatment of cervical myelopathy (P ≤ 0.018–0.001, Chi-square or Fisher’s exact test). At the 1 year follow-up, there was a statistically significant improvement in both physical and mental quality of life as measured by the SF-36 score for the surgical group as compared to the non-surgical group (Repeated Measures ANOVA P < 0.01). There was a statistically significant improvement in the scores from Scale 1 of the MMPI-2 and the screening test for somatization disorder, and the anxiety and depression scores exclusively in the surgical patients (Wilcoxon signed rank, P < 0.001). The surgical treatment of cervical myelopathy due to spinal cord or caudal brainstem compression in patients carrying the diagnosis of fibromyalgia can result in a significant improvement in a wide array of symptoms usually attributed to fibromyalgia with attendant measurable improvements in the quality of life. We recommend detailed neurological and neuroradiological evaluation of patients with fibromyalgia in order to exclude compressive cervical myelopathy, a potentially treatable condition. PMID:17426987

  6. Unusual case of intracranial dural AV fistula presenting with acute myelopathy.

    PubMed

    Abdelsadg, Mohamed; Kanodia, Avinash Kumar; Keston, Peter; Galea, James

    2016-01-01

    We present a case of intracranial arteriovenous fistula with perimedullary venous drainage presenting with acute myelopathy, which is an unusual presentation of this uncommon condition. Subsequent catheter angiogram defined the arterial feeders from the meningohypophyseal trunk and petrosal branch of the middle meningeal artery. The patient was successfully embolised, resulting in complete obliteration of the fistula, and significant resolution of brainstem and cervical cord changes along with clinical improvement. PMID:27122105

  7. Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score

    PubMed Central

    Aggarwal, Rishi Anil; Srivastava, Sudhir Kumar; Bhosale, Sunil Krishna; Nemade, Pradip Sharad

    2016-01-01

    Context: Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM). The role of radiological parameters is still controversial. Aims: Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM. Settings and Design: Retrospective. Materials and Methods: This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA) scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as good if the patient had mJOA score ≥16 and poor if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW), diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI) signal intensity changes were assessed. Statistics: Statistical Package for the Social Sciences (SPSS) (version 20.0) was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score. Results: Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82%) with a score below 5 had good outcome and all patients (100%) with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5. Conclusions: Clinical parameters are better predictors of the outcome as compared to radiological findings, following surgery in CCM. A simple scoring system based on clinicoradiological parameters is suggested in this paper to predict the outcome following surgery in cases of CCM. PMID:27217653

  8. HTLV-1-associated infective dermatitis and probable HTLV-1- associated myelopathy in an adolescent female*

    PubMed Central

    Steglich, Raquel Bisacotti; Tonoli, Renata Elise; Souza, Paulo Ricardo Martins; Pinto, Giselle Martins; Riesgo, Rudimar dos Santos

    2015-01-01

    Human T cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (ID) is a chronic, severe and recurrent eczema occurring during childhood in patients vertically infected with HTLV-1. HTLV-1-associated myelopathy/tropical spastic paraparesia (HAM/ TSP) is slow and progressive. We report the case of an adolescent female from a non-endemic area for HTLV-1 who presents ID and, most likely, associated HAM/TSP. PMID:26312674

  9. Breed Distribution of SOD1 Alleles Previously Associated with Canine Degenerative Myelopathy

    PubMed Central

    Zeng, R; Coates, JR; Johnson, GC; Hansen, L; Awano, T; Kolicheski, A; Ivansson, E; Perloski, M; Lindblad-Toh, K; O'Brien, DP; Guo, J; Katz, ML; Johnson, GS

    2014-01-01

    Background Previous reports associated 2 mutant SOD1 alleles (SOD1:c.118A and SOD1:c.52T) with degenerative myelopathy in 6 canine breeds. The distribution of these alleles in other breeds has not been reported. Objective To describe the distribution of SOD1:c.118A and SOD1:c.52T in 222 breeds. Animals DNA from 33,747 dogs was genotyped at SOD1:c.118, SOD1:c.52, or both. Spinal cord sections from 249 of these dogs were examined. Methods Retrospective analysis of 35,359 previously determined genotypes at SOD1:c.118G>A or SOD1:c.52A>T and prospective survey to update the clinical status of a subset of dogs from which samples were obtained with a relatively low ascertainment bias. Results The SOD1:c.118A allele was found in cross-bred dogs and in 124 different canine breeds whereas the SOD1:c.52T allele was only found in Bernese Mountain Dogs. Most of the dogs with histopathologically confirmed degenerative myelopathy were SOD1:c.118A homozygotes, but 8 dogs with histopathologically confirmed degenerative myelopathy were SOD1:c.118A/G heterozygotes and had no other sequence variants in their SOD1 amino acid coding regions. The updated clinical conditions of dogs from which samples were obtained with a relatively low ascertainment bias suggest that SOD1:c.118A homozygotes are at a much higher risk of developing degenerative myelopathy than are SOD1:c.118A/G heterozygotes. Conclusions and Clinical Importance We conclude that the SOD1:c.118A allele is widespread and common among privately owned dogs whereas the SOD1:c.52T allele is rare and appears to be limited to Bernese Mountain Dogs. We also conclude that breeding to avoid the production of SOD1:c.118A homozygotes is a rational strategy. PMID:24524809

  10. Neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy - a prospective study

    PubMed Central

    Cheung, W. Y.; Arvinte, D.; Wong, Y. W.; Luk, K. D.K.

    2007-01-01

    Cervical spondylotic myelopathy is a common clinical problem. No study has examined the pattern of neurological recovery after surgical decompression. We conducted a prospective study on the pattern of neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy. Patients suffering from cervical spondylotic myelopathy and requiring surgical decompression from January 1995 to December 2000 were prospectively included. Upper limbs, lower limbs and sphincter functions were assessed using the Japanese Orthopaedic Association (JOA) score. Assessment was done before the operation, at 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year and then yearly after surgery. Results were analysed with the t-test. Differences with P-values less than 0.05 were regarded as statistically significant. Fifty-five patients were included. The average follow-up period was 53 months. Thirty-nine patients (71%) had neurological improvement after the operation with a mean recovery rate of 55%. The JOA score improved after surgery, reaching statistical significance at 3 months and a plateau at 6 months. Thirty-six patients (65%) had improvement of upper limb function. Twenty-four patients (44%) had improvement of lower limb function. Eleven patients (20%) had improvement of sphincter function. The recovery rate of upper limb function was 37%, of lower limb function was 23% and of sphincter function was 17%. Surgical decompression worked well in patients with cervical spondylotic myelopathy. Seventy-one percent of patients had neurological improvement after the operation. The neurological recovery reached a plateau at 6 months after the operation. The upper limb function had the best recovery, followed by lower limb and sphincter functions. PMID:17235616

  11. [A tentorial dural arteriovenous fistula presenting progressive myelopathy: a case report].

    PubMed

    Takeshita, Tomonori; Toyoda, Keisuke; So, Gohei; Morofuji, Yoichi; Horie, Nobutaka; Hayashi, Kentaro; Kitagawa, Naoki; Suyama, Kazuhiko; Nagata, Izumi

    2011-06-01

    Abstract We report a case of a dural arteriovenous fistula (DAVF) at the tentorium cerebelli, which presented progressive myelopathy. A 68-year-old man with neurological deterioration of the cervical myelopathy visited our hospital. T2 weighted magnetic resonance (MR) imaging showed high signal area and edema from the medulla to the upper thoracic spinal cord with flow voids on the dorsal surface of the cord. Angiography showed right tentorial DAVF, which was supplied by the right meningohypophyseal trunk, the middle meningeal artery, the accessory meningeal artery, and was drained into the posterior spinal veins. The patient underwent right retrosigmoid suboccipital craniotomy, then disruption of the fistula was performed by using micro Doppler sonography following endovascular obliteration of the main feeders. Postoperative angiography showed complete obliteration of the fistula. His daily functioning gradually improved up to 6 months after the surgery. Tentorial DAVFs with clinical manifestation of myelopathy are rare. Considering its aggressive nature, early surgical treatment could be necessary. (Received: November 17, 2010, Accepted: December 18, 2010). PMID:21613664

  12. Neurogenic bladder following myelopathies: Has it any correlation with neurological and functional recovery?

    PubMed Central

    Menon, Nitin; Gupta, Anupam; Taly, Arun B.; Khanna, Meeka; Kumar, Sushruth Nagesh

    2014-01-01

    Objectives: To observe neurogenic bladder pattern in patients with myelopathy by performing urodynamic study (UDS) and to observe whether it has any correlation with functional and neurological recovery. Patients and Methods: This prospective study was conducted with 90 patients with myelopathy, both traumatic and non-traumatic (males = 65) in a university tertiary research hospital in India between January 2011 and December 2013. Mean age was 33.5 ± 13.2 years (range 15-65 years), mean duration of injury was 82.63 ± 88.3 days (range 14-365 days) and mean length of stay (LOS) in the rehabilitation unit 42.5 ± 23.3 days (range 14-130 days). The urodynamic study was performed in all the patients to assess the neurogenic bladder pattern. Management was based on the UDS findings. Functional recovery was assessed using Barthel index (BI) scores and spinal cord independence measures (SCIM) scores. Neurological recovery was assessed using ASIA impairment scale (AIS). We tried to correlate neurogenic bladder patterns with recovery. Results: Fifty patients (55.6%) had overactive detrusor with 25 each had detrusor sphincter dyssynergia (DSD) and synergic sphincter. Thirty-eight patients had hypoactive/acontractile detrusor and two had normal studies. No significant correlation observed between neurogenic bladder pattern and change in BI scores (P = 0.696), SCIM scores (P = 0.135) or change in ASIA status (P = 0.841) in the study. Conclusions: More than half of the patients with myelopathies had overactive detrusor with or without dyssynergic sphincter according to the urodynamic study. Neurogenic bladder patterns had no significant correlation with functional and neurological recovery in these patients. PMID:25540531

  13. Demographic Trends of Patients with Compressive Myelopathy in a Developing Asian Country

    PubMed Central

    Kumar, Vishal; Kumar, Avinash; Bahadur, Raj

    2016-01-01

    Study Design Prospective case series. Purpose To analyze the demographic picture of the patients suffering from compression myelopathy due to various spinal problems. Overview of Literature: There is a lack of literature depicting demographic picture of such patients with spinal injuries as most of the articles have shown the epidemiology of spinal cord injuries either managed conservatively or operatively. None have focused on the patients with compressive myelopathy requiring surgeries. Methods Patients with spinal pathologies with a neurological deficit due to compressive myelopathy requiring surgical decompression of dorsal and thoracolumbar region were studied. The different kinds of etiologies, the demographic profiles involved, the involvement of various regions of spine in each of the etiologies, sex distribution of different etiologies, association of age and sex with the occurrence of paraplegia, and association of thoracolumbar junction (TLJ) involvement by age and sex were studied. This study addressed the dorsal and TLJ till L2 vertebrae surgically treated by anterior transthoracic transpleural approach. Results With regard to gender, 75% of the females and 67.3% of the males were paraplegic but there was no relationship between gender and the occurrence of paraplegia (p >0.05). There was also no association between TLJ involvement and the age and sex of the patients (p >0.05). Seventy percent of the patients were paraplegic with a mean age of 38.90 years and 30% were paraparetic with a mean age of 43.43 years. Male to female ratio stood at 4.43:1. Conclusions Traumatic spine in females is increasing. The occurrence of paraplegia and involvement of TLJ is not affected by the age and the sex of the patients. Deep epidemiological understanding of spinal pathologies can lead to a better appreciation of the potential impact of health care management strategies and health policies to prevent and minimize their consequences considering limited worldwide reports on the same. PMID:27114774

  14. Postoperative cervical sagittal imbalance negatively affects outcomes following surgery for cervical spondylotic myelopathy

    PubMed Central

    Roguski, Marie; Benzel, Edward C.; Curran, Jill N.; Magge, Subu N.; Bisson, Erica F.; Krishnaney, Ajit A.; Steinmetz, Michael P.; Butler, William E.; Heary, Robert F.; Ghogawala, Zoher

    2014-01-01

    Study Design Prospective observational cohort study Objective To determine if postoperative cervical sagittal balance is an independent predictor of HR-QOL outcome following surgery for CSM. Summary of Background Data Both ventral and dorsal fusion procedures for cervical spondylotic myelopathy (CSM) are effective at reducing the symptoms of myelopathy. The importance of cervical sagittal balance in predicting overall HR-QOL outcome following ventral versus dorsal surgery for CSM has not been previously explored. Methods A prospective, nonrandomized cohort of 49 patients undergoing dorsal and ventral fusion surgery for CSM was examined. Preoperative and postoperative C2-C7 sagittal vertical axis (SVA) was measured on standing lateral cervical spine radiographs. Outcome was assessed with two disease-specific measures – the mJOA scale and the Oswestry NDI- and two generalized outcome measures – the SF-36 PCS and EQ-5D. Assessments were performed preoperatively, and at 3 months, 6 months, and 1 year postoperatively. Statistical analyses were performed using SAS v.9.3 (Cary, NC). Results Most patients experienced improvement in all outcome measures regardless of approach. Both preoperative and postoperative C2-C7 SVA measurements were independent predictors of clinically significant improvement in SF-36 PCS scores (p=0.03 and p=0.02). The majority of patients with C2-C7 SVA values greater than 40mm did not improve from an overall HR-QOL perspective (SF-36 PCS) despite improvement in myelopathy. The postoperative sagittal balance value was inversely correlated with a clinically significant improvement of SF-36 PCS scores in patients undergoing dorsal surgery but not ventral surgery (p=0.03 vs. p=0.93). Conclusions Preoperative and postoperative sagittal balance measurements independently predict clinical outcomes following surgery for CSM. PMID:25419682

  15. Ossified Posterior Longitudinal Ligament With Massive Ossification of the Anterior Longitudinal Ligament Causing Dysphagia in a Diffuse Idiopathic Skeletal Hyperostosis Patient.

    PubMed

    Murayama, Kazuhiro; Inoue, Shinichi; Tachibana, Toshiya; Maruo, Keishi; Arizumi, Fumihiro; Tsuji, Shotaro; Yoshiya, Shinichi

    2015-08-01

    Descriptive case report.To report a case of a diffuse idiopathic skeletal hyperostosis (DISH) patient with both massive ossification of the anterior longitudinal ligament (OALL) leading to severe dysphagia as well as ossification of the posterior longitudinal ligament (OPLL) causing mild cervical myelopathy, warranting not only an anterior approach but also a posterior one.Although DISH can cause massive OALL in the cervical spine, severe dysphagia resulting from DISH is a rare occurrence. OALLs are frequently associated with OPLL. Treatment for a DISH patient with OPLL in setting of OALL-caused dysphagia is largely unknown.A 70-year-old man presented with severe dysphagia with mild cervical myelopathy. Neurological examination showed mild spastic paralysis and hyper reflex in his lower extremities. Plane radiographs and computed tomography of the cervical spine revealed a discontinuous massive OALL at C4-5 and continuous type OPLL at C2-6. Magnetic resonance imaging revealed pronounced spinal cord compression due to OPLL at C4-5. Esophagram demonstrated extrinsic compression secondary to OALL at C4-5.We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. Severe dysphagia markedly improved without any complications.We considered that this patient not only required osteophytectomy and fusion by the anterior approach but also required decompression and spinal fusion by the posterior approach to prevent both deterioration of cervical myelopathy and recurrence of OALL after surgery. PMID:26266365

  16. Ossified Posterior Longitudinal Ligament With Massive Ossification of the Anterior Longitudinal Ligament Causing Dysphagia in a Diffuse Idiopathic Skeletal Hyperostosis Patient

    PubMed Central

    Murayama, Kazuhiro; Inoue, Shinichi; Tachibana, Toshiya; Maruo, Keishi; Arizumi, Fumihiro; Tsuji, Shotaro; Yoshiya, Shinichi

    2015-01-01

    Abstract Descriptive case report. To report a case of a diffuse idiopathic skeletal hyperostosis (DISH) patient with both massive ossification of the anterior longitudinal ligament (OALL) leading to severe dysphagia as well as ossification of the posterior longitudinal ligament (OPLL) causing mild cervical myelopathy, warranting not only an anterior approach but also a posterior one. Although DISH can cause massive OALL in the cervical spine, severe dysphagia resulting from DISH is a rare occurrence. OALLs are frequently associated with OPLL. Treatment for a DISH patient with OPLL in setting of OALL-caused dysphagia is largely unknown. A 70-year-old man presented with severe dysphagia with mild cervical myelopathy. Neurological examination showed mild spastic paralysis and hyper reflex in his lower extremities. Plane radiographs and computed tomography of the cervical spine revealed a discontinuous massive OALL at C4-5 and continuous type OPLL at C2-6. Magnetic resonance imaging revealed pronounced spinal cord compression due to OPLL at C4-5. Esophagram demonstrated extrinsic compression secondary to OALL at C4-5. We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. Severe dysphagia markedly improved without any complications. We considered that this patient not only required osteophytectomy and fusion by the anterior approach but also required decompression and spinal fusion by the posterior approach to prevent both deterioration of cervical myelopathy and recurrence of OALL after surgery. PMID:26266365

  17. Delayed Bilateral C5 Palsy following Circumferential Decompression and Fusion in Patient with Cervical Spondylotic Myelopathy

    PubMed Central

    Jeon, Hyeong-Seok

    2015-01-01

    C5 palsy is a common complication after cervical decompressive surgery, which have 0 to 30% complication rate. A 61-year-old female patient with cervical spondylotic myelopathy showed bilateral C5 palsy following circumferential decompression and fusion. Unexpectedly, bilateral C5 palsy was noted in different time points on postoperative day 2 and 8, respectively. Steroid injection and physical therapy were performed, and her motor function is recovering. Surgeons should make an effort to prevent possible C5 palsy when performing cervical decompression surgery. PMID:26512284

  18. [Results of the surgical treatment of cervical disk hernia and myelopathy with dorsal approach].

    PubMed

    Reinhardt, H F; Ruetschle, M; Stricker, E; Gratzl, O

    1983-06-01

    Between 1978 and 1981 68 patients underwent posterior surgery on the cervical spine at the Neurosurgical Clinic of Basle. In 24 patients the radicular compression syndrome was caused by a soft disc herniation and in 25 patients by degenerative changes of the cervical spine (hard discs). In 19 patients a cervical myelopathy was caused by a narrowing of the spinal canal. After 1-4 years follow-up the results were excellent or good in more than 90% in soft discs, 80% in hard discs and less than 40% in spinal canal stenosis. The advantages and inconveniences of the different approaches and operative methods are discussed. PMID:6873855

  19. Chronic active VZV infection manifesting as zoster sine herpete, zoster paresis and myelopathy.

    PubMed

    Morita, Y; Osaki, Y; Doi, Y; Forghani, B; Gilden, D H

    2003-08-15

    After lumbar-distribution zoster, an HTLV-1-seropositive woman developed chronic radicular sacral-distribution pain (zoster sine herpete), cervical-distribution zoster paresis and thoracic-distribution myelopathy. Detection of anti-varicella zoster virus (VZV) IgM and VZV IgG antibody in cerebrospinal fluid (CSF), with reduced serum/CSF ratios of anti-VZV IgG compared to normal serum/CSF ratios for albumin and total IgG, proved that VZV caused the protracted neurological complications. Diagnosis by antibody testing led to aggressive antiviral treatment and a favorable outcome. PMID:12809993

  20. Subacute posttraumatic ascending myelopathy in a 15-year-old boy.

    PubMed

    Kovanda, Timothy J; Horn, Eric M

    2014-09-01

    Secondary injury following initial spinal cord trauma is uncommon and frequently attributed to mismanagement of an unprotected cord in the acute time period after injury. Subacute posttraumatic ascending myelopathy (SPAM) is a rare occurrence in the days to weeks following an initial spinal cord injury that is unrelated to manipulation of an unprotected cord and involves 4 or more vertebral levels above the original injury. The authors present a case of SPAM occurring in a 15-year-old boy who sustained a T3-4 fracture-dislocation resulting in a complete spinal cord injury, and they highlight the imaging findings and optimum treatment for this rare event. PMID:24905393

  1. Effect of Pulsed Methylprednisolone on Pain, in Patients with HTLV-1-Associated Myelopathy

    PubMed Central

    Buell, Kevin G.; Puri, Aiysha; Demontis, Maria Antonietta; Short, Charlotte L.; Adonis, Adine; Haddow, Jana; Martin, Fabiola; Dhasmana, Divya

    2016-01-01

    HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an immune mediated myelopathy caused by the human T-lymphotropic virus type 1 (HTLV-1). The efficacy of treatments used for patients with HAM/TSP is uncertain. The aim of this study is to document the efficacy of pulsed methylprednisolone in patients with HAM/TSP. Data from an open cohort of 26 patients with HAM/TSP was retrospectively analysed. 1g IV methylprednisolone was infused on three consecutive days. The outcomes were pain, gait, urinary frequency and nocturia, a range of inflammatory markers and HTLV-1 proviral load. Treatment was well tolerated in all but one patient. Significant improvements in pain were: observed immediately, unrelated to duration of disease and maintained for three months. Improvement in gait was only seen on Day 3 of treatment. Baseline cytokine concentrations did not correlate to baseline pain or gait impairment but a decrease in tumour necrosis factor-alpha (TNF-α) concentration after pulsed methylprednisolone was associated with improvements in both. Until compared with placebo, treatment with pulsed methylprednisolone should be offered to patients with HAM/TSP for the treatment of pain present despite regular analgesia. PMID:27077747

  2. Laminoplasty improves respiratory function in elderly patients with cervical spondylotic myelopathy.

    PubMed

    Yanaka, K; Noguchi, S; Asakawa, H; Nose, T

    2001-10-01

    Respiratory insufficiency after acute cervical trauma is well documented, but the relationship between respiratory function and chronic lesions, such as cervical spondylosis, has received scant attention. This clinical study investigated the effect of cervical spondylosis on respiratory function in 12 patients over 65 years of age who underwent expansive laminoplasty. Functional and neurological status were assessed using the Japanese Orthopaedic Association (JOA) scale and Neurosurgical Cervical Spine Scale (NCSS). To assess the effect of laminoplasty on respiratory function in patients with cervical spondylotic myelopathy, lung volumes including vital capacity, tidal volume (TV), inspiratory reserve volume, expiratory reserve volume, inspiratory capacity, and forced expiratory volume were measured by spirometer before surgery and 6 months after surgery. The arterial blood gas values were also measured before and after surgery. All patients showed functional improvement after surgery, and neurological examination 6 months after surgery revealed a significant improvement in both JOA scale and NCSS scores (p < 0.001). There were no significant differences in most lung volumes, but TV (p = 0.039) at 6 months after surgery showed a significant increase compared to before surgery. PCO2 also showed a significant reduction after surgery (p = 0.047). This limited study revealed that laminoplasty improved respiratory function in patients over 65 years of age with cervical spondylotic myelopathy. Lung volume measurement may be one method to estimate spinal cord function after a surgical procedure. PMID:11760383

  3. MRI findings in Hirayama's disease: flexion-induced cervical myelopathy or intrinsic motor neuron disease?

    PubMed

    Schröder, R; Keller, E; Flacke, S; Schmidt, S; Pohl, C; Klockgether, T; Schlegel, U

    1999-11-01

    Hirayama's disease is a benign juvenile form of focal amyotrophy affecting the upper limbs. Previous studies have suggested that the disorder is a neck flexion induced cervical myelopathy. We report clinical and magnetic resonance imaging findings in nine patients with Hirayama's disease. Cervical imaging of seven patients revealed spinal cord changes consisting of focal atrophy and foci of signal alterations. On neck flexion a forward movement and mild reduction in the anteroposterior diameter of the lower cervical cord against the vertebral bodies was noted in affected individuals as well as in five normal controls. In contrast to earlier reports, none of our patients showed complete obliteration of the posterior subarachnoid space. Measurement of the anteroposterior spinal cord diameter in each vertebral segment (C4-C7) revealed no significant differences in the degree of spinal cord flattening between the two groups. Furthermore, two of our patients had significant degenerative changes in the cervical spine (disc herniation, retrospondylosis) contralateral to the clinically affected side. These degenerative changes resulted in a marked cord compression on neck flexion but were not associated with ipsilateral clinical abnormalities or spinal cord alterations. Our results argue against a flexion-induced cervical myelopathy and support the view that Hirayama's disease is an intrinsic motor neuron disease. PMID:10631640

  4. Rehabilitation and long-term course of nontraumatic myelopathy associated with surfing.

    PubMed

    Aoki, Masahiro; Moriizumi, Shigehiro; Toki, Megumi; Murakami, Takanori; Ishiai, Sumio

    2013-09-01

    A nontraumatic spinal cord injury related to surfing is called surfer's myelopathy. The case of a 26-yr-old man who became paraplegic after surfing without apparent traumatic events is described. Physical examination revealed a spinal cord injury at T12 according to the American Spinal Injury Association Impairment Scale A. The initial magnetic resonance image revealed a fusiform swelling of the spinal cord from T7-8 to the conus, which was hyperintense on T2-weighted images. After 6 mos of rehabilitation, the patient was followed for more than 1 yr after onset. He became able to walk with knee-ankle-foot-orthoses without assistance. A magnetic resonance image obtained 1 yr after the onset of paraplegia showed an atrophic spinal cord from T7-8 to the conus. The course of the neurologic findings and the imaging studies suggest that the pathogenesis of surfer's myelopathy may be ischemia of the anterior spinal artery territory induced by the abnormal trunk posture while surfing. PMID:22019977

  5. Intrinsic Functional Plasticity of the Sensory-Motor Network in Patients with Cervical Spondylotic Myelopathy

    PubMed Central

    Zhou, F. Q.; Tan, Y. M.; Wu, L.; Zhuang, Y.; He, L. C.; Gong, H. H.

    2015-01-01

    Several neuroimaging studies have suggested brain reorganisation in patients with cervical spondylotic myelopathy (CSM); however, the changes in spontaneous neuronal activity that are associated with connectedness remain largely unknown. In this study, functional connectivity strength (FCS), a data-driven degree centrality method based on a theoretical approach, was applied for the first time to investigate changes in the sensory-motor network (SMN) at the voxel level. Comparatively, CSM not only showed significantly decreased FCS in the operculum-integrated regions, which exhibited reduced resting-state functional connectivity (rsFC) around the Rolandic sulcus, but it also showed increased FCS in the premotor, primary somatosensory, and parietal-integrated areas, which primarily showed an enhanced rsFC pattern. Correlation analysis showed that altered FCS (in the left premotor-ventral/precentral-operculum, right operculum-parietale 4, and right S1) was associated with worsening Japanese Orthopaedic Association scores and that the rsFC pattern was influenced by cervical cord micro-structural damage at the C2 level. Together, these findings suggest that during myelopathy, the intrinsic functional plasticity of the SMN responds to the insufficient sensory and motor experience in CSM patients. This knowledge may improve our understanding of the comprehensive functional defects found in CSM patients and may inspire the development of new therapeutic strategies in the future. PMID:25897648

  6. Degenerative Cervical Myelopathy: A Spectrum of Related Disorders Affecting the Aging Spine.

    PubMed

    Tetreault, Lindsay; Goldstein, Christina L; Arnold, Paul; Harrop, James; Hilibrand, Alan; Nouri, Aria; Fehlings, Michael G

    2015-10-01

    Cervical spinal cord dysfunction can result from either traumatic or nontraumatic causes, including tumors, infections, and degenerative changes. In this article, we review the range of degenerative spinal disorders resulting in progressive cervical spinal cord compression and propose the adoption of a new term, degenerative cervical myelopathy (DCM). DCM comprises both osteoarthritic changes to the spine, including spondylosis, disk herniation, and facet arthropathy (collectively referred to as cervical spondylotic myelopathy), and ligamentous aberrations such as ossification of the posterior longitudinal ligament and hypertrophy of the ligamentum flavum. This review summarizes current knowledge of the pathophysiology of DCM and describes the cascade of events that occur after compression of the spinal cord, including ischemia, destruction of the blood-spinal cord barrier, demyelination, and neuronal apoptosis. Important features of the diagnosis of DCM are discussed in detail, and relevant clinical and imaging findings are highlighted. Furthermore, this review outlines valuable assessment tools for evaluating functional status and quality of life in these patients and summarizes the advantages and disadvantages of each. Other topics of this review include epidemiology, the prevalence of degenerative changes in the asymptomatic population, the natural history and rates of progression, risk factors of diagnosis (clinical, imaging and genetic), and management strategies. PMID:26378358

  7. Surgical Treatment of Cervical Spondylotic Myelopathy Associated Hypertension--A Retrospective Study of 309 Patients.

    PubMed

    Li, Ze-qun; Zhao, Yun-peng; Jia, Wen-yu; Wang, Xia; Chen, Bin; Shahbaz, Muhammad; Nie, Lin; Cheng, Lei

    2015-01-01

    Hypertension is the most prevalent cardiovascular disease, and various risk factors are known to be involved in it. Cervical spondylotic myelopathy (CSM) is the most common non-traumatic cause of myelopathy, which displays neurological symptoms and may induce systemic symptoms. To date, it is still unknown whether CSM is associated with hypertension, and if so, whether the decompression operations can attenuate CSM associated hypertension. Here, a total of 309 patients with CSM who received anterior or posterior decompression surgery were enrolled as subjects. Blood pressure measurements were performed before and within one week after the surgery. Among the 309 subjects, 144 (46.6%) of them exhibited hypertension before surgery, a significantly higher ratio than that of the whole population. One week after surgery, blood pressure of 106 (73.6%) patients turned back to normal. Blood pressure of another 37(25.7%) patients decreased with different degrees, although still higher than normal. Moreover, it appears that both approaches were effective in improving blood pressure, while the posterior approach was more effective in decreasing systolic blood pressure. We speculate this type of hypertension might result from hyperactivity of sympathetic nervous system as the heart rate of these patients decreased after surgery as well. Collectively, compression of spinal cord in CSM patients might be associated with hypertension, and decompression surgery largely attenuated this type of hypertension. These findings prove CSM to be a potential associated factor of high blood pressure and may shed light on therapies of hypertension in clinics. PMID:26193469

  8. Chronic hypertrophic nonunion of the Type II odontoid fracture causing cervical myelopathy: Case report and review of literature

    PubMed Central

    Shamji, Mohammed F.; Alotaibi, Naif; Ghare, Aisha; Fehlings, Michael G.

    2016-01-01

    Background: Complications of nonunited Type II odontoid fractures can range from neck pain to progressive neurological deficit from cervical myelopathy. Rarely, the hypertrophic nonunion requires both anterior transoral decompression and posterior decompression with instrumented fusion. We present a case and review literature around this entity. Case Description: A 68-year-old female presented with rapidly progressive cervical myelopathy (from normal to moderate myelopathy modified Japanese Orthopedic Association [mJOA] 13) over 3 months. Her history was positive for a Type II odontoid fracture managed conservatively and lost to follow-up for 25 years. Spinal imaging studies revealed hypertrophic nonunion and craniocervical kyphotic deformity with significant subaxial stenosis and segmental kyphosis. The patient underwent anterior transoral decompression, followed by posterior occipitothoracic decompression and instrumented fusion. At follow-up, the cervical myelopathy has improved to near normalcy (mJOA 17) with no evidence or implant-related complication. Conclusion: Rarely, nonunion of Type II odontoid fractures may be hypertrophic where both instability and compression cause neurological morbidity. Such cases require anterior transoral decompression, posterior cervical decompression, and instrumented fusions. PMID:26904365

  9. Spinal extradural arachnoid cyst.

    PubMed

    Choi, Seung Won; Seong, Han Yu; Roh, Sung Woo

    2013-10-01

    Spinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. The etiology remains still unclear. We experienced 2 cases of SEACs and reviewed the cases and previous literatures. A 59-year-old man complained of both leg radiating pain and paresthesia for 4 years. His MRI showed an extradural cyst from T12 to L3 and we performed cyst fenestration and repaired the dural defect with tailored laminectomy. Another 51-year-old female patient visited our clinical with left buttock pain and paresthesia for 3 years. A large extradural cyst was found at T1-L2 level on MRI and a communication between the cyst and subarachnoid space was illustrated by CT-myelography. We performed cyst fenestration with primary repair of dural defect. Both patients' symptoms gradually subsided and follow up images taken 1-2 months postoperatively showed nearly disappeared cysts. There has been no documented recurrence in these two cases so far. Tailored laminotomy with cyst fenestration can be a safe and effective alternative choice in treating SEACs compared to traditional complete resection of cyst wall with multi-level laminectomy. PMID:24294463

  10. Spinal Extradural Arachnoid Cyst

    PubMed Central

    Choi, Seung Won; Seong, Han Yu

    2013-01-01

    Spinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. The etiology remains still unclear. We experienced 2 cases of SEACs and reviewed the cases and previous literatures. A 59-year-old man complained of both leg radiating pain and paresthesia for 4 years. His MRI showed an extradural cyst from T12 to L3 and we performed cyst fenestration and repaired the dural defect with tailored laminectomy. Another 51-year-old female patient visited our clinical with left buttock pain and paresthesia for 3 years. A large extradural cyst was found at T1-L2 level on MRI and a communication between the cyst and subarachnoid space was illustrated by CT-myelography. We performed cyst fenestration with primary repair of dural defect. Both patients' symptoms gradually subsided and follow up images taken 1-2 months postoperatively showed nearly disappeared cysts. There has been no documented recurrence in these two cases so far. Tailored laminotomy with cyst fenestration can be a safe and effective alternative choice in treating SEACs compared to traditional complete resection of cyst wall with multi-level laminectomy. PMID:24294463

  11. Congenital irreducible atlantoaxial dislocation associated with cervical intramedullary astrocytoma causing progressive spastic quadriparesis.

    PubMed

    Chatley, Anooj; Jaiswal, Awadesh K; Jain, Manoj; Behari, Sanjay

    2008-01-01

    Simultaneous presence of congenital irreducible atlantoaxial dislocation (AAD) and cervical intramedullary astrocytoma has not been previously described and may cause disabling myelopathy. This 55-year-old lady presented with suboccipital pain, spastic quadriparesis, Lhermitte's phenomenon and sphincteric disturbances. Lateral radiographs and magnetic resonance imaging showed irreducible AAD, occipitalized atlas, C2-3 fusion, and,an intramedullary tumor from C2-5 level iso-to-hypointense, non-enhancing, except in a small segment in the dorsal C2 level. A suboccipital craniectomy with C2-5 laminectomy revealed a greyish-white tenacious tumor. The tumor was decompressed using a C2-5 midline myelotomy and duroplasty. An occipitocervical lateral mass fixation was performed. Histopathology revealed a low-grade astrocytoma. At three-month follow-up, her spasticity had decreased and quadriparesis and sphincteric disturbances were persisting. Postoperative lateral radiographs and intrathecal contrast CT scan showed a stable occipitocervical construct. Thus, the suboccipital craniectomy and laminectomy with midline myelotomy and duroplasty facilitated space for progressively expanding intramedullary astrocytoma with irreducible AAD; the lateral mass fixation provided stability at the craniovertebral junction. PMID:19127046

  12. Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1.

    PubMed

    Caiafa, Renata Costa; Orsini, Marco; Felicio, Lilian R; Puccioni-Sohler, Marzia

    2016-04-01

    HTLV-1-associated myelopathy is a progressive disabling disease associated with gait abnormalities. Objective To identify and quantify the main muscles affected by weakness and spasticity, their impact on gait, functional capacity and on quality of life of HTLV-1-associated myelopathy patients. Method We evaluated lower limbs muscular strength according to the Medical Research Council scale, spasticity according to the modified Ashworth scale, daily activities according to the Barthel Index and quality of life according to the Short-Form Health Survey-36 of 26 HTLV-1-associated myelopathy patients. Results The muscles most affected by weakness included the dorsal flexors and knee flexors. Spasticity predominated in the hip adductor muscles and in plantar flexors. Assistance for locomotion, minimal dependence in daily activities, limitations in functional capacity and physical aspects were the most common findings. Conclusion The impairment of gait, functional dependence and quality of life were predominantly a consequence of intense muscle weakness in HTLV-1-associated myelopathy patients. PMID:27096999

  13. Effect of Amniotic Membrane to Reduce Postlaminectomy Epidural Adhesion on a Rat Model

    PubMed Central

    Choi, Hyu Jin; Kim, Kyoung Beom

    2011-01-01

    Objective Epidural fibrosis and adhesion are the main reasons for post-laminectomy sustained pain and functional disability. In this study, the authors investigate the effect of irradiated freeze-dried human amniotic membrane on reducing epidural adhesion after laminectomy on a rat model. Methods A total of 20 rats were divided into two groups. The group A did not receive human amniotic membrane implantation after laminectomy and group B underwent human amniotic membrane implantation after laminectomy. Gross and microscopic findings were evaluated and compared at postoperative 1, 3 and 8 weeks. Results The amount of scar tissue and tenacity were reduced grossly in group of rats with human amniotic membrane implantation (group B). On a microscopic evaluation, there were less inflammatory cell infiltration and fibroblast proliferation in group B. Conclusion This experimental study shows that implantation of irradiated freeze-dried human amniotic membrane reduce epidural fibrosis and adhesion after spinal laminectomy in a rat model. PMID:21887388

  14. Neurological complications of endemic skeletal fluorosis, with special emphasis on radiculo-myelopathy.

    PubMed

    Haimanot, R T

    1990-05-01

    The results of surveys carried out between 1976 and 1985 in the fluorosis-endemic area of the Ethiopian Rift Valley is summarised, with emphasis on the neurological complications resulting from the crippling osteofluorosis. The neurological manifestations in the forms of myelopathy with and without radiculopathy (respectively 72% and 28%) occurred after exposure to high fluoride (greater than 4 ppm) for longer than 10 years. These deficits were clearly found to be a consequence of fluoride deposition in bones, resulting in generalised sclerosis and osteophytosis, with reduction in the diameter of the intervertebral foramina and of the spinal conal. Advanced osteosclerosis commonly causes severe spastic quadriparesis in flexion, accompanied by distressing spasms and urinary incontinence. The dilemma of these medical problems in relation to the agro-industrial economic developments of the Ethiopian Rift Valley is discussed. PMID:2172892

  15. Compressive myelopathy of the cervical spine in Komodo dragons (Varanus komodoensis).

    PubMed

    Zimmerman, Dawn M; Douglass, Michael; Sutherland-Smith, Meg; Aguilar, Roberto; Schaftenaar, Willem; Shores, Andy

    2009-03-01

    Cervical subluxation and compressive myelopathy appears to be a cause of morbidity and mortality in captive Komodo dragons (Varanus komodoensis). Four cases of cervical subluxation resulting in nerve root compression or spinal cord compression were identified. Three were presumptively induced by trauma, and one had an unknown inciting cause. Two dragons exhibited signs of chronic instability. Cervical vertebrae affected included C1-C4. Clinical signs on presentation included ataxia, ambulatory paraparesis or tetraparesis to tetraplegia, depression to stupor, cervical scoliosis, and anorexia. Antemortem diagnosis of compression was only confirmed with magnetic resonance imaging or computed tomography. Treatment ranged from supportive care to attempted surgical decompression. All dragons died or were euthanatized, at 4 days to 12 mo postpresentation. Studies to define normal vertebral anatomy in the species are necessary to determine whether the pathology is linked to cervical malformation, resulting in ligament laxity, subsequent instability, and subluxation. PMID:19368265

  16. Immunopathogenesis of HTLV-1-assoaciated myelopathy/tropical spastic paraparesis (HAM/TSP).

    PubMed

    Fuzii, Hellen Thais; da Silva Dias, George Alberto; de Barros, Rodrigo Jose Saraiva; Falcão, Luiz Fabio Magno; Quaresma, Juarez Antonio Simoes

    2014-05-28

    Human T-cell lymphotropic virus type 1 (HTLV-1) is associated with adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Only a limited percentage of infected individuals develop disease in response to the virus while the majority remain asymptomatic, and HAM/TSP is the most common clinical manifestation of the virus. HAM/TSP is an inflammatory disease of the central nervous system (CNS); however, the mechanism by which HTLV-1 induces HAM/TSP is not yet clear. CD4(+) T lymphocytes are the main reservoirs of HTLV-1 in vivo and perform an important role in the immunological response to this retrovirus. This virus-host interaction may provoke changes in the immunological response, such as the enhanced production of inflammatory cytokines and the spontaneous proliferation of T CD4(+) lymphocytes, which are implicated in the pathogenesis of HAM/TSP. PMID:24704970

  17. Chronic compressive myelopathy and progressive neurologic signs associated with melarsomine dihydrochloride administration in a dog.

    PubMed

    Moore, Sarah A; Mariani, Christopher L; Van Wettere, Arnaud; Borst, Luke B

    2013-01-01

    A 7 yr old castrated male Great Dane presented with a history of progressive myelopathy following the intramuscular injection of melarsomine dihydrochloride 8 wk previously. MRI revealed paraspinal and epidural abscesses at the 13th thoracic (T13) and first lumbar (L1) disc space. The dog's condition worsened despite medical management, necessitating surgical decompression. Surgical decompression resulted in rapid improvement of the patient's clinical signs. Histopathologic evaluation of the lesions revealed pyogranulomatous inflammation. Cultures of fluid and tissue within the lesions were negative for bacterial growth, and no infectious organisms were visualized histologically. Melarsomine-associated neurologic signs can be chronic and progressive in nature, presumably secondary to ongoing sterile inflammation that may result in spinal cord compression. PMID:24051262

  18. Modified Open-Door Laminoplasty Using a Ceramic Spacer and Suture Fixation for Cervical Myelopathy

    PubMed Central

    Toyone, Tomoaki; Shiboi, Ryutaro; Inada, Kunimasa; Oikawa, Yasuhiro; Takahashi, Kazuhisa; Ohtori, Seiji; Inoue, Gen; Miyagi, Masayuki; Ishikawa, Tetsuhiro; Shirahata, Toshiyuki; Kudo, Yoshifumi; Inagaki, Katsunori

    2015-01-01

    Purpose To introduce a new simple technique using suture anchors and ceramic spacers to stabilize the elevated laminae in open-door cervical laminoplasty. Although ceramic spacers were placed in the opened laminae and fixed with nylon threads in this series, it was occasionally difficult to fix the nylon threads to the lateral mass. Materials and Methods Study 1: A preliminary study was conducted using a suture anchor system. Sixteen consecutive patients who underwent surgery for cervical myelopathy were prospectively examined. Study 2: The second study was performed prospectively to evaluate the feasibility of this new technique based on the result of the preliminary study. Clinical outcomes were examined in 45 consecutive patients [cervical spondylotic myelopathy (CSM)] and 43 consecutive patients (OPLL). The Japanese Orthopedic Association scoring system (JOA score), axial neck pain, and radiological findings were analyzed. Results 1) In one case, re-operation was necessary due to dislodgement of the ceramic spacer following rupture of the thread. 2) In all patients, postoperative CT scans showed that the anchors were securely inserted into the bone. In the CSM group, the average JOA score improved from 9.5 points preoperatively to 13.3 at follow-up (recovery 51%). In the OPLL group, the average JOA score improved from 10.1 (5-14) points preoperatively to 14.4 (11-16) at follow-up (recovery 62%). There were no serious complications. Conclusion The use of the suture anchor system made it unnecessary to create a hole in the lateral mass and enabled reliable and faster fixation of the HA spacers in open-door laminoplasty. PMID:26446650

  19. Syphilitic myelopathy

    MedlinePlus

    ... not reverse existing nerve damage. For neurosyphilis, aqueous penicillin G (by injection) is the drug of choice. Some patients (for example, pregnant women) with penicillin allergies may have to be desensitized to penicillin ...

  20. A Caucasian Australian presenting with human T-lymphotropic virus type I associated myelopathy: a case report

    PubMed Central

    2014-01-01

    Introduction We report the first known case of human T-lymphotropic virus type I associated myelopathy/tropical spastic paraparesis in an Australian Caucasian, a disease reported in Aboriginal and immigrant populations where the virus is often endemic. Case presentation A 41-year-old Caucasian Australian man had a 3-year background of progressive functional decline from a myelopathy with spastic paraparesis and sphincteric dysfunction. Conclusions Although studies have shown a very low prevalence of human T-lymphotropic virus type I in the greater Australian population, increased focus on Aboriginal health, and the expanding diversity and integration of the Australian population means that presentation of human T-lymphotropic virus type I-associated disease is likely to increase. PMID:25416840

  1. Antemortem diagnosis and successful management of noncompressive segmental myelopathy in a Siberian-Bengal mixed breed tiger.

    PubMed

    Flower, Jennifer E; Lynch, Kate; Clark-Price, Stuart C; Welle, Kenneth R; O'Brien, Robert; Whittington, Julia K

    2013-12-01

    A 10-yr-old female spayed mixed breed tiger presented for a 9-day history of acute and nonprogressive paralysis of the pelvic limbs. Magnetic resonance imaging revealed a lesion suggestive of fibrocartilaginous embolic myelopathy with regional spinal cord edema, decreased disk signal intensity at L2-L3, and mild intervertebral disk protrusion at L1-L2 and L2-L3. Cerebral spinal fluid analysis showed no overt evidence of infection or neoplasia. Medical therapy was instituted, including corticosteroids and gastroprotectants as well as nursing care and physical therapy. The tiger began showing clinical improvement 2 wk after initiating treatment, progressing to the point where the animal was standing and intermittently walking. Three months after diagnosis, the tiger had regained muscle strength of its hind limbs and walked regularly with improving coordination. This case is the first report of antemortem diagnosis and successful medical management of suspected fibrocartilaginous embolic myelopathy in a large exotic felid. PMID:24450082

  2. Identical twins with cervical myelopathy: a case for hereditary cervical spondylosis? Report of two cases and review of the literature.

    PubMed

    Mukerji, Nitin; Sinar, Ernest J

    2007-04-01

    Although degenerative cervical spondylosis is a common neurosurgical problem, not much has been published about the hereditary factors responsible for it. The authors report on a set of identical twins who presented to their service at a relatively young age with myelopathy due to degenerative cervical disc prolapse and who needed surgery. The early age of presentation and the fact that the patients were identical twins suggest a genetic element. The authors also review the available literature on the genetic factors in the causation of degenerative cervical spondylosis. To the best of their knowledge this is the first reported instance of identical twins with cervical myelopathy at a young age needing curative surgery. PMID:17436924

  3. INTERFERON BETA-1A TREATMENT IN HTLV-1-ASSOCIATED MYELOPATHY/TROPICAL SPASTIC PARAPARESIS: A CASE REPORT

    PubMed Central

    Viana, Graça Maria de Castro; da Silva, Marcos Antonio Custódio Neto; Souza, Victor Lima; Lopes, Natália Barbosa da Silva; da Silva, Diego Luz Felipe; Nascimento, Maria do Desterro Soares Brandão

    2014-01-01

    Here a young patient (< 21 years of age) with a history of infective dermatitis is described. The patient was diagnosed with myelopathy associated with HTLV-1/tropical spastic paraparesis and treated with interferon beta-1a. The disease was clinically established as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and laboratory tests confirmed the presence of antibodies to HTLV-1 in the cerebrospinal fluid (CSF). Mumps, cytomegalovirus, Epstein-Barr virus, schistosomiasis, herpes virus 1 and 2, rubella, measles, varicella-zoster toxoplasmosis, hepatitis, HIV, and syphilis were excluded by serology. The patient was diagnosed with neurogenic bladder and presented with nocturia, urinary urgency, paresthesia of the lower left limb, a marked reduction of muscle strength in the lower limbs, and a slight reduction in upper limb strength. During the fourth week of treatment with interferon beta-1a, urinary urgency and paresthesia disappeared and clinical motor skills improved. PMID:25229227

  4. Atlantoaxial Subluxation due to an Os Odontoideum in an Achondroplastic Adult: Report of a Case and Review of the Literature

    PubMed Central

    Rahimizadeh, Abolfazl; Soufiani, Housain F.; Hassani, Valiolah; Rahimizadeh, Ava

    2015-01-01

    The authors report the first example of an adult achondroplastic dwarf with progressive quadriparesis secondary to atlantoaxial subluxation as a consequence of an os odontoideum. Actually, craniocervical region is a frequent site of compression and myelopathy in achondroplasia particularly in children as a result of small foramen magnum and hypertrophied opisthion. Moreover, very rarely in achondroplastic patients, coexistence of atlantoaxial instability as the sequel of os odontoideum can result in further compression of the already compromised cervicomedullary neural tissues, the scenario that has been reported only in five achondroplastic children. Herein, a 39-year-old achondroplastic male suffering such an extremely rare combination is presented. With C1-C2 screw rod instrumentation, atlas arch laminectomy, limited suboccipital craniectomy, and release of dural fibrous bands, reduction, decompression, and stabilization could be achieved properly resulting in steady but progressive recovery. PMID:26693369

  5. Thoracic arachnoid cyst resection.

    PubMed

    Deutsch, Harel

    2014-09-01

    Arachnoid cysts in the spinal cord may be asymptomatic. In some cases arachnoid cysts may exert mass effect on the thoracic spinal cord and lead to pain and myelopathy symptoms. Arachnoid cysts may be difficult to visualize on an MRI scan because the thin walled arachnoid may not be visible. Focal displacement of the thoracic spinal cord and effacement of the spinal cord with apparent widening of the cerebrospinal fluid space is seen. This video demonstrates surgical techniques to remove a dorsal arachnoid cyst causing spinal cord compression. The surgery involves a thoracic laminectomy. The dura is opened sharply with care taken not to open the arachnoid so that the cyst can be well visualized. The thickened arachnoid walls of the cyst are removed to alleviate the compression caused by the arachnoid cyst. The video can be found here: http://youtu.be/pgUrl9xvsD0. PMID:25175582

  6. Cervical myelopathy due to chronic overshunting in a pediatric patient: case report and review of the literature.

    PubMed

    Ulrich, Nils Harry-Bert; Maier, Matthias; Bernays, Rene-Ludwig; Krayenbuhl, Niklaus; Kollias, Spyros

    2013-01-01

    We present a rare cause of cervical myelopathy produced by an engorged suboccipital epidural venous plexus due to chronic cerebrospinal fluid (CSF) overdrainage. A 17-year-old boy with obstructive hydrocephalus due to a retrocerebellar cyst and secondary implantation of a ventricloperitoneal shunt (VP-shunt) presented with progressive spastic tetraparesis. MRI imaging revealed myelopathy due to significant compression of the cervical spinal cord by engorged epidural veins. Further assessment at a low-pressure setting revealed a broken shunt valve. The VP-shunt valve was changed with an additional anti-siphon device leading to a gradual increase of the intracranial pressure (ICP). After intensive physiotherapy, the patient showed slight clinical improvement. Follow-up imaging within nine days showed distinct regression of the dilated venous plexus at the cranial-cervical junction (CCJ) with the resolution of cord compression. Engorgement of the epidural venous plexus should always be considered in the differential diagnosis of myelopathy in long-term shunt patients even when classical clinical and radiological signs of overshunting are missing. PMID:23756987

  7. Comparisons of three anterior cervical surgeries in treating cervical spondylotic myelopathy

    PubMed Central

    2014-01-01

    Background Anterior cervical discectomy and fusion (ACDF) was one of the preferred treatments for degenerative cervical spondylosis. However, the motion of adjacent segment was significantly increased after operation. So cervical disc arthroplasty have been suggested to keep the motion of adjacent segment. A new implant named dynamic cervical implant (DCI) has been developed to keep the motion of adjacent segment. Methods We retrospectively reviewed 91 patients treated for single level cervical spondylotic myelopathy with anterior cervical discectomy and fusion (ACDF), dynamic cervical implant (DCI) and cervical total disc replacement (CTDR) between sep 2009 and Mar 2011 in our hospital. They were divided into three groups by surgical methods: ACDF group (group A, 34 cases), DCI group (group B, 25 cases), CTDR group (group C, 32 cases). Operation time, intraoperative blood loss, preoperative and postoperative JOA score and JOA recovery rate were compared among the three groups. Pre-and postoperative hyperextension and hyperflexion radiograms were observed to measure range of motion (ROM) of C2–7, operative and adjacent levels. Results There was no statistical difference in operative time, intraoperative blood loss, and JOA recovery rate (P > 0.05) among three groups. But the differences of their postoperative JOA scores and preoperative JOA scores were of statistical significance (P < 0.05). Compared the pre-and postoperative ROM of C2–7, operative, upper and lower levels of each group respectively, the difference between preoperative ROM and postoperative ROM of group A were of statistically significant (P < 0.05), while was no statistically significant of group C (P > 0.05). There was no statistically significant difference between preoperative ROM and postoperative ROM of upper and lower levels in group B (P > 0.05), but had statistically significance of C2–7 and operative levels (P < 0.05). Conclusions Three operations are effective therapies for single level cervical spondylotic myelopathy. But each group has respective advantages and disadvantages. PMID:25012927

  8. Comparative Analysis of VOCs in Exhaled Breath of Amyotrophic Lateral Sclerosis and Cervical Spondylotic Myelopathy Patients.

    PubMed

    Wang, Changsong; Li, Mingjuan; Jiang, Hongquan; Tong, Hongshuang; Feng, Yue; Wang, Yue; Pi, Xin; Guo, Lei; Nie, Maomao; Feng, Honglin; Li, Enyou

    2016-01-01

    Amyotrophic lateral sclerosis (ALS) is an incurable neurological degenerative disease. It can cause irreversible neurological damage to motor neurons; typical symptoms include muscle weakness and atrophy, bulbar paralysis and pyramidal tract signs. The ALS-mimicking disease cervical spondylotic myelopathy (CSM) presents similar symptoms, but analysis of breath volatile organic compounds (VOCs) can potentially be used to distinguish ALS from CSM. In this study, breath samples were collected from 28 ALS and 13 CSM patients. Subsequently, gas chromatography/mass spectrometry (GCMS) was used to analyze breath VOCs. Principal component analysis (PCA) and orthogonal partial least-squares discriminant analysis (OPLSDA) were the statistical methods used to process the final data. We identified 4 compounds with significantly decreased levels in ALS patients compared with CSM controls: (1) carbamic acid, monoammonium salt; (2) 1-alanine ethylamide, (S)-; (3) guanidine, N,N-dimethyl-; and (4) phosphonic acid, (p-hydroxyphenyl)-. Currently, the metabolic origin of the VOCs remains unclear; however, several pathways might explain the decreasing trends observed. The results of this study demonstrate that there are specific VOC profiles associated with ALS and CSM patients that can be used to differentiate between the two. In addition, these metabolites could contribute to a better understanding of the underlying pathophysiological mechanisms of ALS. PMID:27212435

  9. Cervical Spondylotic Myelopathy due to the Ochronotic Arthropathy of the Cervical Spine

    PubMed Central

    Li, Nan; Yuan, Qiang; He, Da

    2016-01-01

    Ochronosis is a musculoskeletal manifestation of alkaptonuria, a rare hereditary metabolic disorder occurs due to the absence of homogentisic acid oxidase and leading to various systemic abnormalities related to deposition of homogentisic acid pigmentation (ochronotic pigmentation). The present case reports the clinical features, radiographic findings, treatments and results of a cervical spondylotic myelopathy woman patient due to the ochronotic arthropathy of the cervical spine. The patient aged 62 years was presented with gait disturbance and hand clumsiness. Physical examination, X-rays, computed tomography and lab results of the urine sample confirmed the presence of ochronosis with the involvement of the cervical spine. The patient underwent a modified cervical laminoplasty due to multi-segment spinal cord compression. The postoperative follow-up showed a good functional outcome with patient satisfaction. The present study concludes the conditions and important diagnostic and surgical aspects of a patient. It is necessary to identify the condition clinically and if cord compression is observed, appropriate surgical interventions needs to be instituted. PMID:26885289

  10. Feline ischaemic myelopathy with a predilection for the cranial cervical spinal cord in older cats.

    PubMed

    Simpson, Katherine M; De Risio, Luisa; Theobald, Anita; Garosi, Laurent; Lowrie, Mark

    2014-12-01

    All previous studies on feline ischaemic myelopathy (IM) have reported an acute onset of a single event with no recurrence of clinical signs. This study aimed to evaluate clinical and long-term follow-up data in cats presumptively diagnosed with cervical IM in the territory of the ventral spinal artery (VSA). Eight cats (four females and four males) were included with a mean age of 14 years and 2 months. Neurological status at the time of presentation ranged from ambulatory tetraparesis to tetraplegia with nociception present. Six cats had marked cervical ventroflexion. All eight cats were diagnosed with one or more concurrent medical conditions, including chronic kidney disease (n = 2), hypertrophic cardiomyopathy (n = 2) and hypertension (n = 6). Median time to ambulation was 5.7 days (range 2-14 days). Long-term follow-up ranged from 7 months to 3 years and 3 months (median 1 year and 2 months). Five cats had no reported recurrence of clinical signs and 3/8 had a chronic relapsing disease course. One cat had an acute recurrence of clinical signs 4 months after the first event and was euthanased. Two cats had acute onsets of suspected intracranial infarctions, one of which had further suspected intracranial infarcts every 3 months and was euthanased after one of these. This study highlights the importance of performing ancillary diagnostic tests in older cats presenting with IM, particularly when VSA embolisation is suspected. PMID:24509256

  11. Systems biology approaches reveal a specific interferon-inducible signature in HTLV-1 associated myelopathy.

    PubMed

    Tattermusch, Sonja; Skinner, Jason A; Chaussabel, Damien; Banchereau, Jacques; Berry, Matthew P; McNab, Finlay W; O'Garra, Anne; Taylor, Graham P; Bangham, Charles R M

    2012-01-01

    Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus that persists lifelong in the host. In ?4% of infected people, HTLV-1 causes a chronic disabling neuroinflammatory disease known as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The pathogenesis of HAM/TSP is unknown and treatment remains ineffective. We used gene expression microarrays followed by flow cytometric and functional assays to investigate global changes in blood transcriptional profiles of HTLV-1-infected and seronegative individuals. We found that perturbations of the p53 signaling pathway were a hallmark of HTLV-1 infection. In contrast, a subset of interferon (IFN)-stimulated genes was over-expressed in patients with HAM/TSP but not in asymptomatic HTLV-1 carriers or patients with the clinically similar disease multiple sclerosis. The IFN-inducible signature was present in all circulating leukocytes and its intensity correlated with the clinical severity of HAM/TSP. Leukocytes from patients with HAM/TSP were primed to respond strongly to stimulation with exogenous IFN. However, while type I IFN suppressed expression of the HTLV-1 structural protein Gag it failed to suppress the highly immunogenic viral transcriptional transactivator Tax. We conclude that over-expression of a subset of IFN-stimulated genes in chronic HTLV-1 infection does not constitute an efficient host response but instead contributes to the development of HAM/TSP. PMID:22291590

  12. Systems Biology Approaches Reveal a Specific Interferon-Inducible Signature in HTLV-1 Associated Myelopathy

    PubMed Central

    Tattermusch, Sonja; Skinner, Jason A.; Chaussabel, Damien; Banchereau, Jacques; Berry, Matthew P.; McNab, Finlay W.; O'Garra, Anne; Taylor, Graham P.; Bangham, Charles R. M.

    2012-01-01

    Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus that persists lifelong in the host. In ?4% of infected people, HTLV-1 causes a chronic disabling neuroinflammatory disease known as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The pathogenesis of HAM/TSP is unknown and treatment remains ineffective. We used gene expression microarrays followed by flow cytometric and functional assays to investigate global changes in blood transcriptional profiles of HTLV-1-infected and seronegative individuals. We found that perturbations of the p53 signaling pathway were a hallmark of HTLV-1 infection. In contrast, a subset of interferon (IFN)-stimulated genes was over-expressed in patients with HAM/TSP but not in asymptomatic HTLV-1 carriers or patients with the clinically similar disease multiple sclerosis. The IFN-inducible signature was present in all circulating leukocytes and its intensity correlated with the clinical severity of HAM/TSP. Leukocytes from patients with HAM/TSP were primed to respond strongly to stimulation with exogenous IFN. However, while type I IFN suppressed expression of the HTLV-1 structural protein Gag it failed to suppress the highly immunogenic viral transcriptional transactivator Tax. We conclude that over-expression of a subset of IFN-stimulated genes in chronic HTLV-1 infection does not constitute an efficient host response but instead contributes to the development of HAM/TSP. PMID:22291590

  13. Comparison of Two Reconstructive Techniques in the Surgical Management of Four-Level Cervical Spondylotic Myelopathy

    PubMed Central

    Li, FengNing; Li, ZhongHai; Huang, Xuan; Chen, Zhi; Zhang, Fan; Shen, HongXing; Kang, YiFan; Zhang, YinQuan; Cai, Bin; Hou, TieSheng

    2015-01-01

    To compare the clinical efficacy and radiological outcome of treating 4-level cervical spondylotic myelopathy (CSM) with either anterior cervical discectomy and fusion (ACDF) or “skip” corpectomy and fusion, 48 patients with 4-level CSM who had undergone ACDF or SCF at our hospital were analyzed retrospectively between January 2008 and June 2011. Twenty-seven patients received ACDF (Group A) and 21 patients received SCF. Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and Cobb's angles of the fused segments and C2-7 segments were compared in the two groups. The minimum patient follow-up was 2 years. No significant differences between the groups were found in demographic and baseline disease characteristics, duration of surgery, or follow-up time. Our study demonstrates that there was no significant difference in the clinical efficacy of ACDF and SCF, but ACDF involves less intraoperative blood loss, better cervical spine alignment, and fewer postoperative complications than SCF. PMID:25692140

  14. Characterizing Thalamocortical Disturbances in Cervical Spondylotic Myelopathy: Revealed by Functional Connectivity under Two Slow Frequency Bands

    PubMed Central

    Zhou, Fuqing; Wu, Lin; Liu, Xiaojia; Gong, Honghan; Luk, Keith Dip-Kei; Hu, Yong

    2015-01-01

    Background and Purpose Recent advanced MRI studies on cervical spondylotic myelopathy (CSM) revealed alterations of sensorimotor cortex, but the disturbances of large-scale thalamocortical systems remains elusive. The purpose of this study was to characterizing the CSM-related thalamocortical disturbances, which were associated with spinal cord structural injury, and clinical measures. Methods A total of 17 patients with degenerative CSM and well-matched control subjects participated. Thalamocortical disturbances were quantified using thalamus seed-based functional connectivity in two distinct low frequencies bands (slow-5 and slow-4), with different neural manifestations. The clinical measures were evaluated by Japanese Orthopaedic Association (JOA) score system and Neck Disability Index (NDI) questionnaires. Results Decreased functional connectivity was found in the thalamo-motor, -somatosensory, and -temporal circuits in the slow-5 band, indicating impairment of thalamo-cortical circuit degeneration or axon/synaptic impairment. By contrast, increased functional connectivity between thalami and the bilateral primary motor (M1), primary and secondary somatosensory (S1/S2), premotor cortex (PMC), and right temporal cortex was detected in the slow-4 band, and were associated with higher fractional anisotropy values in the cervical cord, corresponding to mild spinal cord structural injury. Conclusions These thalamocortical disturbances revealed by two slow frequency bands inform basic understanding and vital clues about the sensorimotor dysfunction in CSM. Further work is needed to evaluate its contribution in central functional reorganization during spinal cord degeneration. PMID:26053316

  15. Diffusion tensor imaging of cervical spinal cord: A quantitative diagnostic tool in cervical spondylotic myelopathy

    PubMed Central

    Toktas, Zafer Orkun; Tanrıkulu, Bahattin; Koban, Orkun; Kilic, Turker; Konya, Deniz

    2016-01-01

    Background: Diffusion tensor imaging (DTI) is a novel magnetic resonance imaging (MRI) technique potentially able to evaluate the microscopic structural organization of white matter fibers. Aim: This study aimed to compare fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values obtained by DTI in stenotic versus nonstenotic cervical spinal segments of patients with clinical and neurological evidence of cervical spondylotic myelopathy (CSM). Materials and Methods: This prospective study included 21 patients with CSM but without T2 changes on conventional MRI. Diffusion tensor (DT) images from the stenotic and nonstenotic segments of the subjects were obtained. FA and ADC values were estimated and compared with stenotic versus nonstenotic segments. Statistical Analysis: Paired t-test was used [Statistical Package for the Social Sciences (SPSS) 12.0]. Results: In the most stenotic segments, the mean FA value was significantly lower (0.4228 ± 0.1090 vs 0.6884 ± 0.0075, P < 0.001) and the mean ADC value was significantly higher (1.312 ± 0.2405 vs 0.9183 ± 0.1477, P < 0.001) when compared to nonstenotic segments. In addition, there was a negative correlation between FA and ADC values (r = 0.63, P = 0.002). Conclusions: DTI of the cervical spine seems to be a promising novel imaging modality in patients with CSM. Advances in Knowledge: DTI may offer increased diagnostic sensitivity as compared to standard MRI and enables earlier detection of the disease. PMID:27041882

  16. Hypometabolism of watershed areas of the brain in HTLV-1-associated myelopathy/tropical spastic paraparesis.

    PubMed

    Taniguchi, Akitoshi; Mochizuki, Hitoshi; Nagamachi, Shigeki; Ebihara, Yuka; Ishii, Nobuyuki; Shiomi, Kazutaka; Nakazato, Masamitsu

    2015-11-01

    In previous studies of human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), areas of slow blood flow in the spinal cord were related to pathological changes. While the pathological changes in the brain are milder than those in the spinal cord, they are also more significant in sites with slow blood flow. In this study, we investigated brain glucose metabolism in slow blood flow areas using fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET). Clinical features and brain (18)F-FDG-PET parameters were analyzed in six patients with HAM/TSP. For comparison of PET data, eight healthy volunteers were enrolled as normal controls (NLs). Glucose metabolism in the watershed areas of the middle and posterior cerebral arteries, as compared with that in the occipital lobes as a control, was significantly lower in HAM/TSP patients than in NLs. This result confirmed the relationship between slow blood flow areas and hypometabolism in HAM/TSP, and is consistent with previous findings that pathological changes are accentuated in sites with slow blood flow. PMID:26156876

  17. Assessment of interobserver agreement and use of selected magnetic resonance imaging variables for differentiation of acute noncompressive nucleus pulposus extrusion and ischemic myelopathy in dogs.

    PubMed

    Specchi, Swan; Johnson, Philippa; Beauchamp, Guy; Masseau, Isabelle; Pey, Pascaline

    2016-05-01

    OBJECTIVE To evaluate interobserver agreement for features used in presumptive diagnosis of acute noncompressive nucleus pulposus extrusion (ANNPE) or ischemic myelopathy by MRI, compare findings on postcontrast T1-weighted (T1W) MRI sequences with fat saturation (FS) for the 2 conditions, and determine whether length and directional patterns of hyperintensity of the intramedullary spinal cord on T2-weighted (T2W) fast spin echo (FSE) MRI sequences differ between dogs with these diseases. DESIGN Retrospective, observational study. ANIMALS 20 dogs with clinical signs compatible with ANNPE (n = 14) or ischemic myelopathy (6). PROCEDURES 3 observers evaluated MRI data (including T2W FSE, T2W single-shot FSE, and T1W FS sequences) for dogs with a presumptive diagnosis of ischemic myelopathy or ANNPE. Interobserver agreement for variables of interest including presumptive diagnosis was assessed by κ statistic calculations. Associations between diagnosis and variables of interest were assessed with Fisher exact or Cochran-Mantel-Haenszel tests. RESULTS Perfect interobserver agreement (κ = 1 for all comparisons) was found for the presumptive diagnosis of ischemic myelopathy versus ANNPE. Meningeal enhancement on postcontrast T1W FS MRI images and nonlongitudinal directional pattern of intramedullary hyperintensity on T2W FSE images were significantly associated with a diagnosis of ANNPE. Greater length of intramedullary hyperintensity was significantly associated with a diagnosis of ischemic myelopathy. CONCLUSIONS AND CLINICAL RELEVANCE Directional pattern and length of intramedullary hyperintensity on T2W FSE MRI images and enhancement patterns in postcontrast T1W FS sequences may provide important contributions to the criteria currently used in the presumptive diagnosis of ischemic myelopathy versus ANNPE. PMID:27074609

  18. Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy.

    PubMed

    Thirumala, Parthasarathy D; Muralidharan, Aditya; Loke, Yoon K; Habeych, Miguel; Crammond, Donald; Balzer, Jeffrey

    2016-03-01

    The primary aim of this study was to conduct a systematic review of reports of patients with cervical spondylotic myelopathy and to assess the value of intraoperative monitoring (IOM), including somatosensory evoked potentials, transcranial motor evoked potentials and electromyography, in anterior cervical procedures. A search was conducted to collect a small database of relevant papers using key words describing disorders and procedures of interest. The database was then shortlisted using selection criteria and data was extracted to identify complications as a result of anterior cervical procedures for cervical spondylotic myelopathy and outcome analysis on a continuous scale. In the 22 studies that matched the screening criteria, only two involved the use of IOM. The average sample size was 173 patients. In procedures done without IOM a mean change in Japanese Orthopaedic Association score of 3.94 points and Nurick score by 1.20 points (both less severe post-operatively) was observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia was seen in 2.71% of patients for studies without IOM and 0.91% of patients for studies with IOM. Variations persist in the existing literature in the evaluation of complications associated with anterior cervical spinal procedures. Based on the review of published studies, sufficient evidence does not exist to make recommendations regarding the use of different IOM modalities to reduce neurological complications during anterior cervical procedures. However, future studies with objective measures of neurological deficits using a specific IOM modality may establish it as an effective and reliable indicator of injury during such surgeries. PMID:26677786

  19. A Comparison of Computed Tomography Measures for Diagnosing Cervical Spinal Stenosis Associated with Myelopathy: A Case-Control Study

    PubMed Central

    Hoffler, C Edward; Cameron, Brian M; Rhee, John M; Bawa, Maneesh; Malone, David G; Bent, Melissa; Yoon, Tim S

    2015-01-01

    Study Design Retrospective comparative study. Purpose To assess differences in computed tomography (CT) imaging parameters between patients with cervical myelopathy and controls. Overview of Literature There is a lack of information regarding the best predictor of symptomatic stenosis based on osseous canal dimensions. We postulate that smaller osseous canal dimensions increase the risk of symptomatic central stenosis. Methods CT images and medical records of patients with cervical myelopathy (19 patients, 8 males; average age, 64.4±13.4 years) and controls (18 patients, 14 males; average age, 60.4±11.0 years) were collected. A new measure called the laminar roof pitch angle (=angle between the lamina) was conducted along with linear measures, ratios and surrogates of canal perimeter and area at each level C2-C7 (222 levels). Receiver-operator curves were used to assess the diagnostic value of each. Rater reliability was assessed for the measures. Results The medial-lateral (ML) diameter (at mid-pedicle level) and calculated canal area (=anterior-posterior.×ML diameters) were the most accurate and highly reliable. ML diameter below 23.5 mm and calculated canal area below 300 mm2 generated 82% to 84% sensitivity and 67% to 68% sensitivity. No significant correlations were identified between age, height, weight, body mass in dex and gender for each of the CT measures. Conclusions CT measures including ML dimensions were most predictive. This study is the first to identify an important role for the ML dimension in cases of slowly progressive compressive myelopathy. A ML reserve may be protective when the canal is progressively compromised in the anterior-posterior dimension. PMID:25705331

  20. Ipilimumab-induced necrotic myelopathy in a patient with metastatic melanoma: A case report and review of literature.

    PubMed

    Abdallah, Al-Ola; Herlopian, Aline; Ravilla, Rahul; Bansal, Meghana; Chandra-Reddy, Sowmya; Mahmoud, Fade; Ong, Shirley; Gokden, Murat; Hutchins, Laura

    2016-06-01

    Ipilimumab is a novel humanized monoclonal antibody directed against cytotoxic T lymphocyte antigen 4, a T-cell surface molecule involved in down-regulation and suppression of the T cell response to stimuli. Patients treated with ipilimumab are at risk for immune-related adverse events involving the skin, digestive tract, liver and endocrine organs. Few case reports of immune-related adverse effects involving central or peripheral nervous system due to ipilimumab are published. These include inflammatory myopathy, aseptic meningitis, severe meningo-radiculo-neuritis, temporal arteritis, Guillain-Barre syndrome, and posterior reversible encephalopathy syndrome. We report the first case of ipilimumab-induced progressive necrotic myelopathy. PMID:25712627

  1. Amyotrophic lateral sclerosis presentation of a human T-lymphotropic virus type-1 myelopathy--insight into pathogenesis.

    PubMed

    Alkhawajah, Nuha M; Chapman, Kristine M; Moore, G R Wayne; Oger, Joel

    2015-09-01

    A 41-year-old human T-lymphotropic virus type 1-positive woman developed a syndrome with upper and lower motor neuron signs sometime after bilateral vertebral artery dissections. Over 2 years, she developed a progressive myelopathy affecting predominantly the motor system. She had the picture of a 'person in a barrel' and died from complications. At autopsy, spinal cord revealed inflammatory infiltrates and extensive gliosis involving mainly the anterior horns. The vertebral arterial dissections may have permitted the entry of infected lymphocytes and macrophages, secreting cytokines and metalloproteinases, into the medulla progressing to the spinal cord. Few cases with pathological correlation have been reported. PMID:26224593

  2. Subacute post-traumatic ascending myelopathy (SPAM): two cases of SPAM following surgical treatment of thoracolumbar fractures.

    PubMed

    Farooque, Kamran; Kandwal, Pankaj; Gupta, Ankit

    2014-01-01

    To report two cases of traumatic paraplegia who developed Sub-acute Post-Traumatic Ascending Myelopathy (SPAM) following surgical decompression.We hereby report two cases (both 35yr old male) with traumatic paraplegia that developed ascending weakness at 3rd and 5th Post-Op day respectively following surgical decompression. Both the patients experienced remarkable improvement in Neurology after treatment with steroids. The authors conclude by emphasizing on minimum cord handling during surgical decompression of the spinal cord to avoid this potentially life threatening complication. PMID:24823733

  3. Tropical spastic paraparesis and HTLV-1 associated myelopathy: clinical, epidemiological, virological and therapeutic aspects.

    PubMed

    Gessain, A; Mahieux, R

    2012-03-01

    In 1980, Human T cell leukemia/lymphoma virus type 1 (HTLV-1) was the first oncogenic human retrovirus to be discovered. HTLV-1 belongs to the Retroviridae family, the Orthoretrovirinae subfamily and to the deltaretrovirus genus. HTLV-1 preferentially infects CD4(+) lymphoid cells in vivo. Three molecules have been identified for binding and/or entry of HTLV-1: heparan sulfate proteoglycans, neuropilin-1, and glucose transporter 1. An efficient transfer of the virus from an infected cell to a target cell can occur through the formation of a viral synapse and/or by virofilm structure. As for all retroviruses, HTLV-1 genome possesses three major ORFs (gag, pol and env) encoding the structural and enzymatic proteins. HTLV-1 encodes also some regulatory and auxillary proteins including the tax protein with transforming activities and the HBZ protein which plays a role in the proliferation and maintenance of the leukemic cells. HTLV-1 is present throughout the world with clusters of high endemicity including mainly Southern Japan, the Caribbean region, areas in South America and in intertropical Africa. The worldwide HTLV-1 infected population is estimated to be around 10-20 million. HTLV-1 has three modes of transmission: (1): mother to child, mainly linked to prolonged breast-feeding; (2): sexual, mainly occurring from male to female and (3): contaminated blood products. HTLV-1 possesses a remarkable genetic stability. HTLV-1 is the etiological agent of mainly two severe diseases: a malignant T CD4(+) cell lymphoproliferation, of very poor prognosis, named Adult T cell Leukemia/Lymphoma (ATLL), and a chronic neuro-myelopathy named Tropical spastic paraparesis/HTLV-1 Associated Myelopathy (TSP/HAM). The lifetime risk among HTLV-1 carriers is estimated to be around 0.25 to 3%. TSP/HAM mainly occurs in adults, with a mean age at onset of 40-50 years and it is more common in women than in men. Blood transfusion is a major risk factor for TSP/HAM development. Clinically, TSP/HAM is mainly defined as a chronic spastic paraparesis and minor sensory signs. The onset is insidious with often gait disturbance and urinary symptoms. In more than 90% of the cases, the neurological features involve: spasticity and/or hyperreflexia of the lower extremities, urinary bladder disturbance, lower extremity muscle weakness, and in around 50% of the cases, sensory disturbances with low back pain. Central functions and cranial nerves are usually spared. The clinical course is generally progressive without remission. High levels of antibodies titers directed against HTLV-1 antigens are present in blood and cerebrospinal fluid (CSF). A high HTLV-1 proviral load is frequently observed in the blood. Mild to moderate increase of proteins may be present in the CSF. However, intrathecal production of specific HTLV-1 antibody index provides additional data to support the diagnosis. Brain white matter lesions on magnetic resonance imaging are frequent. A mild atrophy of the thoracic spinal cord can also be observed. Pathologically, it is characterized by a chronic inflammation with perivascular lymphocytic cuffing and mild parenchymal lymphocytic infiltrates. The cells are mostly CD4(+) in early disease and mostly CD8(+) in latter disease. Pyramidal tract damage with myelin and axonal loss, mainly in the lower thoracic spinal cord are observed. TSP/HAM pathogenesis is still poorly understood and viral and host factors as the proviral load and the cellular immune response play a major role in disease progression. TSP/HAM can be associated with other HTLV-1 associated symptoms (uveitis, myositis, infective dermatitis). Therapy of TSP/HAM remains disappointing and symptomatic treatment remains still the mainstay of therapy. PMID:22405461

  4. Voxel-based analysis of grey and white matter degeneration in cervical spondylotic myelopathy.

    PubMed

    Grabher, Patrick; Mohammadi, Siawoosh; Trachsler, Aaron; Friedl, Susanne; David, Gergely; Sutter, Reto; Weiskopf, Nikolaus; Thompson, Alan J; Curt, Armin; Freund, Patrick

    2016-01-01

    In this prospective study, we made an unbiased voxel-based analysis to investigate above-stenosis spinal degeneration and its relation to impairment in patients with cervical spondylotic myelopathy (CSM). Twenty patients and 18 controls were assessed with high-resolution MRI protocols above the level of stenosis. Cross-sectional areas of grey matter (GM), white matter (WM), and posterior columns (PC) were measured to determine atrophy. Diffusion indices assessed tract-specific integrity of PC and lateral corticospinal tracts (CST). Regression analysis was used to reveal relationships between MRI measures and clinical impairment. Patients showed mainly sensory impairment. Atrophy was prominent within the cervical WM (13.9%, p = 0.004), GM (7.2%, p = 0.043), and PC (16.1%, p = 0.005). Fractional anisotropy (FA) was reduced in the PC (-11.98%, p = 0.006) and lateral CST (-12.96%, p = 0.014). In addition, radial (+28.47%, p = 0.014), axial (+14.72%, p = 0.005), and mean (+16.50%, p = 0.001) diffusivities were increased in the PC. Light-touch score was associated with atrophy (R(2) = 0.3559, p = 0.020) and FA (z score 3.74, p = 0.003) in the PC, as was functional independence and FA in the lateral CST (z score 3.68, p = 0.020). This study demonstrates voxel-based degeneration far above the stenosis at a level not directly affected by the compression and provides unbiased readouts of tract-specific changes that relate to impairment. PMID:27095134

  5. Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy Undergoing Unilateral Open-Door Laminoplasty

    PubMed Central

    Shin, Ji-Won; Jin, Sung-Won; Choi, Jong-Il; Kim, Bum-Joon; Kim, Sang-Dae; Lim, Dong-Jun

    2015-01-01

    Objective This study aimed to analyze prognostic factors affecting surgical outcomes of expansive laminoplasty for cervical spondylotic myelopathy (CSM). Methods Using the Frankel scale and Japanese Orthopaedic Association (JOA) scale, we retrospectively reviewed the outcomes of 45 consecutive patients who underwent modified unilateral open-door laminoplasty using hydroxyapatite spacers and malleable titanium miniplates between June 2008 and May 2014. The patients were assigned to the good and poor clinical outcome groups, with good outcome defined as a JOA recovery rate >75%. Results The mean preoperative JOA scale was significantly higher in the good outcome group (14.95±3.21 vs. 10.78±6.07, p<0.001), whereas the preoperative cervical range of motion (ROM) in this group was significantly lower (29.89°±10.11 vs. 44.35°± 8.88, p<0.001). In univariate analysis, a high preoperative JOA scale (odds ratio (OR) 1.271, 95% confidence interval (CI) 1.005-1.607) and low preoperative cervical ROM(OR 0.858, 95% CI 0.786-0.936) were statistically correlated with good outcomes. Furthermore, these factors demonstrated an independent association with clinical outcomes (preoperative JOA scale: OR 1.344, 95% CI 1.019-1.774, p=0.036; preoperative cervical ROM: OR 0.860, 95% CI 0.788-0.940, p=0.001). Conclusion In this study, a high preoperative JOA scale was associated with good clinical outcome after laminoplasty, whereas a higher preoperative cervical spine ROM was associated with poor clinical outcome. This may suggests that cervical mobility and preoperative neurological status affect clinical outcomes of laminoplasty. PMID:26834814

  6. Risk Factor Analysis for C5 Palsy after Double-Door Laminoplasty for Cervical Spondylotic Myelopathy

    PubMed Central

    Ikuta, Ko; Ikeuchi, Hiroko; Shiraki, Makoto; Komiya, Norihiro; Kitamura, Takahiro; Senba, Hideyuki; Shidahara, Satoshi

    2016-01-01

    Study Design A retrospective comparative study. Purpose To clarify the risk factors related to the development of postoperative C5 palsy through radiological studies after cervical double-door laminoplasty (DDL). Overview of Literature Although postoperative C5 palsy is generally considered to be the result of damage to the nerve root or segmental spinal cord, the associated pathology remains controversial. Methods A consecutive case series of 47 patients with cervical spondylotic myelopathy treated by DDL at our institution between April 2008 and April 2015 were reviewed. Postoperative C5 palsy occurred in 5 of 47 cases after DDL. We investigated 9 radiologic factors that have been reported to be risk factors for C5 palsy in various studies, and statistically examined these between the two groups of palsy and the non-palsy patients. Results We found a significant difference between patients with and without postoperative C5 palsy with regards to the posterior shift of spinal cord at C4/5 (p=0.008). The logistic regression analyses revealed posterior shift of the spinal cord at C4/5 (odds ratio, 12.066; p=0.029; 95% confidence interval, 1.295–112.378). For the other radiologic factors, there were no statistically significant differences between the two groups. Conclusions In the present study, we showed a significant difference in the posterior shift of the spinal cord at C4/5 between the palsy and the non-palsy groups, indicating that the "tethering phenomenon" was likely a greater risk factor for postoperative C5 palsy. PMID:27114771

  7. Clinical, imaging, and pathologic characteristics of Gurltia paralysans myelopathy in domestic cats from Chile.

    PubMed

    Mieres, Marcelo; Gómez, Marcelo A; Lillo, Carla; Rojas, Marcela A; Moroni, Manuel; Muñoz, Pamela; Acosta-Jamett, Gerardo; Wiegand, Ricardo

    2013-01-01

    Gurltia paralysans is a rare metastrongylid nematode of domestic cats that is found mainly in the veins of the spinal cord subarachnoid space and parenchyma. Endemic regions for G. paralysans mainly include Chile and Argentina. The ante mortem diagnosis of gurltiosis is difficult and based primarily on neurological signs, epidemiological factors, and the exclusion of other causes of feline myelopathies. The purpose of this retrospective case series was to describe clinical, imaging, and pathologic characteristics in nine domestic cats naturally infected with G. paralysans. Imaging tests included radiography, myelography, computed tomographic myelography (myelo-CT), and magnetic resonance imaging (MRI). Neurological signs included paraparesis, paraplegia, pelvic limb ataxia and proprioceptive deficits, pelvic limb tremors, lumbosacral hyperesthesia, and tail trembling or atony. Complete blood count findings included a decrease in the mean corpuscular hemoglobin concentration value in eight cats. Eosinophilia in peripheral blood was observed in three cats, and thrombocytopenia was observed in three cats. Cerebrospinal fluid analysis revealed mononuclear pleocytosis in five cases. Myelo-CT showed diffuse enlargement of the spinal cord at the midthoracic, lumbar, and sacral regions in all cats. Magnetic resonance image findings in the thoracic and lumbar region demonstrated multiple small nodular areas of T2 hyperintensity in the periphery of the spinal cord parenchyma. Localized intraparenchymal areas of increased T2 intensity were also observed in the thoracolumbar spinal cord and lumbosacral conus medullaris. In conclusion, G. paralysans should be considered as a differential diagnosis for domestic cats in endemic regions that have this combination of clinical and imaging characteristics. PMID:23464605

  8. Cortical Reorganization Is Associated with Surgical Decompression of Cervical Spondylotic Myelopathy

    PubMed Central

    Green, Andrew; Cheong, Priscilia W. T.; Fook-Chong, Stephanie; Tiruchelvarayan, Rajendra; Guo, Chang Ming; Yue, Wai Mun; Chen, John; Lo, Yew Long

    2015-01-01

    Background. Cervical spondylotic myelopathy (CSM) results in sensorimotor limb deficits, bladder, and bowel dysfunction, but mechanisms underlying motor plasticity changes before and after surgery are unclear. Methods. We studied 24 patients who underwent decompression surgery and 15 healthy controls. Patients with mixed upper and lower limb dysfunction (Group A) and only lower limb dysfunction (Group B) were then analysed separately. Results. The sum amplitude of motor evoked potentials sMEP (p < 0.01) and number of focal points where MEPs were elicited (N) (p < 0.001) were significantly larger in CSM patients compared with controls. For Group A (16 patients), sMEP (p < 0.01) and N (p < 0.001) showed similar findings. However, for Group B (8 patients), only N (p = 0.03) was significantly larger in patients than controls. Group A had significantly increased grip strength (p = 0.02) and reduced sMEP (p = 0.001) and N (p = 0.003) after surgery. Changes in sMEP (cMEP) significantly correlated inversely with improved feeding (p = 0.03) and stacking (p = 0.04) times as was the change in number of focal points (NDiff) with improved writing times (p = 0.03). Group B did not show significant reduction in sMEP or N after surgery, or significant correlation of cMEP or NDiff with all hand function tests. No significant differences in H reflex parameters obtained from the flexor carpi radialis, or central motor conduction time changes, were noted after surgery. Discussion. Compensatory expansion of motor cortical representation occurs largely at cortical rather than spinal levels, with a tendency to normalization after surgery. These mirrored improvements in relevant tasks requiring utilization of intrinsic hand muscles. PMID:26609437

  9. Voxel-based analysis of grey and white matter degeneration in cervical spondylotic myelopathy

    PubMed Central

    Grabher, Patrick; Mohammadi, Siawoosh; Trachsler, Aaron; Friedl, Susanne; David, Gergely; Sutter, Reto; Weiskopf, Nikolaus; Thompson, Alan J.; Curt, Armin; Freund, Patrick

    2016-01-01

    In this prospective study, we made an unbiased voxel-based analysis to investigate above-stenosis spinal degeneration and its relation to impairment in patients with cervical spondylotic myelopathy (CSM). Twenty patients and 18 controls were assessed with high-resolution MRI protocols above the level of stenosis. Cross-sectional areas of grey matter (GM), white matter (WM), and posterior columns (PC) were measured to determine atrophy. Diffusion indices assessed tract-specific integrity of PC and lateral corticospinal tracts (CST). Regression analysis was used to reveal relationships between MRI measures and clinical impairment. Patients showed mainly sensory impairment. Atrophy was prominent within the cervical WM (13.9%, p = 0.004), GM (7.2%, p = 0.043), and PC (16.1%, p = 0.005). Fractional anisotropy (FA) was reduced in the PC (−11.98%, p = 0.006) and lateral CST (−12.96%, p = 0.014). In addition, radial (+28.47%, p = 0.014), axial (+14.72%, p = 0.005), and mean (+16.50%, p = 0.001) diffusivities were increased in the PC. Light-touch score was associated with atrophy (R2 = 0.3559, p = 0.020) and FA (z score 3.74, p = 0.003) in the PC, as was functional independence and FA in the lateral CST (z score 3.68, p = 0.020). This study demonstrates voxel-based degeneration far above the stenosis at a level not directly affected by the compression and provides unbiased readouts of tract-specific changes that relate to impairment. PMID:27095134

  10. Probabilities of Radiation Myelopathy Specific to Stereotactic Body Radiation Therapy to Guide Safe Practice

    SciTech Connect

    Sahgal, Arjun; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON ; Weinberg, Vivian; Ma, Lijun; Chang, Eric; Chao, Sam; Muacevic, Alexander; Gorgulho, Alessandra; Soltys, Scott; Gerszten, Peter C.; Ryu, Sam; Angelov, Lilyana; Gibbs, Iris; Wong, C. Shun; Larson, David A.

    2013-02-01

    Purpose: Dose-volume histogram (DVH) results for 9 cases of post spine stereotactic body radiation therapy (SBRT) radiation myelopathy (RM) are reported and compared with a cohort of 66 spine SBRT patients without RM. Methods and Materials: DVH data were centrally analyzed according to the thecal sac point maximum (Pmax) volume, 0.1- to 1-cc volumes in increments of 0.1 cc, and to the 2 cc volume. 2-Gy biologically equivalent doses (nBED) were calculated using an {alpha}/{beta} = 2 Gy (units = Gy{sub 2/2}). For the 2 cohorts, the nBED means and distributions were compared using the t test and Mann-Whitney test, respectively. Significance (P<.05) was defined as concordance of both tests at each specified volume. A logistic regression model was developed to estimate the probability of RM using the dose distribution for a given volume. Results: Significant differences in both the means and distributions at the Pmax and up to the 0.8-cc volume were observed. Concordant significance was greatest for the Pmax volume. At the Pmax volume the fit of the logistic regression model, summarized by the area under the curve, was 0.87. A risk of RM of 5% or less was observed when limiting the thecal sac Pmax volume doses to 12.4 Gy in a single fraction, 17.0 Gy in 2 fractions, 20.3 Gy in 3 fractions, 23.0 Gy in 4 fractions, and 25.3 Gy in 5 fractions. Conclusion: We report the first logistic regression model yielding estimates for the probability of human RM specific to SBRT.

  11. Effects of brain derived neurotrophic factor Val66Met polymorphism in patients with cervical spondylotic myelopathy.

    PubMed

    Abode-Iyamah, Kingsley O; Stoner, Kirsten E; Grossbach, Andrew J; Viljoen, Stephanus V; McHenry, Colleen L; Petrie, Michael A; Dahdaleh, Nader S; Grosland, Nicole M; Shields, Richard K; Howard, Matthew A

    2016-02-01

    Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord related disability in the elderly. It results from degenerative narrowing of the spinal canal, which causes spinal cord compression. This leads to gait instability, loss of dexterity, weakness, numbness and urinary dysfunction. There has been indirect data that implicates a genetic component to CSM. Such a finding may contribute to the variety in presentation and outcome in this patient population. The Val66Met polymorphism, a mutation in the brain derived neurotrophic factor (BDNF) gene, has been implicated in a number of brain and psychological conditions, and here we investigate its role in CSM. Ten subjects diagnosed with CSM were enrolled in this prospective study. Baseline clinical evaluation using the modified Japanese Orthopaedic Association (mJOA) scale, Nurick and 36-Item Short Form Health Survey (SF-36) were collected. Each subject underwent objective testing with gait kinematics, as well as hand functioning using the Purdue Peg Board. Blood samples were analyzed for the BDNF Val66Met mutation. The prevalence of the Val66Met mutation in this study was 60% amongst CSM patients compared to 32% in the general population. Individuals with abnormal Met allele had worse baseline mJOA and Nurick scores. Moreover, baseline gait kinematics and hand functioning testing were worse compared to their wild type counterpart. BDNF Val66Met mutation has a higher prevalence in CSM compared to the general population. Those with BDNF mutation have a worse clinical presentation compared to the wild type counterpart. These findings suggest implication of the BDNF mutation in the development and severity of CSM. PMID:26461908

  12. Intramedullary cysticercosis.

    PubMed

    Holtzman, R N; Hughes, J E; Sachdev, R K; Jarenwattananon, A

    1986-08-01

    In 1976 a 28-year-old Ecuadoran male suffered paraparesis after a kick to his back. Iophendylate myelography was followed by thoracic laminectomy with incomplete resolution of the paraparesis. One year later, worsening of the paraparesis was managed by further thoracic laminectomy without improvement. In 1978 a spinal cord stimulator was implanted via low thoracic laminectomy as a measure to counter his spasticity. In 1984 metrizamide myelography and computed tomography scanning were performed for increasing spastic paraparesis that disclosed an intramedullary lesion at the T-4 level. Exploration and myelotomy revealed an intramedullary cysticercal cyst, which was totally removed. PMID:3726745

  13. Clinical Case Report of Expansive Laminoplasty for Cervical Myelopathy Due to Both Disc Herniation and Developmental Cervical Spinal Canal Stenosis in Older Adolescents.

    PubMed

    Zhou, Hua; Sun, Yu; Zhang, Fengshan; Dang, Gengting; Liu, Zhongjun

    2016-02-01

    Reports on adolescent patients with cervical myelopathy who underwent anterior cervical discectomy and fusion are scarce. However, to our knowledge, no cases of expansive laminoplasty for cervical myelopathy associated with progressive neurological deficit after a series of conservative treatment, caused by both disc herniation and developmental cervical spinal canal stenosis, have been reported.From January 2006 to July 2012, we retrospectively studied 3 patients in late adolescence presenting with cervical myelopathy who underwent expansive unilateral open-door laminoplasty at our hospital. The outcomes after the surgery were evaluated according to the Japanese Orthopedic Association scores.Symptoms presented by these patients were due to both disc herniation and developmental cervical spinal canal stenosis. No major complications occurred after the surgical procedures. The median follow-up time was 66 months (range 36-112 months). The Japanese Orthopedic Association scores after surgery showed a significant increase. Long-term outcomes after surgery were satisfactory according to the evaluation criteria for the Japanese Orthopedic Association scores. However, the ranges of motion of the cervical spine decreased, especially the ranges of motion on flexion after surgery showed a significant decrease.Expansive laminoplasty is helpful for older adolescent patients with cervical myelopathy due to both disc herniation and developmental cervical spinal canal stenosis, presenting with progressive neurological deficit after long conservative treatment. PMID:26937923

  14. Clinical Case Report of Expansive Laminoplasty for Cervical Myelopathy Due to Both Disc Herniation and Developmental Cervical Spinal Canal Stenosis in Older Adolescents

    PubMed Central

    Zhou, Hua; Sun, Yu; Zhang, Fengshan; Dang, Gengting; Liu, Zhongjun

    2016-01-01

    Abstract Reports on adolescent patients with cervical myelopathy who underwent anterior cervical discectomy and fusion are scarce. However, to our knowledge, no cases of expansive laminoplasty for cervical myelopathy associated with progressive neurological deficit after a series of conservative treatment, caused by both disc herniation and developmental cervical spinal canal stenosis, have been reported. From January 2006 to July 2012, we retrospectively studied 3 patients in late adolescence presenting with cervical myelopathy who underwent expansive unilateral open-door laminoplasty at our hospital. The outcomes after the surgery were evaluated according to the Japanese Orthopedic Association scores. Symptoms presented by these patients were due to both disc herniation and developmental cervical spinal canal stenosis. No major complications occurred after the surgical procedures. The median follow-up time was 66 months (range 36–112 months). The Japanese Orthopedic Association scores after surgery showed a significant increase. Long-term outcomes after surgery were satisfactory according to the evaluation criteria for the Japanese Orthopedic Association scores. However, the ranges of motion of the cervical spine decreased, especially the ranges of motion on flexion after surgery showed a significant decrease. Expansive laminoplasty is helpful for older adolescent patients with cervical myelopathy due to both disc herniation and developmental cervical spinal canal stenosis, presenting with progressive neurological deficit after long conservative treatment. PMID:26937923

  15. Myelopathy mimicking subacute combined degeneration in a Down syndrome patient with methotrexate treatment for B lymphoblastic leukemia: report of an autopsy case.

    PubMed

    Satomi, Kaishi; Yoshida, Mari; Matsuoka, Kentaro; Okita, Hajime; Hosoya, Yosuke; Shioda, Yoko; Kumagai, Masa-Aki; Mori, Tetsuya; Morishita, Yukio; Noguchi, Masayuki; Nakazawa, Atsuko

    2014-08-01

    We report clinicopathological features of a 23-year-old woman with Down syndrome (DS) presenting with subacute myelopathy treated with chemotherapy, including intravenous and intrathecal administration of methotrexate (MTX), and with allogenic bone-marrow transplantation for B lymphoblastic leukemia. Autopsy revealed severe demyelinating vacuolar myelopathy in the posterior and lateral columns of the spinal cord, associated with macrophage infiltration, marked axonal loss and some swollen axons. Pathological changes of posterior and lateral columns were observed from the medulla oblongata to lumbar cord. Proximal anterior and posterior roots were preserved. Cerebral white matter was relatively well preserved. There were no vascular lesions or meningeal dissemination of leukemia. Longitudinal extension of cord lesions was extensive, unlike typical cases of subacute combined degeneration (SACD), but distribution of lesions and histological findings were similar to that of SACD. DS patients show heightened sensitivity to MTX because of their genetic background. Risk factors for toxic myelopathy of DS are discussed, including delayed clearance of MTX despite normal renal function, alterations in MTX polyglutamation and enhanced folic acid depletion due to gene dosage effects of chromosome 21. Alteration of folate metabolism and/or vitamin B12 levels through intravenous or intrathecal administration of MTX might exist, although vitamin B12 and other essential nutrients were managed using intravenous hyperalimentation. To the best of our knowledge, this is the first report of an autopsy case that shows myelopathy mimicking SACD in a DS patient accompanied by B lymphoblastic leukemia. The case suggests a pathophysiological mechanism of MTX-related myelopathy in DS patients with B lymphoblastic leukemia mimicking SACD. PMID:24661121

  16. A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy.

    PubMed

    Tetreault, Lindsay; Ibrahim, Ahmed; Côté, Pierre; Singh, Anoushka; Fehlings, Michael G

    2016-01-01

    OBJECT Although generally safe and effective, surgery for the treatment of cervical spondylotic myelopathy (CSM) is associated with complications in 11%-38% of patients. Several predictors of postoperative complications have been proposed but few are used to detect high-risk patients. A standard approach to identifying "at-risk" patients would improve surgeons' ability to prevent and manage these complications. The authors aimed to compare the complication rates between various surgical procedures used to treat CSM and to identify patient-specific, clinical, imaging, and surgical predictors of complications. METHODS The authors conducted a systematic review of the literature and searched MEDLINE, MEDLINE in Process, EMBASE, and Cochrane Central Register of Controlled Trials from 1948 to September 2013. Cohort studies designed to evaluate predictors of complications and intervention studies conducted to compare different surgical approaches were included. Each article was critically appraised independently by 2 reviewers, and the evidence was synthesized according to the principles outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS A total of 5472 citations were retrieved. Of those, 60 studies met the inclusion criteria and were included in the review. These studies included 36 prognostic cohort studies and 28 comparative intervention studies. High evidence suggests that older patients are at a greater risk of perioperative complications. Based on low evidence, other clinical factors such as body mass index, smoking status, duration of symptoms, and baseline severity score, are not predictive of complications. With respect to surgical factors, low to moderate evidence suggests that estimated blood loss, surgical approach, and number of levels do not affect rates of complications. A longer operative duration (moderate evidence), however, is predictive of perioperative complications and a 2-stage surgery is related to an increased risk of major complications (high evidence). In terms of surgical techniques, higher rates of neck pain were found in patients undergoing laminoplasty compared with anterior spinal fusion (moderate evidence). In addition, with respect to laminoplasty techniques, there was a lower incidence of C-5 palsy in laminoplasty with concurrent foraminotomy compared with nonforaminotomy (low evidence). CONCLUSIONS The current review suggests that older patients are at a higher risk of perioperative complications. A longer operative duration and a 2-stage surgery both reflect increased case complexity and can indirectly predict perioperative complications. PMID:26407090

  17. Night blindness due to vitamin A deficiency associated with copper deficiency myelopathy secondary to bowel bypass surgery

    PubMed Central

    Abdul Jabbar AlHassany, Ali

    2014-01-01

    We present an interesting case of combined vitamin A and copper deficiency after a history of gastric bypass surgery where symptoms improved after parenteral copper and vitamin A treatment. Gastric bypass surgery as a cause of fat soluble vitamin deficiency is generally under-reported. Copper deficiency has been reported after gastric bypass surgery. Vitamin A deficiency after gastric bypass surgery has also been reported in the literature, but the reported cases again fall below the actual figures. B12 and folate deficiencies can produce a type of myelopathy similar to that produced by copper deficiency, and differentiation on the basis of laboratory tests, neurophysiology and improvement of symptoms after replacement therapy might be the hallmark of diagnosis. Combinations of vitamin deficiencies were previously reported, but no cases of combined vitamin A and copper deficiency could be found in the literature. PMID:24781845

  18. Night blindness due to vitamin A deficiency associated with copper deficiency myelopathy secondary to bowel bypass surgery.

    PubMed

    AlHassany, Ali Abdul Jabbar

    2014-01-01

    We present an interesting case of combined vitamin A and copper deficiency after a history of gastric bypass surgery where symptoms improved after parenteral copper and vitamin A treatment. Gastric bypass surgery as a cause of fat soluble vitamin deficiency is generally under-reported. Copper deficiency has been reported after gastric bypass surgery. Vitamin A deficiency after gastric bypass surgery has also been reported in the literature, but the reported cases again fall below the actual figures. B12 and folate deficiencies can produce a type of myelopathy similar to that produced by copper deficiency, and differentiation on the basis of laboratory tests, neurophysiology and improvement of symptoms after replacement therapy might be the hallmark of diagnosis. Combinations of vitamin deficiencies were previously reported, but no cases of combined vitamin A and copper deficiency could be found in the literature. PMID:24781845

  19. Scheie syndrome: enzyme replacement therapy does not prevent progression of cervical myelopathy due to spinal cord compression.

    PubMed

    Illsinger, S; Lücke, T; Hartmann, H; Mengel, E; Müller-Forell, W; Donnerstag, F; Das, A M

    2009-12-01

    Hurler-Scheie syndrome is caused by alpha-l-iduronidase deficiency. Enzyme replacement therapy (ERT) can improve physical capacity and reduces organomegaly. However, the effect on bradytrophic connective tissue is limited. As intravenously administered enzyme cannot cross the blood-brain barrier, the therapy of choice for the more severe Hurler syndrome is haematopoietic stem cell transplantation (HCT). In the more attenuated Scheie syndrome, neurological impairment is less severe; therefore, ERT may be appropriate to treat these patients. Information on long-term outcome in Scheie patients undergoing ERT is scarce. We report a 38-year-old female Scheie patient who has been on ERT for 8 years. While non-neurological symptoms improved, she developed paresthesias in her hands and feet and progressive pain in her legs. Somatosensory evoked potentials were abnormal, suggesting dysfunction of the dorsal funiculus and lemniscus medialis. After 6 years of ERT, a spinal MRI showed dural thickening at the upper cervical spine. These soft-tissue deposits are presumably due to the accumulation of mucopolysaccharides. Intramedullary hyperintensities at the level of C1/2 revealed cervical myelopathy. An MRI before the start of ERT had shown milder spinal lesions. Cystic lesions in the white matter of the centrum semiovale due to dilated Virchow-Robin spaces were essentially unchanged compared with the MRI scan before ERT. Decompression of the spinal cord resulted in clinical improvement. In an adult patient with Scheie syndrome, ERT failed to prevent progression of cervical myelopathy. Clinical significance of cerebral changes is unclear. Whether early HCT or intrathecal ERT could have prevented these lesions remains speculative. PMID:19894140

  20. Foraminotomy

    MedlinePlus

    ... or laminectomy ). The surgeon may do a spinal fusion to make sure your spinal column is stable ... spine surgery. If you had foraminotomy and spinal fusion, the spinal column above and below the fusion ...

  1. Possible causes of seizure after spine surgery

    PubMed Central

    Habibi, Zohreh; Nejat, Farideh; El Khashab, Mostafa

    2010-01-01

    Seizure after laminectomy for spinal procedure is very rare and has not been reported after lipomyelomeningocele surgery beforehand. Here, two cases of seizure following laminectomy for lipomyelomeningocele are reported. The exact etiology of the event is unknown but anesthetic material, pneumocephalus, intracranial hypotension subsequent to cerebrospinal fluid leakage after spinal procedures, spinal-induced seizure and the potential toxic effect of fat molecules could be considered. PMID:21042506

  2. Surgical outcome in patients with cervical ossified posterior longitudinal ligament: A single institutional experience

    PubMed Central

    Kommu, Rao; Sahu, B. P.; Purohit, A. K.

    2014-01-01

    Objective: Ossification of the posterior longitudinal ligament (OPLL) is a complex multi-factorial disease process having both metabolic and biomechanical factors. The role of surgical intervention as well as the choice of approach weather anterior or posterior is ambiguous. The objective of this study was to assess the surgical out come and post operative functional improvement in patients with cervical OPLL at a tertiary care centre. Patients and Methods: This prospective study included 63 patients of cervical OPLL who underwent either anterior and/or posterior surgeries in Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad between June 2009 to May 2011. Patient's data including age, sex, pre and post operative functional status, radiographic findings and OPLL subtypes were recorded and analyzed over a follow up ranging up to minimum two years. Results: The mean age of the patients was 51.1 (range 30-80 years) involving 14 women and 49 men. Out of 63 patients, 14 patients underwent surgery by anterior approach (corpectomy and fusion) and all of them improved (P = 0.52). 49 patients underwent surgery by posterior approach where decompressive laminectomy was performed in 40, laminectomy with instrumentation was done in 5, laminoplasty was done in 3 and 1 patient underwent both anterior and posterior surgeries. Of those who underwent posterior surgery, 40 patients improved, 7 remained the same as their preoperative status (who were having signal intensity changes on T2W MRI) and 2 patients deteriorated in the immediate post operative period and then showed gradual improvement. All the patients were followed up for 24 months. The mean pre-operative Nurick grade was 2.82 which later on improved to 2.03 post surgery (P < 0.05). Minor complications included wound infections in two patients (1.26%). Conclusions: Anterior cervical decompression and reconstruction is a safe and appropriate treatment for cervical spondylitic myelopathy in the setting of single or two level OPLL. Laminectomy or laminoplasty is indicated in patients with preserved cervical lordosis having three or more levels of involvement. Younger patients with good pre operative functional status and less than 2 levels of involvement have better outcome following anterior surgery. PMID:25685216

  3. The value of preoperative magnetic resonance imaging in predicting postoperative recovery in patients with cervical spondylosis myelopathy: a meta-analysis

    PubMed Central

    Chen, Hui; Pan, Jun; Nisar, Majid; Zeng, Huan Bei; Dai, Li Fang; Lou, Chao; Zhu, Si Pin; Dai, Bing; Xiang, Guang Heng

    2016-01-01

    This meta-analysis was designed to elucidate whether preoperative signal intensity changes could predict the surgical outcomes of patients with cervical spondylosis myelopathy on the basis of T1-weighted and T2-weighted magnetic resonance imaging images. We searched the Medline database and the Cochrane Central Register of Controlled Trials for this purpose and 10 studies meeting our inclusion criteria were identified. In total, 650 cervical spondylosis myelopathy patients with (+) or without (-) intramedullary signal changes on their T2-weighted images were examined. Weighted mean differences and 95% confidence intervals were used to summarize the data. Patients with focal and faint border changes in the intramedullary signal on T2 magnetic resonance imaging had similar Japanese Orthopaedic Association recovery ratios as those with no signal changes on the magnetic resonance imaging images of the spinal cord did. The surgical outcomes were poorer in the patients with both T2 intramedullary signal changes, especially when the signal changes were multisegmental and had a well-defined border and T1 intramedullary signal changes compared with those without intramedullary signal changes. Preoperative magnetic resonance imaging including T1 and T2 imaging can thus be used to predict postoperative recovery in cervical spondylosis myelopathy patients. PMID:27074180

  4. Cox Decompression Manipulation and Guided Rehabilitation of a Patient With a Post Surgical C6-C7 Fusion With Spondylotic Myelopathy and Concurrent L5-S1 Radiculopathy

    PubMed Central

    Joachim, George C.

    2014-01-01

    Objective The purpose of this case report is to describe combined treatment utilizing Cox distraction manipulation and guided rehabilitation for a patient with spine pain and post-surgical C6-7 fusion with spondylotic myelopathy and L5-S1 radiculopathy. Clinical features A 38-year-old man presented to a chiropractic clinic with neck pain and a history of an anterior cervical spine plate fusion at C6-7 after a work related accident 4 years earlier. He had signs and symptoms of spondolytic myelopathy and right lower back, right posterior thigh pain and numbness. Intervention and outcome The patient was treated with Cox technique and rehabilitation. The patient experienced a reduction of pain on a numeric pain scale from 8/10 to 3/10. The patient was seen a total of 12 visits over 3 months. No adverse effects were reported. Conclusions A patient with a prior C6-7 fusion with spondylotic myelopathy and concurrent L5-S1 radiculopathy improved after a course of rehabilitation and Cox distraction manipulation. Further research is needed to establish its efficiency. PMID:25685119

  5. Cervical anterior hybrid technique with bi-level Bryan artificial disc replacement and adjacent segment fusion for cervical myelopathy over three consecutive segments.

    PubMed

    Chen, Jiang; Xu, Lin; Jia, Yu-Song; Sun, Qi; Li, Jin-Yu; Zheng, Chen-Ying; Bai, Chun-Xiao; Yu, Qin-Sheng

    2016-05-01

    This study aimed to assess the preliminary clinical efficacy and feasibility of the hybrid technique for multilevel cervical myelopathy. Considering the many shortcomings of traditional treatment methods for multilevel cervical degenerative myelopathy, hybrid surgery (bi-level Bryan artificial disc [Medtronic Sofamor Danek, Memphis, TN, USA] replacement and anterior cervical discectomy and fusion) should be considered. Between March 2006 and November 2012, 108 patients (68 men and 40 women, average age 45years) underwent hybrid surgery. Based on the Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Odom's criteria, the clinical symptoms and neurological function before and after surgery were evaluated. Mean surgery duration was 90minutes, with average blood loss of 30mL. Mean follow-up duration was 36months. At the final follow-up, the mean JOA (± standard deviation) scores were significantly higher compared with preoperative values (15.08±1.47 versus 9.18±1.22; P<0.01); meanwhile, NDI values were markedly decreased (12.32±1.03 versus 42.68±1.83; P<0.01). Using Odom's criteria, the clinical outcomes were rated as excellent (76 patients), good (22 patients), fair (six patients), and poor (four patients). These findings indicate that the hybrid method provides an effective treatment for cervical myelopathy over three consecutive segments, ensuring a good clinical outcome. PMID:26758702

  6. Prognostic value of magnetic resonance imaging combined with electromyography in the surgical management of cervical spondylotic myelopathy

    PubMed Central

    LIU, FA-JING; SUN, YA-PENG; SHEN, YONG; DING, WEN-YUAN; WANG, LIN-FENG

    2013-01-01

    The present study aimed to evaluate the value of pre-operative magnetic resonance imaging (MRI) combined with electromyography (EMG) for predicting clinical outcome following surgical management of cervical spondylotic myelopathy (CSM). A total of 94 patients with cervical compressive myelopathy were prospectively enrolled and treated with anterior, posterior and posterior-anterior united decompression between October 2007 and February 2009. Prior to surgery 1.5-T MRI and EMG were performed in all patients. The patients were classified into four types based on the presence (+) or absence (−) of an increased signal intensity (ISI) on the T2-weighted magnetic resonance (MR) images and also based on the positive (+)/negative (−) results of the EMG. The four types were as follows: Type I, MRI/EMG (−/−); Type II, MRI/EMG (+/−); Type III, MRI/EMG (−/+); and Type IV, MRI/EMG (+/+). The clinical outcome was also graded according to a modified Japanese Orthopedic Association (JOA) scoring system. Furthermore, pre- and post-operative clinical data were statistically analyzed to explore the correlation between the factors. There were 36 cases (38%) of Type I, 16 (17%) of Type II, 13 (14%) of Type III and 29 (31%) of Type IV. According to the analysis of the clinical data between the four types, there were significant differences in the disability classifications, pre-operative JOA scores and disease duration (P<0.05), but there were no significant differences in gender, age or cord compression ratios (P>0.05). Until the final follow-up, there was a significant difference in the recovery ratio between the four study groups (Hc=27.46, P<0.05). Further comparison showed that the surgical outcome was best in Type I patients and worst in Type IV patients. In conclusion, there was a distinct correlation between classification and the rate of clinical improvement. Patients who had a negative EMG and those without an ISI on T2-weight images tended to suffer only mild symptoms, a short disease duration and, most significantly, experience a good surgical outcome. PMID:23596492

  7. Comparison of Functional and Radiological Outcomes Between Two Posterior Approaches in the Treatment of Multilevel Cervical Spondylotic Myelopathy

    PubMed Central

    Ren, Da-Jiang; Li, Fang; Zhang, Zhi-Cheng; Kai, Guan; Shan, Jian-Lin; Zhao, Guang-Min; Sun, Tian-Sheng

    2015-01-01

    Background: Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM). Each posterior technique has its own advantages and disadvantages. In the present study, we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM. Methods: Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery, Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study. Patients were divided into two groups by surgical procedure: Laminoplasty (Group L) and hemilaminectomy (Group H). Perioperative parameters including age, sex, duration of symptoms, operative duration, and intraoperative blood loss were recorded and compared. Spinal canal area, calculated using AutoCAD® software (Autodesk Inc., San Rafael, CA, USA), and neurological improvement, evaluated with Japanese Orthopedic Association score, were also compared. Results: Neurological improvement did not differ significantly between groups. Group H had a significantly shorter operative duration and significantly less blood loss. Mean expansion ratio was significantly greater in Group L (77.83 ± 6.41%) than in Group H (62.72 ± 3.86%) (P < 0.01). Conclusions: Both surgical approaches are safe and effective in treating multilevel CSM. Laminoplasty provides a greater degree of enlargement of the spinal canal, whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss. PMID:26228218

  8. Human T-lymphotropic virus type I-associated myelopathy and tax gene expression in CD4+ T lymphocytes.

    PubMed

    Moritoyo, T; Reinhart, T A; Moritoyo, H; Sato, E; Izumo, S; Osame, M; Haase, A T

    1996-07-01

    Infection by human T-lymphotropic virus type I (HTLV-I) is associated with adult T-cell leukemia and a slowly progressive disease of the central nervous system (CNS), HTLV-I-associated myelopathy/tropical spastic paraparesis, characterized pathologically by inflammation and white matter degeneration in the spinal cord. One of the explanations for the tissue destruction is that HTLV-I infects cells in the CNS, or HTLV-I-infected CD4+ T lymphocytes enter the CNS, and this drives local expansion of virus-specific CD8+ cytotoxic T lymphocytes, which along with cytokines cause the pathological changes. Because both in the circulation and in the cerebrospinal fluid, CD8+ cytotoxic T lymphocytes are primarily reactive to the product of the HTLV-I tax gene, we sought evidence of expression of this gene within cells in the inflammatory lesions. After using double-label in situ hybridization techniques, we now report definitive localization of HTLV-I tax gene expression in CD4+ T lymphocytes in areas of inflammation and white matter destruction. These findings lend support to a hypothetical scheme of neuropathogenesis in which HTLV-I tax gene expression provokes and sustains an immunopathological process that progressively destroys myelin and axons in the spinal cord. PMID:8687197

  9. Depression contributed an unsatisfactory surgery outcome among the posterior decompression of the cervical spondylotic myelopathy patients: a prospective clinical study.

    PubMed

    Zong, Yaqi; Xue, Yuan; Zhao, Ying; Ding, Huairong; He, Dong; Li, Zhiyang; Tang, Yanming; Wang, Yi

    2014-09-01

    Posterior decompression surgery was performed on 610 patients (mean age 62 years) with clinically and radiologically defined cervical spondylotic myelopathy (CSM) at Tianjin Medical University General Hospital, between October 2007 and October 2011. After 2-year follow-up, we had a full data sets from 396 patients with normal mood or continued depression during the whole process to be compared. Depression was assessed with the 21-item Beck Depression Inventory. Physical functioning and pain were assessed with the modified Japanese Orthopedic Association (mJOA) scoring system, neck disability index (NDI), and visual analog scale (VAS). There were statistically significant differences from baseline to 2-year follow-up between normal mood (n = 258) and continuous depression (n = 138) groups in mJOA score (6.76 ± 3.12 vs. 1.42 ± 0.56, respectively; p < 0.01), VAS (23.85 ± 20.79 vs. 16.08 ± 19.76, respectively; p < 0.01), and NDI (21.11 ± 11.36 vs. 7.31 ± 2.18; p < 0.05). The adverse consequences of depression are supported by previous findings that patients with depression suffer more unsatisfactory surgery outcome than the patients with normal mood. We emphasize that patients with continuous depression show poorer improvement after posterior decompression in CSM patients with respect to symptom severity, pain intensity, and the disability score than patients without depression at any stage. PMID:24643580

  10. Physiotherapy for human T-lymphotropic virus 1-associated myelopathy: review of the literature and future perspectives

    PubMed Central

    Sá, Katia N; Macêdo, Maíra C; Andrade, Rosana P; Mendes, Selena D; Martins, José V; Baptista, Abrahão F

    2015-01-01

    Human T-lymphotropic virus 1 (HTLV-1) infection may be associated with damage to the spinal cord – HTLV-associated myelopathy/tropical spastic paraparesis – and other neurological symptoms that compromise everyday life activities. There is no cure for this disease, but recent evidence suggests that physiotherapy may help individuals with the infection, although, as far as we are aware, no systematic review has approached this topic. Therefore, the objective of this review is to address the core problems associated with HTLV-1 infection that can be detected and treated by physiotherapy, present the results of clinical trials, and discuss perspectives on the development of knowledge in this area. Major problems for individuals with HTLV-1 are pain, sensory-motor dysfunction, and urinary symptoms. All of these have high impact on quality of life, and recent clinical trials involving exercises, electrotherapeutic modalities, and massage have shown promising effects. Although not influencing the basic pathologic disturbances, a physiotherapeutic approach seems to be useful to detect specific problems related to body structures, activity, and participation related to movement in HTLV-1 infection, as well as to treat these conditions. PMID:25759588

  11. Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder.

    PubMed

    Kalsi-Ryan, Sukhvinder; Karadimas, Spyridon K; Fehlings, Michael G

    2013-08-01

    Cervical spondylotic myelopathy (CSM) is a common disorder involving chronic progressive compression of the cervical spinal cord due to degenerative disc disease, spondylosis, or other degenerative pathology. CSM is the most common form of spinal cord impairment and causes functional decline leading to reduced independence and quality of life. Despite a sound understanding of the disease process, clinical presentation and management, a universal definition of CSM and a standardized index of severity are not currently used universally. Work is required to develop a definition and establish clinical predictors of progression to improve management of CSM. Despite advances in decompressive and reconstructive surgery, patients are often left with residual disability. Gaps in knowledge of the pathobiology of CSM have limited therapeutic advances to complement surgery. Although the histopathologic and pathophysiologic similarities between CSM and traumatic spinal cord injury have long been acknowledged, the unique pathomechanisms of CSM remain unexplored. Increased efforts to elucidate CSM pathobiology could lead to the discovery of novel therapeutic targets for human CSM and other spinal cord diseases. Here, the natural history of CSM, epidemiology, clinical presentation, and current methods of clinical management are reported, along with the current state of basic scientific research in the field. PMID:23204243

  12. The Practical Application of Clinical Prediction Rules: A Commentary Using Case Examples in Surgical Patients with Degenerative Cervical Myelopathy

    PubMed Central

    Tetreault, Lindsay; Le, David; Côté, Pierre; Fehlings, Michael

    2015-01-01

    Study Design Commentary. Objective This commentary aims to discuss the practical applications of a clinical prediction rule (CPR) developed to predict functional status in patients undergoing surgery for the treatment of degenerative cervical myelopathy. Methods Clinical cases from the AOSpine CSM-North America study were used to illustrate the application of a prediction rule in a surgical setting and to highlight how this CPR can be used to ultimately enhance patient care. Results A CPR combines signs and symptoms, patient characteristics, and other predictive factors to estimate disease probability, treatment prognosis, or risk of complications. These tools can influence allocation of health care resources, inform clinical decision making, and guide the design of future research studies. In a surgical setting, CPRs can be used to (1) manage patients' expectations of outcome and, in turn, improve overall satisfaction; (2) facilitate shared decision making between patient and physician; (3) identify strategies to optimize surgical results; and (4) reduce heterogeneity of care and align surgeons' perceptions of outcome with objective evidence. Conclusions Valid and clinically-relevant CPRs have tremendous value in a surgical setting. PMID:26682095

  13. Clinical Reversible Myelopathy in T-Cell Lymphoblastic Lymphoma Treated with Nelarabine and Radiotherapy: Report of a Case and Review of Literature of an Increasing Complication

    PubMed Central

    Tisi, Maria Chiara; Ausoni, Giuseppe; Vita, Maria Gabriella; Tartaglione, Tommaso; Balducci, Mario; Laurenti, Luca; Chiusolo, Patrizia; Hohaus, Stefan; Sica, Simona

    2015-01-01

    Eleven cases of neurological defects in T-ALL patients treated with nelarabine have been described in the last 4 years, seven of these after stem cell transplantation (SCT) for T Lymphoblastic Lymphoma (T-LBL). Most of these patients had an unfavorable outcome or irreversible neurological damage. We now report the case of a 41-year-old woman suffering from T-LBL who presented with severe, but reversible myelopathy after receiving nelarabine-based treatment and mediastinal radiotherapy, and we provide a review of the literature on the topic. PMID:25745552

  14. The pathogenesis of tropical spastic paraparesis/human T-cell leukemia type I-associated myelopathy.

    PubMed

    Casseb, J; Penalva-de-Oliveira, A C

    2000-12-01

    Tropical spastic paraparesis/human T-cell leukemia type I-associated myelopathy (TSP/HAM) is caused by a human T-cell leukemia virus type I (HTLV-I) after a long incubation period. TSP/HAM is characterized by a chronic progressive paraparesis with sphincter disturbances, no/mild sensory loss, the absence of spinal cord compression and seropositivity for HTLV-I antibodies. The pathogenesis of this entity is not completely known and involves a multivariable phenomenon of immune system activation against the presence of HTLV-I antigens, leading to an inflammatory process and demyelination, mainly in the thoracic spinal cord. The current hypothesis about the pathogenesis of TSP/HAM is: 1) presence of HTLV-I antigens in the lumbar spinal cord, noted by an increased DNA HTLV-I load; 2) CTL either with their lytic functions or release/production of soluble factors, such as CC-chemokines, cytokines, and adhesion molecules; 3) the presence of Tax gene expression that activates T-cell proliferation or induces an inflammatory process in the spinal cord; 4) the presence of B cells with neutralizing antibody production, or complement activation by an immune complex phenomenon, and 5) lower IL-2 and IFN-gamma production and increased IL-10, indicating drive to a cytokine type 2 pattern in the TSP/HAM subjects and the existence of a genetic background such as some HLA haplotypes. All of these factors should be implicated in TSP/HAM and further studies are necessary to investigate their role in the development of TSP/HAM. PMID:11105090

  15. CSF CXCL10, CXCL9, and Neopterin as Candidate Prognostic Biomarkers for HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis

    PubMed Central

    Sato, Tomoo; Coler-Reilly, Ariella; Utsunomiya, Atae; Araya, Natsumi; Yagishita, Naoko; Ando, Hitoshi; Yamauchi, Junji; Inoue, Eisuke; Ueno, Takahiko; Hasegawa, Yasuhiro; Nishioka, Kusuki; Nakajima, Toshihiro; Jacobson, Steven; Izumo, Shuji; Yamano, Yoshihisa

    2013-01-01

    Background Human T-lymphotropic virus type 1 (HTLV-1) -associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a rare chronic neuroinflammatory disease. Since the disease course of HAM/TSP varies among patients, there is a dire need for biomarkers capable of predicting the rate of disease progression. However, there have been no studies to date that have compared the prognostic values of multiple potential biomarkers for HAM/TSP. Methodology/Principal Findings Peripheral blood and cerebrospinal fluid (CSF) samples from HAM/TSP patients and HTLV-1-infected control subjects were obtained and tested retrospectively for several potential biomarkers, including chemokines and other cytokines, and nine optimal candidates were selected based on receiver operating characteristic (ROC) analysis. Next, we evaluated the relationship between these candidates and the rate of disease progression in HAM/TSP patients, beginning with a first cohort of 30 patients (Training Set) and proceeding to a second cohort of 23 patients (Test Set). We defined “deteriorating HAM/TSP” as distinctly worsening function (≥3 grades on Osame's Motor Disability Score (OMDS)) over four years and “stable HAM/TSP” as unchanged or only slightly worsened function (1 grade on OMDS) over four years, and we compared the levels of the candidate biomarkers in patients divided into these two groups. The CSF levels of chemokine (C-X-C motif) ligand 10 (CXCL10), CXCL9, and neopterin were well-correlated with disease progression, better even than HTLV-1 proviral load in PBMCs. Importantly, these results were validated using the Test Set. Conclusions/Significance As the CSF levels of CXCL10, CXCL9, and neopterin were the most strongly correlated with rate of disease progression, they represent the most viable candidates for HAM/TSP prognostic biomarkers. The identification of effective prognostic biomarkers could lead to earlier detection of high-risk patients, more patient-specific treatment options, and more productive clinical trials. PMID:24130912

  16. Surgical approach to cervical spondylotic myelopathy on the basis of radiological patterns of compression: prospective analysis of 129 cases.

    PubMed

    Bapat, Mihir R; Chaudhary, Kshitij; Sharma, Amit; Laheri, Vinod

    2008-12-01

    This is a prospective analysis of 129 patients operated for cervical spondylotic myelopathy (CSM). Paucity of prospective data on surgical management of CSM, especially multilevel CSM (MCM), makes surgical decision making difficult. The objectives of the study were (1) to identify radiological patterns of cord compression (POC), and (2) to propose a surgical protocol based on POC and determine its efficacy. Average follow-up period was 2.8 years. Following POCs were identified: POC I: one or two levels of anterior cord compression. POC II: one or two levels of anterior and posterior compression. POC III: three levels of anterior compression. POC III variant: similar to POC III, associated with significant medical morbidity. POC IV: three or more levels of anterior compression in a developmentally narrow canal or with multiple posterior compressions. POC IV variant: similar to POC IV with one or two levels, being more significant than the others. POC V: three or more levels of compression in a kyphotic spine. Anterior decompression and reconstruction was chosen for POC I, II and III. Posterior decompression was chosen in POC III variant because they had more incidences of preoperative morbidity, in spite of being radiologically similar to POC III. Posterior surgery was also performed for POC IV and IV variant. For POC IV variant a targeted anterior decompression was considered after posterior decompression. The difference in the mJOA score before and after surgery for patients in each POC group was statistically significant. Anterior surgery in MCM had better result (mJOA = 15.9) versus posterior surgery (mJOA = 14.96), the difference being statistically significant. No major graft-related complications occurred in multilevel groups. The better surgical outcome of anterior surgery in MCM may make a significant difference in surgical outcome in younger and fitter patients like those of POC III whose expectations out of surgery are more. Judicious choice of anterior or posterior approach should be made after individualizing each case. PMID:18946692

  17. Infective dermatitis has similar immunological features to human T lymphotropic virus-type 1-associated myelopathy/tropical spastic paraparesis.

    PubMed

    Nascimento, M C F; Primo, J; Bittencourt, A; Siqueira, I; de Ftima Oliveira, M; Meyer, R; Schriefer, A; Santos, S B; Carvalho, E M

    2009-06-01

    Human T lymphotropic virus-type 1 (HTLV-1) is the causal agent of the HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), adult T cell leukaemia/lymphoma and infective dermatitis associated with HTLV-1 (IDH). Over-production of proinflammatory cytokines and an increase in HTLV-1 proviral load are features of HAM/TSP, but the immunological basis of IDH has not been established. In addition to severe cutaneous manifestations, the importance of IDH relies on the observation that up to 30% of children with IDH develop HAM/TSP in childhood and adolescence. In this study we determined the immune response in patients with IDH measuring interleukin (IL)-4, IL-5, IL-10, interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha levels as well as the HTLV-1 proviral load. Additionally, regulatory cytokines and anti-cytokines were added to cultures to evaluate the ability of these molecules to down-modulate TNF-alpha and IFN-gamma synthesis. HTLV-1 carriers and patients with HAM/TSP served as controls. TNF-alpha and IFN-gamma levels were higher in IDH than in HTLV-1 carriers. There was no difference in IFN-gamma and TNF-alpha concentrations in IDH and HAM/TSP patients. There was a tendency for higher IL-4 mRNA expression and immunoglobulin E (IgE) levels in IDH than in HTLV-1 carriers, but the difference did not reach statistical significance. The HTLV-1 proviral load was significantly higher in IDH patients than in HTLV-1 carriers. IDH is characterized by an exaggerated Th1 immune response and high HTLV-1 proviral load. The similarities between the immunological response in patients with IDH and HAM/TSP and the high proviral load observed in IDH provide support that IDH is a risk factor for development of HAM/TSP. PMID:19438598

  18. Use of multivariate linear regression and support vector regression to predict functional outcome after surgery for cervical spondylotic myelopathy.

    PubMed

    Hoffman, Haydn; Lee, Sunghoon I; Garst, Jordan H; Lu, Derek S; Li, Charles H; Nagasawa, Daniel T; Ghalehsari, Nima; Jahanforouz, Nima; Razaghy, Mehrdad; Espinal, Marie; Ghavamrezaii, Amir; Paak, Brian H; Wu, Irene; Sarrafzadeh, Majid; Lu, Daniel C

    2015-09-01

    This study introduces the use of multivariate linear regression (MLR) and support vector regression (SVR) models to predict postoperative outcomes in a cohort of patients who underwent surgery for cervical spondylotic myelopathy (CSM). Currently, predicting outcomes after surgery for CSM remains a challenge. We recruited patients who had a diagnosis of CSM and required decompressive surgery with or without fusion. Fine motor function was tested preoperatively and postoperatively with a handgrip-based tracking device that has been previously validated, yielding mean absolute accuracy (MAA) results for two tracking tasks (sinusoidal and step). All patients completed Oswestry disability index (ODI) and modified Japanese Orthopaedic Association questionnaires preoperatively and postoperatively. Preoperative data was utilized in MLR and SVR models to predict postoperative ODI. Predictions were compared to the actual ODI scores with the coefficient of determination (R(2)) and mean absolute difference (MAD). From this, 20 patients met the inclusion criteria and completed follow-up at least 3 months after surgery. With the MLR model, a combination of the preoperative ODI score, preoperative MAA (step function), and symptom duration yielded the best prediction of postoperative ODI (R(2)=0.452; MAD=0.0887; p=1.17 × 10(-3)). With the SVR model, a combination of preoperative ODI score, preoperative MAA (sinusoidal function), and symptom duration yielded the best prediction of postoperative ODI (R(2)=0.932; MAD=0.0283; p=5.73 × 10(-12)). The SVR model was more accurate than the MLR model. The SVR can be used preoperatively in risk/benefit analysis and the decision to operate. PMID:26115898

  19. Congestive Myelopathy due to Intradural Spinal AVM Supplied by Artery of Adamkiewicz: Case Report with Brief Literature Review and Analysis of the Foix-Alajouanine Syndrome Definition

    PubMed Central

    Sood, Dinesh; Mistry, Kewal A.; Khatri, Garvit D.; Chadha, Veenal; Garg, Swati; Suthar, Pokhraj P.; Patel, Dhruv G.; Patel, Ankitkumar

    2015-01-01

    Summary Background Spinal arteriovenous malformations (AVMs) can lead to development of congestive myelopathy (Foix-Alajouanine syndrome). Spinal AVMs are rare and so is this syndrome. Diagnosis is often missed due to its rarity and confusing definitions of the Foix-Alajouanine syndrome. Case Report We report a case of a 47-year-old male patient suffering from this rare syndrome with an AVM arising from the artery of Adamkiewicz, which is another rarity. Our patient was treated by embolization of the lesion with 20% glue, after which he showed mild improvement of symptoms. We also present a brief review of literature on spinal AVMs and elucidate the evolution of the term Foix-Alajouanine syndrome. Conclusions Use of the term “Foix-Alajouanine syndrome” should be restricted to patients with progressive subacute to chronic neurological symptoms due to congestive myelopathy caused by intradural spinal AVMs. CT angiography should supplement DSA as preliminary Imaging modality. Patients may be treated with surgery or endovascular procedures. PMID:26171088

  20. Abnormalities of spinal magnetic resonance images implicate clinical variability in human T-cell lymphotropic virus type I-associated myelopathy.

    PubMed

    Umehara, Fujio; Nose, Hirohisa; Saito, Mineki; Fukuda, Michinari; Ogino, Mieko; Toyota, Tomoko; Yuhi, Tomoaki; Arimura, Kimiyoshi; Osame, Mitsuhiro

    2007-06-01

    This study investigated the role of human T-cell lymphotropic virus type I HTLV-I infection in 11 patients who developed slowly progressive myelopathy with abnormal spinal cord lesions. The authors performed clinical and neuroradiological examinations and calculated the odds that an HTLV-I-infected individual of a specific genotype, age, and provirus load has HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Anti-HTLV-I antibodies were present in both the serum and cerebrospinal fluid in all of the patients. Abnormal magnetic resonance imaging (MRI) lesions were classified as cervical to thoracic type (CT type), cervical type (C type), and thoracic type (T type). In each type, there was swelling of the spinal cords with high-intensity lesions, which were located mainly in bilateral posterior columns, posterior horns, or lateral columns. Virological and immunological analyses revealed that all patients showed a high risk of developing HAM/TSP. These 11 patients may have developed HAM/TSP, as manifested by spinal cord abnormalities shown on MRI. These MRIs implicate clinical variability of HAM/TSP, which may indicate active-early stages of HAM/TSP lesions. PMID:17613716

  1. Comparison of two anterior fusion methods in two-level cervical spondylosis myelopathy: a meta-analysis

    PubMed Central

    Huang, Zhe-Yu; Wu, Ai-Min; Li, Qing-Long; Lei, Tao; Wang, Kang-Yi; Xu, Hua-Zi; Ni, Wen-Fei

    2014-01-01

    Objective The aim of this study was to evaluate the efficacy and safety of anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) for treating two-adjacent-level cervical spondylosis myelopathy (CSM). Design A meta-analysis of the two anterior fusion methods was conducted. The electronic databases of PubMed, the Cochrane Central Register of Controlled Trials, ScienceDirect, CNKI, WANFANG DATA and CQVIP were searched. Quality assessment of the included studies was evaluated using the Cochrane Risk of Bias Tool and the Methodological Index for Non-Randomised Studies criteria. Pooled risk ratios of dichotomous outcomes and standardised mean differences (SMDs) of continuous outcomes were generated. Using the χ2 and I2 tests, the statistical heterogeneity was assessed. Subgroup and sensitivity analyses were also performed. Participants Nine eligible trials with a total of 631 patients and a male-to-female ratio of 1.38:1 were included in this meta-analysis. Inclusion criteria Randomised controlled trials (RCTs) and non-randomised controlled trials that adopted ACCF and ACDF to treat two-adjacent-level CSM were included. Results No significant differences were identified between the two groups regarding hospital stay, the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) scores for neck and arm pain, total cervical range of motion (ROM), fusion ROM, fusion rate, adjacent-level ossification and complications, while ACDF had significantly less bleeding (SMD=1.14, 95% CI (0.74 to 1.53)); a shorter operation time (SMD=1.13, 95% CI (0.82 to 1.45)); greater cervical lordosis, total cervical (SMD=−2.95, 95% CI (−4.79 to −1.12)) and fused segment (SMD=−2.24, 95% CI (−3.31 to −1.17)); higher segmental height (SMD=−0.68, 95% CI (−1.03 to −0.34)) and less graft subsidence (SMD=0.40, 95% CI (0.06 to 0.75)) compared to ACCF. Conclusions The results suggested that ACDF has more advantages compared to ACCF. However, additional high-quality RCTs and a longer follow-up duration are needed. PMID:25031189

  2. Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: a meta-analysis

    PubMed Central

    Fei, Qi; Li, Jinjun; Su, Nan; Wang, Bingqiang; Li, Dong; Meng, Hai; Wang, Qi; Lin, Jisheng; Ma, Zhao; Yang, Yong

    2015-01-01

    Background Whether anterior cervical discectomy with fusion (ACDF) or anterior cervical corpectomy with fusion (ACCF) is superior in the treatment of cervical spondylotic myelopathy remains controversial. Therefore, we conducted a meta-analysis to quantitatively compare the efficacy and safety of ACDF and ACCF in the treatment of cervical spondylotic myelopathy. Methods PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People’s Republic of China), and CNKI (China National Knowledge Infrastructure, People’s Republic of China) were systematically searched to identify all available studies comparing efficacy and safety between patients receiving ACDF and ACCF. The weighted mean difference (WMD) was pooled to compare the Japanese Orthopaedic Association scores, visual analog scale scores, hospital stay, operation time, and blood loss. The risk ratio was pooled to compare the incidence of complications and fusion rate. Pooled estimates were calculated by using a fixed-effects model or a random-effects model according to the heterogeneity among studies. Results Eighteen studies (17 observational studies and one randomized controlled trial) were included in this meta-analysis. Our results suggest that hospital stay (WMD =−1.33, 95% confidence interval [CI]: −2.29, −0.27; P=0.014), operation time (WMD =−26.9, 95% CI: −46.13, −7.67; P=0.006), blood loss (WMD =−119.36, 95% CI: −166.94, −71.77; P=0.000), and incidence of complications (risk ratio =0.51, 95% CI: 0.33, 0.80; P=0.003) in the ACDF group were significantly less than that in the ACCF group. However, other clinical outcomes, including post-Japanese Orthopaedic Association score (WMD =−0.27, 95% CI: −0.57, 0.03; P=0.075), visual analog scale score (WMD =0.03, 95% CI: −1.44, 1.50; P=0.970), and fusion rate (risk ratio =1.04, 95% CI: 0.99, 1.09; P=0.158), between the two groups were not significantly different. Conclusion Evidence from the meta-analysis of 18 studies demonstrated that surgical options of cervical spondylotic myelopathy using ACDF or ACCF seemed to have similar clinical outcomes. However, ACDF was found to be superior to ACCF in terms of hospital stay, operation time, blood loss, and incidence of complications. PMID:26604771

  3. A prospective uncontrolled trial of fermented milk drink containing viable Lactobacillus casei strain Shirota in the treatment of HTLV-1 associated myelopathy/tropical spastic paraparesis.

    PubMed

    Matsuzaki, Toshio; Saito, Mineki; Usuku, Koichiro; Nose, Hirohisa; Izumo, Shuji; Arimura, Kimiyoshi; Osame, Mitsuhiro

    2005-10-15

    Ten patients with human T-cell lymphotropic virus type-1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) were treated in an uncontrolled preliminary trial by oral administration of viable Lactobacillus casei strain Shirota (LcS) containing fermented milk. HTLV-1 provirus load, motor function, neurological findings, and immunological parameters were evaluated after 4 weeks. Although LcS did not change the frequencies or absolute numbers of all the examined cell surface phenotypes of peripheral blood mononuclear cells, NK cell activity was significantly increased after 4 weeks of oral administration of LcS preparation. Improvements in spasticity (modified Ashworth Scale scores) and urinary symptoms were also seen after LcS treatment. No adverse effect was observed in all the 10 patients throughout the study period. Our results indicated that LcS may be a safe and beneficial agent for the treatment of HAM/TSP; therefore randomized controlled studies are warranted. PMID:15961107

  4. Common γ-chain blocking peptide reduces in vitro immune activation markers in HTLV-1-associated myelopathy/tropical spastic paraparesis.

    PubMed

    Massoud, Raya; Enose-Akahata, Yoshimi; Tagaya, Yutaka; Azimi, Nazli; Basheer, Asjad; Jacobson, Steven

    2015-09-01

    Human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a progressive inflammatory myelopathy occurring in a subset of HTLV-1-infected individuals. Despite advances in understanding its immunopathogenesis, an effective treatment remains to be found. IL-2 and IL-15, members of the gamma chain (γc) family of cytokines, are prominently deregulated in HAM/TSP and underlie many of the characteristic immune abnormalities, such as spontaneous lymphocyte proliferation (SP), increased STAT5 phosphorylation in the lymphocytes, and increased frequency and cytotoxicity of virus-specific cytotoxic CD8(+) T lymphocytes (CTLs). In this study, we describe a novel immunomodulatory strategy consisting of selective blockade of certain γc family cytokines, including IL-2 and IL-15, with a γc antagonistic peptide. In vitro, a PEGylated form of the peptide, named BNZ132-1-40, reduced multiple immune activation markers such as SP, STAT5 phosphorylation, spontaneous degranulation of CD8(+) T cells, and the frequency of transactivator protein (Tax)-specific CD8(+) CTLs, thought to be major players in the immunopathogenesis of the disease. This strategy is thus a promising therapeutic approach to HAM/TSP with the potential of being more effective than single monoclonal antibodies targeting either IL-2 or IL-15 receptors and safer than inhibitors of downstream signaling molecules such as JAK1 inhibitors. Finally, selective cytokine blockade with antagonistic peptides might be applicable to multiple other conditions in which cytokines are pathogenic. PMID:26283355

  5. Myelopathy-mimicking symptoms of epidural venous engorgement and syringomyelia due to inferior vena cava stenosis at the thoracolumbar junction in a patient with Budd-Chiari syndrome.

    PubMed

    Lee, Jung-Hee; Song, Wook-Jae; Kang, Kyung-Chung

    2015-10-01

    Epidural venous engorgement can result from various lesions, such as arteriovenous malformation, thrombosis or occlusion of the inferior vena cava (IVC), or an abdominal masslike lesion. Most patients with these problems complain of low-back pain, radicular pain, or neurogenic claudication, which are symptoms suggestive of disc herniation or spinal stenosis. However, these patients rarely exhibit neurological deficits or cauda equina syndrome. The authors encountered a case of a 60-year-old man presenting with lower-extremity weakness and voiding difficulty for a period of 1 year. To investigate the patient's myelopathy-mimicking symptoms, a lumbar spine MRI scan was performed. The MR images exhibited tortuous and dilated spinal vessels compressing the spinal cord and thecal sac at the T11-L3 level, which were concurrent with syringomyelia evidenced by a 22 × 2.5-mm cyst at the T11-12 level. 3D CT scanning of the whole aorta revealed total occlusion and regression of the IVC in the intrahepatic region 3 cm inferior to the right atrium and dilation of multiple collateral veins. The patient was diagnosed with chronic Budd-Chiari syndrome Type I. The authors performed venography, followed by intrahepatic IVC recanalization via stent placement under fluoroscopic and ultra sonographic guidance and without surgical exploration. After this treatment, there was a marked decrease in epidural venous engorgement and the patient's symptoms resolved almost completely. This case indicates that epidural venous engorgement at thoracolumbar levels may cause symptoms suggestive of myelopathy and can be successfully treated by minimally invasive procedures to eliminate the underlying causes. PMID:26140407

  6. Common γ-chain blocking peptide reduces in vitro immune activation markers in HTLV-1-associated myelopathy/tropical spastic paraparesis

    PubMed Central

    Massoud, Raya; Enose-Akahata, Yoshimi; Tagaya, Yutaka; Azimi, Nazli; Basheer, Asjad; Jacobson, Steven

    2015-01-01

    Human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a progressive inflammatory myelopathy occurring in a subset of HTLV-1-infected individuals. Despite advances in understanding its immunopathogenesis, an effective treatment remains to be found. IL-2 and IL-15, members of the gamma chain (γc) family of cytokines, are prominently deregulated in HAM/TSP and underlie many of the characteristic immune abnormalities, such as spontaneous lymphocyte proliferation (SP), increased STAT5 phosphorylation in the lymphocytes, and increased frequency and cytotoxicity of virus-specific cytotoxic CD8+ T lymphocytes (CTLs). In this study, we describe a novel immunomodulatory strategy consisting of selective blockade of certain γc family cytokines, including IL-2 and IL-15, with a γc antagonistic peptide. In vitro, a PEGylated form of the peptide, named BNZ132-1-40, reduced multiple immune activation markers such as SP, STAT5 phosphorylation, spontaneous degranulation of CD8+ T cells, and the frequency of transactivator protein (Tax)-specific CD8+ CTLs, thought to be major players in the immunopathogenesis of the disease. This strategy is thus a promising therapeutic approach to HAM/TSP with the potential of being more effective than single monoclonal antibodies targeting either IL-2 or IL-15 receptors and safer than inhibitors of downstream signaling molecules such as JAK1 inhibitors. Finally, selective cytokine blockade with antagonistic peptides might be applicable to multiple other conditions in which cytokines are pathogenic. PMID:26283355

  7. Acute inflammatory myelopathies.

    PubMed

    Cree, Bruce A C

    2014-01-01

    Inflammatory injury to the spinal cord causes a well-recognized clinical syndrome. Patients typically develop bilateral weakness, usually involving the legs, although the arms may also become affected, in association with a pattern of sensory changes that suggests a spinal cord dermatomal level. Bowel and bladder impairment is also common in many patients. Recognition of the clinical pattern of spinal cord injury should lead clinicians to perform imaging studies to evaluate for compressive etiologies. MRI of the spine is particularly useful in helping visualize intraparenchymal lesions and when these lesions enhance following contrast administration a diagnosis of myelitis is made. Cerebrospinal fluid analysis can also confirm a diagnosis of myelitis when a leukocytosis is present. There are many causes of non-compressive spinal cord injury including infectious, parainfectious, toxic, nutritional, vascular, systemic as well as idiopathic inflammatory etiologies. This review focuses on inflammatory spinal cord injury and its relationships with multiple sclerosis, neuromyelitis optica, acute disseminated encephalomyelitis and systemic collagen vascular and paraneoplastic diseases. PMID:24507538

  8. Complications corner: Anterior thoracic disc surgery with dural tear/CSF fistula and low-pressure pleural drain led to severe intracranial hypotension

    PubMed Central

    Oudeman, Eline A.; Tewarie, Rishi D. S. Nandoe; Jbsis, G. Joost; Arts, Mark P.; Kruyt, Nyika D.

    2015-01-01

    Background: Thoracic disc surgery can lead to a life-threatening complication: intracranial hypotension due to a subarachnoid-pleural fistula. Case Description: We report a 63-year-old male with paraparesis due to multiple herniated thoracic discs, with compressive myelopathy. The patient required a circumferential procedure including a laminectomy/fusion followed by an anterior thoracic decompression to address both diffuse idiopathic skeletal hyperostosis (DISH) anteriorly and posterior stenosis. The postoperative course was complicated by severe intracranial hypotension attributed to the erroneous placement of a low-pressure drain placed in the pleural cavity instead of a lumbar drain; this resulted in subdural hematoma's necessitating subsequent surgery. Conclusion: Severe neurological deterioration occurring after thoracic decompressive surgery may rarely be attributed to intracranial hypotension due to a subarachnoid-pleural fistula. Patients should be treated with external lumbar drainage of cerebrospinal fluid for 35 days rather than a low-pressure pleural drain to avoid the onset of intracranial hypotension leading to symptomatic subdural hematomas. PMID:26005575

  9. [Surgical aspects of the cervical spine in rheumatoid arthritis].

    PubMed

    Grob, D

    2004-10-01

    Approximately 20% percent of the patients with rheumatoid arthritis show pathology in the cervical spine. The translational instability between axis and atlas might be painful and leads in the long term to myelopathic changes due to chronic traumatization of the myelon. Ongoing osseous resorption of the lateral masses of the atlas cause upward migration of the dens into the foramen magnum. In the subaxial cervical spine, the inflammatory process causes instability and deformity. Neck pain is the most common indication for surgery, but neurological symptoms with myelopathy or radicular deficits might be the primary cause for surgery. Neurophysiological investigation is suitable to obtain objective results. Stabilization of the atlantoaxial segment is the most common procedure for treatment of atlantoaxial instability. It is performed by screw fixation technique from a posterior approach. In case of severe occipitocervical dislocation, the fixation has to be extended to the occiput. Persistent dislocation or compression by the dislocated dens has to be treated by transoral decompression. In the subaxial spine, instabilities may be treated by posterior plate fixation with lateral mass screws or pedicle screws. Concomitant nar-rowing of the spinal canal should be approached by anterior decompression with corpectomy and/or posterior laminectomy. The timing of surgery in rheumatoid patients is crucial to obtain satisfactory clinical results. PMID:15375655

  10. Direct analysis of viral-specific CD8+ T cells with soluble HLA-A2/Tax11-19 tetramer complexes in patients with human T cell lymphotropic virus-associated myelopathy.

    PubMed

    Bieganowska, K; Höllsberg, P; Buckle, G J; Lim, D G; Greten, T F; Schneck, J; Altman, J D; Jacobson, S; Ledis, S L; Hanchard, B; Chin, J; Morgan, O; Roth, P A; Hafler, D A

    1999-02-01

    Human T cell lymphotropic virus-I (HTLV-I)-associated myelopathy is a slowly progressive neurologic disease characterized by inflammatory infiltrates in the central nervous system accompanied by clonal expansion of HTLV-I-reactive CD8+ T-cells. In patients carrying the HLA-A2 allele, the immune response is primarily directed to the Tax11-19 peptide. The frequency, activation state, and TCR usage of HLA-A2/Tax11-19 binding T cells in patients with HTLV-I-associated myelopathy was determined using MHC class I tetramers loaded with the Tax11-19 peptide. Circulating Tax11-19-reactive T cells were found at very high frequencies, approaching 1:10 circulating CD8+ T cells. T cells binding HLA-A2/Tax11-19 consisted of heterogeneous populations expressing different chemokine receptors and the IL-2R beta-chain but not the IL-2R alpha-chain. Additionally, Tax11-19-reactive CD8+ T cells used one predominant TCR Vbeta-chain for the recognition of the HLA-A2/Tax11-19 complex. These data provide direct evidence for high frequencies of circulating Tax11-19-reactive CD8+ T cells in patients with HTLV-I-associated myelopathy. PMID:9973440

  11. Spinal stenosis.

    PubMed

    Melancia, João Levy; Francisco, António Fernandes; Antunes, João Lobo

    2014-01-01

    Narrowing of the spinal canal or foramina is a common finding in spine imaging of the elderly. Only when symptoms of neurogenic claudication and/or cervical myelopathy are present is a spinal stenosis diagnosis made, either of the lumbar spine, cervical spine or both (only very rarely is the thoracic spine involved). Epidemiological data suggest an incidence of 1 case per 100 000 for cervical spine stenosis and 5 cases per 100 000 for lumbar spine stenosis. Cervical myelopathy in patients over 50 years of age is most commonly due to cervical spine stenosis. Symptomatic spinal narrowing can be congenital, or, more frequently, acquired. The latter may be the result of systemic illneses, namely endocrinopathies (such as Cushing disease or acromegaly), calcium metabolism disorders (including hyporarthyroidism and Paget disease), inflammatory diseases (such as rheumathoid arthritis) and infectious diseases. Physical examination is more often abnormal in cervical spondylotic myeloptahy whereas in lumbar spinal stenosis it is typically normal. Therefore spinal stenosis diagnosis relies on the clinical picture corresponding to conspicuous causative changes identified by imaging techniques, most importantly CT and MRI. Other ancillary diagnostic tests are more likely to be yielding for establishing a differential diagnosis, namely vascular claudication. Most patients have a progressive presentation and are offered non operative management as first treatment strategy. Surgery is indicated for progressive intolerable symptoms or, more rarely, for the neurologically catastrophic initial presentations. Surgical strategy consists mainly of decompression (depending on the anatomical level and type of narrowing: laminectomy, foraminotomy, discectomy, corporectomy) with additional instrumentation should spinal stability and sagittal balance be at risk. For cervical spine stenosis the main objective of surgery is to halt disease progression. There is class 1b evidence that surgery is of benefit for lumbar stenosis at least in the short term. PMID:24365318

  12. Biomechanical Analysis of Fusion Segment Rigidity Upon Stress at Both the Fusion and Adjacent Segments: A Comparison between Unilateral and Bilateral Pedicle Screw Fixation

    PubMed Central

    Kim, Ho-Joong; Kang, Kyoung-Tak; Chang, Bong-Soon; Lee, Choon-Ki; Kim, Jang-Woo

    2014-01-01

    Purpose The purpose of this study was to investigate the effects of unilateral pedicle screw fixation on the fusion segment and the superior adjacent segment after one segment lumbar fusion using validated finite element models. Materials and Methods Four L3-4 fusion models were simulated according to the extent of decompression and the method of pedicle screws fixation in L3-4 lumbar fusion. These models included hemi-laminectomy with bilateral pedicle screw fixation in the L3-4 segment (BF-HL model), total laminectomy with bilateral pedicle screw fixation (BF-TL model), hemi-laminectomy with unilateral pedicle screw fixation (UF-HL model), and total laminectomy with unilateral pedicle screw fixation (UF-TL model). In each scenario, intradiscal pressures, annulus stress, and range of motion at the L2-3 and L3-4 segments were analyzed under flexion, extension, lateral bending, and torsional moments. Results Under four pure moments, the unilateral fixation leads to a reduction in increment of range of motion at the adjacent segment, but larger motions were noted at the fusion segment (L3-4) in the unilateral fixation (UF-HL and UF-TL) models when compared to bilateral fixation. The maximal von Mises stress showed similar patterns to range of motion at both superior adjacent L2-3 segments and fusion segment. Conclusion The current study suggests that unilateral pedicle screw fixation seems to be unable to afford sufficient biomechanical stability in case of bilateral total laminectomy. Conversely, in the case of hemi-laminectomy, unilateral fixation could be an alternative option, which also has potential benefit to reduce the stress of the adjacent segment. PMID:25048501

  13. Accumulation of human T lymphotropic virus (HTLV)-I-specific T cell clones in HTLV-I-associated myelopathy/tropical spastic paraparesis patients.

    PubMed

    Höger, T A; Jacobson, S; Kawanishi, T; Kato, T; Nishioka, K; Yamamoto, K

    1997-08-15

    Human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraperesis (HAM/TSP) is a slowly progressive neurologic disorder following infection with HTLV-I. It is characterized by spasticity and hyper-reflexia of the lower extremities, urinary bladder disturbance, lower extremity muscle weakness, and sensory disturbances. HTLV-I, as an inducer of a strong humoral and cytotoxic response, is a well-known pathogenic factor for the progression of HAM/TSP. Peptides derived from proviral tax and env genes provide epitopes recognized by T cells. We herein report an accumulation of distinct clonotypes of alpha/beta TCR+ peripheral blood T lymphocytes from HAM/TSP patients in comparison with that observed in both asymptomatic carriers and healthy controls, using the reverse-transcriptase PCR/single-strand conformation polymorphism method. We also found that some of the accumulated T cell clones in the peripheral blood and cerebrospinal fluid are HTLV-I Tax(11-19) peptide specific. Such clones were found to expand strongly after being cultured with an HTLV-I Tax(11-19) peptide. Moreover, the cultured samples exhibited a strong MHC class I-restricted cytotoxic activity against HTLV-I Tax(11-19) peptide-expressing targets, and therefore most likely also include the disease-associated T cell clones observed in the patients. This is the first report of a direct assessment of Ag-specific T cell responses in fresh PBL and cerebrospinal fluid. PMID:9257872

  14. Defective human T-cell lymphotropic virus type I (HTLV-I) provirus in seronegative tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM) patients.

    PubMed

    Ramirez, E; Fernandez, J; Cartier, L; Villota, C; Rios, M

    2003-02-01

    Infection with human T-cell lymphotropic virus type I (HTLV-I) have been associated with the development of the tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). We studied the presence of HTLV-I provirus in peripheral blood mononuclear cells (PBMC) from 72 Chilean patients with progressive spastic paraparesis by polymerase chain reaction: 32 seropositive and 40 seronegative cases. We amplified different genomic regions of HTLV-I using primers of 5' ltr, tax, env/tax, pX, pol and env genes. These genes were detected from all seropositive patients. The seronegative patients were negative with 5' ltr, pol, env, and pX primers. However, amplified product of tax and env/tax genes was detected from 16 and four seronegative patients, respectively. Three of them were positive with both genetic regions. The results of this study show that the complete HTLV-I provirus is found in 100% of seropositive cases. In seronegative cases, clinically very similar of seropositive cases, was found only tax gene in 42.5% (17/40) of patients. These results suggest the presence of a defective HTLV-I provirus in some seronegative patients with progressive spastic paraparesis, and suggest a pathogenic role of this truncate provirus for a group of TSP/HAM. PMID:12573502

  15. High production of RANTES and MIP-1alpha in the tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM).

    PubMed

    Montanheiro, Patricia; Vergara, Maria Paulina Posada; Smid, Jerusa; da Silva Duarte, Alberto José; de Oliveira, Augusto César Penalva; Casseb, Jorge

    2007-08-01

    Human T cell lymphotropic virus type 1 (HTLV-1) infection is associated with progressive neurological disorders and tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM). The pathogenesis of TSP/HAM is considered as immune mediated, involving cytotoxic T cell (CTL) responses to a number of viral proteins and notably the regulation protein Tax. T CD8+ cells produce beta-chemokines, which are important in the anti-viral response. In the present study, we have analyzed the CC chemokines (RANTES, MIP-1beta and MIP-1alpha) production in retrovirus-infected subjects. A total of 191 subjects were studied: 52 healthy controls, 72 asymptomatic HTLV-1-infected carriers and 67 TSP/HAM patients. Peripheral blood mononuclear cells were maintained in the presence or absence of PHA, and supernatant fluids were assayed using EIA. MIP-1beta concentration was not significantly different across groups, but RANTES and MIP-1alpha concentrations showed significant differences when the three groups were compared. In TSP/HAM patients, the increase in the production of chemokines may lead to a recruitment of pro-inflammatory factors, contributing to the membrane's myelin damage. PMID:17588676

  16. Characterization of Thoracic Motor and Sensory Neurons and Spinal Nerve Roots in Canine Degenerative Myelopathy, a Potential Disease Model of Amyotrophic Lateral Sclerosis

    PubMed Central

    Morgan, Brandie R.; Coates, Joan R.; Johnson, Gayle C.; Shelton, G. Diane; Katz, Martin L.

    2014-01-01

    Canine Degenerative Myelopathy (DM) is a progressive adult-onset multisystem degenerative disease with many features in common with amyotrophic lateral sclerosis (ALS). As with some forms of ALS, DM is associated with mutations in superoxide dismutase 1 (SOD1). Clinical signs include general proprioceptive ataxia and spastic upper motor neuron paresis in pelvic limbs, which progress to flaccid tetraplegia and dysphagia. The purpose of this study was to characterize DM as a potential disease model for ALS. We previously reported that intercostal muscle atrophy develops in dogs with advanced stage DM. To determine if other components of the thoracic motor unit (MU) also demonstrated morphological changes consistent with dysfunction, histopathologic and morphometric analyses were conducted on thoracic spinal motor neurons (MN) and dorsal root ganglia (DRG), and in motor and sensory nerve root axons from DM-affected Boxers and Pembroke Welsh Corgis (PWCs). No alterations in MNs, or motor root axons were observed in either breed. However, advanced stage PWCs exhibited significant losses of sensory root axons, and numerous DRG sensory neurons displayed evidence of degeneration. These results indicate that intercostal muscle atrophy in DM is not preceded by physical loss of the motor neurons innervating these muscles, or of their axons. Axonal loss in thoracic sensory roots and sensory nerve death suggest sensory involvement may play an important role in DM disease progression. Further analysis of the mechanisms responsible for these morphological findings would aid in the development of therapeutic intervention for DM and some forms of ALS. PMID:24375814

  17. Clinical and demographic features of HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Rio de Janeiro, Brazil.

    PubMed

    Araújo, A de Q; Alfonso, C R; Schor, D; Leite, A C; de Andrada-Serpa, M J

    1993-07-01

    In Rio de Janeiro (RJ) most cases of paraparesis of obscure origin are associated with the human T-cell lymphotropic virus type I (HTLV-I). Thirty-four consecutive patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) from RJ were evaluated. Most patients came from low socio-economic levels. There was no difference in terms of gender. The main affected racial group was white. A history of sexually transmitted diseases was a major risk factor for HAM/TSP and a positive serology for syphilis was found in 26.5% of the patients. The major clinical findings were of a spastic paraparesis with generalized brisk tendon jerks and bilateral Babinki's sign. Sensation was abnormal in 25 patients (73.5%) and five (14.7%) had a sensory level. Three patients (8.8%) had optic atrophy. The cerebrospinal fluid showed a lymphocytic pleocytosis with a mean total protein content of 0.4 g/litre, and an increased intrathecal IgG synthesis in 59.4% of patients. HAM/TSP and multiple sclerosis (MS) occur indigenously in RJ and some HAM/TSP cases can be sometimes confused with MS. Therefore we propose that, in places where MS coexist with HAM/TSP, HTLV-I antibodies should be sought routinely in those MS suspected cases with prominent spastic paraparesis. PMID:8372632

  18. High-resolution nuclear magnetic resonance spectroscopic study of metabolites in the cerebrospinal fluid of patients with cervical myelopathy and lumbar radiculopathy

    PubMed Central

    Morio, Yasuo; Meshitsuka, Shunsuke; Yamane, Koji; Nanjo, Yoshiro; Teshima, Ryota

    2010-01-01

    There have been few reports describing substances related to oxidative and intermediary metabolism in the cerebrospinal fluid (CSF) in patients with spinal degenerative disorders. This study investigated whether the concentrations of metabolites in the CSF differed between patients with spinal degenerative disorders and controls, and whether the concentrations of these metabolites correlated with the severity of symptoms. CSF samples were obtained from 30 patients with cervical myelopathy (Group M), 30 patients with lumbar radiculopathy (Group R), and 10 volunteers (control). Metabolites in these CSF samples were measured by nuclear magnetic resonance spectroscopy. There were no differences in the concentrations of lactate, alanine, acetate, glutamate, pyruvate, or citrate between Groups M and R, between Group M and the control, or between Group R and the control. In Group M, neither symptom duration nor the Japanese Orthopaedic Association score correlated with the concentration of any metabolite. In Group R, the symptom duration positively correlated with the concentration of lactate, glutamate, and citrate in CSF. The duration of nerve root block showed a negative correlation with the concentrations of acetate in CSF of the patients in Group R. In patients with lumbar radiculopathy, there is a possibility of increased aerobic metabolic activity or decreased gluconeogenic activity in patients with shorter symptom duration, and increased aerobic metabolic activity in patients with severe inflammation around a nerve root. PMID:20490871

  19. HLA DRB1*DQB1* haplotype in HTLV-I-associated familial infective dermatitis may predict development of HTLV-I-associated myelopathy/tropical spastic paraparesis

    SciTech Connect

    LaGrenade, L.; Miller, W.; Pate, E.; Rodgers-Johnson, P.

    1996-01-02

    A possible causal association between infective dermatitis and HTLV-I infection was reported in 1990 and confirmed in 1992. We now report familial infective dermatitis (ID) occurring in a 26-year-old mother and her 9-year-old son. The mother was first diagnosed with ID in 1969 at the age of 2 years in Dermatology Unit at the University Hospital of the West Indies (U.H.W.I.) in Jamacia. The elder of her 2 sons was diagnosed with ID at the age of 3 years, also at U.H.W.I. Both mother and son are HTLV-I-seropositive. A second, younger son, currently age 2 years, is also HTLV-I-seropositive, but without clinical evidence of ID. Major histocompatibility complex (MHC), class II, human leucocyte antigen (HLA) genotyping documented a shared class II haplotype, DRB1*DQB1* (1101-0301), in the mother and her 2 sons. This same haplotype has been described among Japanese patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and has been associated with a possible pathologically heightened immune response to HTLV-I infection. The presence of this haplotype in these familial ID cases with clinical signs of HAM/TSP may have contributed to their risk for development of HAM/TSP. The unaffected, HTLV-I-seropositive, younger son requires close clinical follow-up. 20 refs., 1 fig., 1 tab.

  20. Visualization of HTLV-1Specific Cytotoxic T Lymphocytes in the Spinal Cords of Patients With HTLV-1Associated Myelopathy/Tropical Spastic Paraparesis

    PubMed Central

    Matsuura, Eiji; Kubota, Ryuji; Tanaka, Yuetsu; Takashima, Hiroshi; Izumo, Shuji

    2015-01-01

    Abstract Activated human T-lymphotropic virus type-1 (HTLV-1)specific CD8-positive cytotoxic T lymphocytes (CTLs) are markedly increased in the periphery of patients with HTLV-1associated myelopathy/tropical spastic paraparesis (HAM/TSP), an HTLV-1induced inflammatory disease of the CNS. Although virus-specific CTLs play a pivotal role to eliminate virus-infected cells, the potential role of HTLV-1specific CTLs in the pathogenesis of HAM/TSP remains unclear. To address this issue, we evaluated the infiltration of HTLV-1specific CTLs and the expression of HTLV-1 proteins in the spinal cords of 3 patients with HAM/TSP. Confocal laser scanning microscopy with our unique staining procedure made it possible to visualize HTLV-1specific CTLs infiltrating the CNS of the HAM/TSP patients. The frequency of HTLV-1specific CTLs was more than 20% of CD8-positive cells infiltrating the CNS. In addition, HTLV-1 proteins were detected in CD4-positive infiltrating T lymphocytes but not CNS resident cells. Although neurons were generally preserved, apoptotic oligodendrocytes were frequently in contact with CD8-positive cells; this likely resulted in demyelination. These findings suggest that the immune responses of the CTLs against HTLV-1infected CD4-positive lymphocytes migrating into the CNS resulted in bystander neural damage. PMID:25470342

  1. Therapeutic benefits of an oral vitamin B1 derivative for human T lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis (HAM/TSP).

    PubMed

    Kira, Jun-Ichi

    2013-01-01

    Prosultiamine, a vitamin B1 derivative, has long been used for beriberi neuropathy and Wernicke's encephalopathy. Based on the finding that prosultiamine induces apoptosis in human T lymphotropic virus type I (HTLV-I)-infected T cells, Nakamura et al. conducted a clinical trial of prosultiamine in patients with HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP). In this open-label, single arm study enrolling 24 HAM/TSP patients recently published in BMC Medicine, oral prosultiamine (300 mg/day for 12 weeks) was found to be effective by neurological, urological and virological evaluations. Notably, it increased detrusor pressure, bladder capacity and maximum flow rate, and improved detrusor overactivity and detrusor-sphincter dyssynergia. A significant decrease in HTLV-I copy numbers in peripheral blood following the treatment provided a rationale for using the drug. The trial has some limitations, such as the small numbers of participants, the open-label design, the lack of a placebo arm, and the short trial period. Nevertheless, the observation that such a safe, cheap drug may have excellent therapeutic effects on HAM/TSP, a chronic devastating illness occurring mainly in developing countries, provides support for future large-scale randomized controlled trials.Please see related research: http://www.biomedcentral.com/1741-7015/11/182. PMID:23945332

  2. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of multilevel cervical spondylotic myelopathy: systematic review and a meta-analysis

    PubMed Central

    Wen, Zhi-qiang; Du, Jing-yu; Ling, Zhi-heng; Xu, Hai-dong; Lin, Xiang-jin

    2015-01-01

    Background To date, the decision to treat multilevel cervical spondylotic myelopathy (CSM) with anterior cervical discectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) remains controversial. Therefore, we conducted a meta-analysis to quantitatively determine the efficacy of ACDF and ACCF in the treatment of multilevel CSM. Methods We searched several databases for related research articles published in English or Chinese. We extracted and assessed the data independently. We determined the pooled data, data heterogeneity, and overall effect, respectively. Results We identified 15 eligible studies with 1,368 patients. We found that blood loss and numbers of complications during surgery in ACDF were significantly less that in ACCF; however, other clinical outcomes, such as operation time, bone fusion failure, post Japanese Orthopedic Association scores, recovery rates, and visual analog scale scores between ACDF and ACCF with multilevel CSM were not significantly different. Conclusion Our results strongly suggest that surgical treatments of multilevel CSM are similar in terms of most clinical outcomes using ACDF or ACCF. PMID:25673996

  3. Physalin F, a seco-steroid from Physalis angulata L., has immunosuppressive activity in peripheral blood mononuclear cells from patients with HTLV1-associated myelopathy.

    PubMed

    Pinto, Lorena A; Meira, Cássio S; Villarreal, Cristiane F; Vannier-Santos, Marcos A; de Souza, Claudia V C; Ribeiro, Ivone M; Tomassini, Therezinha C B; Galvão-Castro, Bernardo; Soares, Milena B P; Grassi, Maria F R

    2016-04-01

    Human T-lymphotropic virus type 1 (HTLV-1) induces a strong activation of the immune system, especially in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Physalin F is a secosteroid with potent anti-inflammatory and immunomodulatory activities. The present study aimed to investigate the effects of physalin F on peripheral blood mononuclear cells (PBMC) of HAM/TSP subjects. A concentration-dependent inhibition of spontaneous proliferation of PBMC from HAM/TSP subjects was observed in the presence of physalin F, as evaluated by (3)H-thymidine uptake. The IC50 for physalin F was 0.97±0.11μM. Flow cytometry analysis using Cytometric Bead Array (CBA) showed that physalin F (10μM) significantly reduced the levels of IL-2, IL-6, IL-10, TNF-α and IFN-γ, but not IL-17A, in supernatants of PBMC cultures. Next, apoptosis induction was addressed by using flow cytometry to evaluate annexin V expression. Treatment with physalin F (10μM) increased the apoptotic population of PBMC in HAM/TSP subjects. Transmission electron microscopy analysis of PBMC showed that physalin F induced ultrastructural changes, such as pyknotic nuclei, damaged mitochondria, enhanced autophagic vacuole formation, and the presence of myelin-like figures. In conclusion, physalin F induces apoptosis of PBMC, decreasing the spontaneous proliferation and cytokine production caused by HTLV-1 infection. PMID:27044821

  4. Midline Splitting Cervical Laminoplasty Using Allogeneic Bone Spacers: Comparison of Fusion Rates between Cervical Spondylotic Myelopathy and Ossification of Posterior Longitudinal Ligament

    PubMed Central

    Sheen, Jae Jon

    2014-01-01

    Objective To analyze factors associated with fusion using allogeneic bone spacers for midline splitting cervical laminoplasty (MSCL). Methods During April 2012 and September 2013, seventeen patients with cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) underwent MSCL with allogeneic bone spacers by a single surgeon. Mean follow up periods was 11.3 months (range, 6-19 months). Clinical outcomes were evaluated by the Japanese Orthopedic Association (JOA) scores at preoperative and postoperative 6 months. Simple cervical X-rays were taken preoperatively, immediate postoperatively, 3, and 6 months after operation. Computed tomography (CT) scans were performed preoperatively, immediate postoperatively and 6 months postoperatively. The differences between two diseases were analyzed on cervical lordosis, canal dimension, anteroposterior (AP) distance, fusion between lamina and allogeneic bone spacer and affecting factors of fusion. Results All surgeries were performed on 59 levels. There were no significant differences on the changes of lordosis (p=0.602), canal dimension (p=0.554), and AP distance (p=0.924) as well as JOA scores (p=0.257) between CSM and OPLL groups. Overall fusion rate was 51%. Multivariate analysis on the factor for the fusion rates between lamina and spacers showed that the immediate postoperative contact status between lamina and spacers in CT as significant factor of fusion (p=0.024). Conclusion The present study suggests that CSM and OPLL did not show difference of surgical outcome in MSCL using allogeneic bone spacer. In addition, we should consider the contact status between lamina and bone spacer for the better fusion rates for this surgery. PMID:27169035

  5. [Manifestation of primary biliary cirrhosis and Basedow's disease caused by exposure to carbon monoxide in a patient with HTLV-1 associated myelopathy].

    TOXLINE Toxicology Bibliographic Information

    Takigawa H; Kowa H; Kitayama M; Doi S; Araga S; Nakashima K

    2000-04-01

    A 55-year-old woman with HTLV-1 associated myelopathy (HAM) was discovered in a rentan kotatsu (Japanese foot warmer with a frame and a coverlet by burning briquet) with conscious disorder and admitted to an emergency hospital. Her conscious disturbance waned the 3rd day after admission with gradual improvement of communication and food intake. However, on the 18th day after admission, her orientation was poor again and she was unable to take food for herself and keep sitting. She was diagnosed as suffering from an interval form of acute carbon monoxide (CMO) poisoning and transferred to our hospital for the purpose of hyperbaric oxygen therapy on the 20th day after exposure to CMO. In the course of treatment she recovered but showed jaundice, pruritus, liver dysfunction and elevation of antimitochondrial antibody. She received liver biopsy and was found to have primary biliary cirrhosis (PBC). On the 150th day, she manifested perspiration and hypertension. The clinical and immunological feature revealed her Basedow's disease. The relationship between HAM and PBC due to the autoimmune process has been predicted by investigators. The implication of autoimmune disease and HLA haplotype is a main focus of attention. Our case supports their hypothesis, and suggested that the complication occurred with immunological and genetic correlation. Anti-HTLV-1 antibody was positive at a titer of 1:8192 before exposure to CMO. On transferring to us, it was negative and revealed excessive positive at a titer of 1:20,480 on the 80th day. Immunoglobulin analysis was normal on admission and increased during hospitalization. It was reported that prenatal exposure to relatively mild concentrations of CMO in rats reduces splenic macrophage phagocytosis and killing ability as well as macrophage respiratory burst. These data suggested that PBC and Basedow's disease were manifested by exposure to carbon monoxide.

  6. A Review of Fibrocartilaginous Embolic Myelopathy and Different Types of Peracute Non-Compressive Intervertebral Disk Extrusions in Dogs and Cats

    PubMed Central

    De Risio, Luisa

    2015-01-01

    This review discusses terminology, pathological, clinical, and magnetic resonance imaging (MRI) findings, treatment, outcome, and prognostic factors of fibrocartilaginous embolic myelopathy (FCEM), acute non-compressive nucleus pulposus extrusion (ANNPE), and intradural/intramedullary intervertebral disk extrusion (IIVDE). FCEM, ANNPE, and IIVDE have a similar clinical presentation characterized by peracute onset of neurological dysfunction that is generally non-progressive after the initial 24–48 h. Differentiating between these conditions can be challenging, however, certain clinical and imaging findings can help. FCEM can occur in both adult and immature animals, whereas ANNPE or IIVDE have been reported only in animals older than 1 year. In dogs, ANNPE and IIVDE most commonly occur in the intervertebral disk spaces between T12 and L2, whereas FCEM has not such site predilection. In cats, FCEM occurs more frequently in the cervical spinal cord than in other locations. Data on cats with ANNPE and IIVDE are limited. Optimal MRI definition and experience in neuroimaging can help identify the findings that allow differentiation between FCEM, ANNPE, and IIVDE. In animals with ANNPE and IIVDE, the affected intervertebral disk space is often narrowed and the focal area of intramedullary hyperintensity on T2-weighted images is located above the affected intervertebral disk space. In dogs with ANNPE signal changes associated with the extruded nucleus pulposus and epidural fat disruption can be identified in the epidural space dorsal to the affected intervertebral disk. Identification of a linear tract (predominantly hyperintense on T2-weighted images, iso to hypointense on T1-weighted images and hypointense on T2*-weighted gradient recall echo images) extending from the intervertebral disk into the spinal cord parenchyma is highly suggestive of IIVDE. Treatment of FCEM and ANNPE is conservative. Dogs reported with IIVDE have been managed either conservatively or surgically. Prognostic factors include degree of neurological dysfunction (particularly loss of nociception) and disease-specific MRI variables. PMID:26664953

  7. Texture-based characterization of pre- and post-operative T2-weighted magnetic resonance signals of the cervical spinal cord in cervical spondylotic myelopathy

    NASA Astrophysics Data System (ADS)

    Boniatis, Ioannis; Klironomos, George; Gatzounis, George; Panayiotakis, George

    2009-10-01

    The utility of texture analysis regarding the provision of quantitative prognostic factors, potentially valuable to the prediction of the post-operative outcome of cervical spondylotic myelopathy (CSM) patients, is investigated. The clinical sample of the study comprised six subjects, who had undergone surgical therapeutic intervention for CSM. Following a specific imaging protocol, a pair of MR images of the cervical spine, corresponding to pre- and post-operative MR scans, was obtained for each of the patients. Accordingly, 12 sagittal T2-weighted magnetic resonance (MR) images were studied. Employing custom developed software, a Region Of Interest (ROI) within the spinal cord, corresponding to the region of the high-intensity CSM MR signal, was segmented on each image, according to the region growing method. Utilizing custom developed algorithms, the following sets of textural features were generated from the segmented ROIs: (i) gradient features, (ii) mean values of features from co-occurrence matrices (co-occurrence features) and (iii) range values of co-occurrence features. Utilizing each one of these sets of features, as well as the least-squares minimum distance and the quadratic classification algorithms, pattern recognition classification schemes were implemented for the discrimination between pre-operative and post-operative MR signals. Statistical analysis revealed the existence of statistically significant differences (p < 0.05) between textural features generated from pre-operative and post-operative high-intensity MR signals. The classification accuracies accomplished ranged from 75% to 100%. Textural features, descriptive of relevant properties of the high-intensity MR signal in CSM, may be considered as quantitative information of potential value for the prediction of the post-operative outcome of CSM patients.

  8. Development and characterization of a novel rat model of cervical spondylotic myelopathy: the impact of chronic cord compression on clinical, neuroanatomical, and neurophysiological outcomes.

    PubMed

    Lee, JangBo; Satkunendrarajah, Kajana; Fehlings, Michael G

    2012-03-20

    Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord impairment worldwide and is a risk factor for traumatic central cord syndrome. Despite advances in surgery, there are no effective neuroprotective treatments for CSM, which reflects a limited understanding of its pathophysiology. In order to develop therapeutic strategies, we have developed a novel rat model of chronic progressive cervical spinal cord compression that mimics CSM. A titanium-screw-based chronic compression device (CCD) was designed to achieve progressive cord compression at the C6 level. The CCD was fixed to the C2 and T2 spinous processes and a threaded screw was turned to induce compression. Sprague-Dawley rats (n=75) were divided into three groups: (1) sham (no compression, n=6), (2) mild compression (1.4 mm stenosis, n=27), and (3) severe compression (2.6 mm stenosis, n=42). Compression was evaluated using micro-computed tomography (micro-CT). The area of spared white matter, extent of cord flattening ratio, and loss of neurons were assessed. Functional deficits were characterized using sensory-evoked potential (SEP) recordings, and with neurobehavioral tests: the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale, inclined plane, paw grip strength, and assessment of mechanical and thermal allodynia. Micro-CT confirmed progressive canal stenosis. The loss of intact white matter and cord flattening were significantly greater in rats with severe cord compression, and the number of neurons was reduced at the epicenter of cord compression. With chronic cord compression there was a significant decline in locomotor function, forelimb function, trunk stability/coordination, an increase in mechanical allodynia, and impaired axonal conduction. The CCD model results in chronic and precise cervical cord compression. The compression is associated with mechanical allodynia and measurable neurobehavioral, neurophysiological, and neuropathological deficits. We anticipate that the CCD model will enable the investigation of translationally-relevant therapeutic strategies for CSM. PMID:21561323

  9. [Manifestation of primary biliary cirrhosis and Basedow's disease caused by exposure to carbon monoxide in a patient with HTLV-1 associated myelopathy].

    PubMed

    Takigawa, H; Kowa, H; Kitayama, M; Doi, S; Araga, S; Nakashima, K

    2000-04-01

    A 55-year-old woman with HTLV-1 associated myelopathy (HAM) was discovered in a rentan kotatsu (Japanese foot warmer with a frame and a coverlet by burning briquet) with conscious disorder and admitted to an emergency hospital. Her conscious disturbance waned the 3rd day after admission with gradual improvement of communication and food intake. However, on the 18th day after admission, her orientation was poor again and she was unable to take food for herself and keep sitting. She was diagnosed as suffering from an interval form of acute carbon monoxide (CMO) poisoning and transferred to our hospital for the purpose of hyperbaric oxygen therapy on the 20th day after exposure to CMO. In the course of treatment she recovered but showed jaundice, pruritus, liver dysfunction and elevation of antimitochondrial antibody. She received liver biopsy and was found to have primary biliary cirrhosis (PBC). On the 150th day, she manifested perspiration and hypertension. The clinical and immunological feature revealed her Basedow's disease. The relationship between HAM and PBC due to the autoimmune process has been predicted by investigators. The implication of autoimmune disease and HLA haplotype is a main focus of attention. Our case supports their hypothesis, and suggested that the complication occurred with immunological and genetic correlation. Anti-HTLV-1 antibody was positive at a titer of 1:8192 before exposure to CMO. On transferring to us, it was negative and revealed excessive positive at a titer of 1:20,480 on the 80th day. Immunoglobulin analysis was normal on admission and increased during hospitalization. It was reported that prenatal exposure to relatively mild concentrations of CMO in rats reduces splenic macrophage phagocytosis and killing ability as well as macrophage respiratory burst. These data suggested that PBC and Basedow's disease were manifested by exposure to carbon monoxide. PMID:10967651

  10. Electrophysiological Analysis Shows Dizziness as the First Symptom in Human T Cell Lymphotropic Virus Type-Associated Myelopathy/Tropical Spastic Paraparesis

    PubMed Central

    Labanca, Ludimila; Starling, Ana Lúcia Borges; de Sousa-Pereira, Silvio Roberto; Romanelli, Luiz Cláudio Ferreira; Carneiro-Proietti, Anna Bárbara de Freitas; Carvalho, Lucas Novaes; Fernandes, Daniele Rosa

    2015-01-01

    Abstract Dizziness is a symptom in human T cell lymphotropic virus type-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and may occur due to vestibulospinal tract dysfunction. This tract can be assessed by an electrophysiological test called vestibular-evoked myogenic potential (VEMP). The aim was to correlate the result of VEMP generated by acoustic stimuli and dizziness in individuals with human T cell lymphotropic virus type 1 (HTLV-1)-asymptomatic infection and HAM/TSP. VEMP was recorded from the sternocleidomastoid muscle of 60 HTLV-1-negative adults (60±8 years) and 60 individuals infected with HTLV-1, 30 being asymptomatic (59±8 years) and 30 with HAM/TSP (59±8 years). In all groups, 90% of the participants were women. VEMP was generated by acoustic stimuli (short tone bursts), with an intensity of 118 dBHL and band-pass filter from 10 Hz to 1,500 Hz, and presented 200 stimuli at a frequency of 1,000 Hz with a record time of 60 ms. Of 60 HTLV-1-negative individuals, 14 (23%) reported dizziness; VEMP was normal in all. In the HTLV-1-asymptomatic group, 11(37%) complained of dizziness (p=0.31); VEMP was altered in four (40%) subjects with dizziness and in one (5%) without dizziness (p=0.00). In the group with HAM/TSP, dizziness was reported by 17 (57%) subjects (p=0.002); VEMP was altered in 11 (64%) with dizziness and in 5 (38%) without dizziness (p=0.15). Dizziness without an apparent etiology in HTLV-1-asymptomatic carriers deserves attention in terms of a possible subclinical spinal cord involvement that can be clarified through spinal electrophysiological tests. Damage of the vestibulospinal tract seems to occur in the early stages of HAM/TSP. PMID:25760424

  11. CD80+ and CD86+ B cells as biomarkers and possible therapeutic targets in HTLV-1 associated myelopathy/tropical spastic paraparesis and multiple sclerosis

    PubMed Central

    2014-01-01

    Background Human T-cell lymphotropic virus (HTLV-1) is the causative agent of the incapacitating, neuroinflammatory disease HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Currently, there are no disease-modifying therapies with long-term clinical benefits or validated biomarkers for clinical follow-up in HAM/TSP. Although CD80 and CD86 costimulatory molecules play prominent roles in immune regulation and reflect disease status in multiple sclerosis (MS), data in HAM/TSP are lacking. Methods Using flow cytometry, we quantified ex vivo and in vitro expression of CD80 and CD86 in PBMCs of healthy controls, HTLV-1-infected individuals with and without HAM/TSP, and MS patients. We hypothesized ex vivo CD80 and CD86 expressions and their in vitro regulation by interferon (IFN)-α/β mirror similarities between HAM/TSP and MS and hence might reveal clinically useful biomarkers in HAM/TSP. Results Ex vivo expression of CD80 and CD86 in T and B cells increased in all HTLV-1 infected individuals, but with a selective defect for B cell CD86 upregulation in HAM/TSP. Despite decreased total B cells with increasing disease duration (p = 0.0003, r = −0.72), CD80+ B cells positively correlated with disease severity (p = 0.0017, r = 0.69) in HAM/TSP. B cell CD80 expression was higher in women with HAM/TSP, underscoring that immune markers can reflect the female predominance observed in most autoimmune diseases. In contrast to MS patients, CD80+ (p = 0.0001) and CD86+ (p = 0.0054) lymphocytes expanded upon in vitro culture in HAM/TSP patients. The expansion of CD80+ and CD86+ T cells but not B cells was associated with increased proliferation in HTLV-1 infection. In vitro treatment with IFN-β but not IFN-α resulted in a pronounced increase of B cell CD86 expression in healthy controls, as well as in patients with neuroinflammatory disease (HAM/TSP and MS), similar to in vivo treatment in MS. Conclusions We propose two novel biomarkers, ex vivo CD80+ B cells positively correlating to disease severity and CD86+ B cells preferentially induced by IFN-β, which restores defective upregulation in HAM/TSP. This study suggests a role for B cells in HAM/TSP pathogenesis and opens avenues to B cell targeting (with proven clinical benefit in MS) in HAM/TSP but also CD80-directed immunotherapy, unprecedented in both HAM/TSP and MS. PMID:24472094

  12. The 2-Year Cost-Effectiveness of 3 options to Treat Lumbar Spinal Stenosis Patients

    PubMed Central

    Udeh, Belinda L.; Costandi, Shrif; Dalton, Jarrod E.; Ghosh, Raktim; Yousef, Hani; Mekhail, Nagy

    2016-01-01

    Lumbar spinal stenosis (LSS) may result from degenerative changes of the spine, which lead to neural ischemia, neurogenic claudication, and a significant decrease in quality of life. Treatments for LSS range from conservative management including epidural steroid injections (ESI) to laminectomy surgery. Treatments vary greatly in cost and success. ESI is the least costly treatment may be successful for early stages of LSS but often must be repeated frequently. Laminectomy surgery is more costly and has higher complication rates. Minimally invasive lumbar decompression (mild®) is an alternative. Using a decision-analytic model from the Medicare perspective, a cost-effectiveness analysis was performed comparing mild® to ESI or laminectomy surgery. The analysis population included patients with LSS who have moderate to severe symptoms and have failed conservative therapy. Costs included initial procedure, complications, and repeat/revision or alternate procedure after failure. Effects measured as change in quality-adjusted life years (QALY) from preprocedure to 2 years postprocedure. Incremental cost-effectiveness ratios were determined, and sensitivity analysis conducted. The mild® strategy appears to be the most cost-effective ($43,760/QALY), with ESI the next best alternative at an additional $37,758/QALY. Laminectomy surgery was the least cost-effective ($125,985/QALY). PMID:24393198

  13. The Roads to Mitochondrial Dysfunction in a Rat Model of Posttraumatic Syringomyelia

    PubMed Central

    Hu, Zhiqiang

    2015-01-01

    The pathophysiology of posttraumatic syringomyelia is incompletely understood. We examined whether local ischemia occurs after spinal cord injury. If so, whether it causes neuronal mitochondrial dysfunction and depletion, and subsequent energy metabolism impairment results in cell starvation of energy and even cell death, contributing to the enlargement of the cavity. Local blood flow was measured in a rat model of posttraumatic syringomyelia that had received injections of quisqualic acid and kaolin. We found an 86 ± 11% reduction of local blood flow at C8 where a cyst formed at 6 weeks after syrinx induction procedure (P < 0.05), and no difference in blood flow rate between the laminectomy and intact controls. Electron microscopy confirmed irreversible neuronal mitochondrion depletion surrounding the cyst, but recoverable mitochondrial loses in laminectomy rats. Profound energy loss quantified in the spinal cord of syrinx animals, and less ATP and ADP decline observed in laminectomy rats. Our findings demonstrate that an excitotoxic injury induces local ischemia in the spinal cord and results in neuronal mitochondrial depletion, and profound ATP loss, contributing to syrinx enlargement. Ischemia did not occur following laminectomy induced trauma in which mitochondrial loss and decline in ATP were reversible. This confirms excitotoxic injury contributing to the pathology of posttraumatic syringomyelia. PMID:25685811

  14. Role of posterior elements in the disc bulging of a degenerated cervical spine

    PubMed Central

    Solitro, Giovanni F.; Siemionow, Kris; Drucker, David; Upadhyay, Ashish; Patel, Priyesh

    2015-01-01

    Background Many studies have been developed to characterize the mechanical behavior of the intervertebral disc specifically for the lumbar spine and there have been limited studies done on the cervical spine with the goal to evaluate the strength of the cervical spine under compression without any information on the bulging of the intervertebral discs. The goal of the current study is to examine the deformation response of the cervical intervertebral disc classified with grade III or greater degeneration and analyze the relationship between axial deformation and anterior and posterior bulge under compression up to 550 N. Methods Each specimen was compressed for 3 cycles to a maximum load of 550N in steps of 50 N. The bulge was measured using Linear Variable Differential Transformers (LVDTs on an intact spinal segment, spinal segment with post laminectomy, and spinal segment post facetectomy. Results The anterior budge for an intact spinal segment shows a change of slope at loads of 262N±66N. For a physiological load of 250N the vertical displacement or spine segment height was reduced by 10.1% for an intact segment and 8.78% for the laminectomy and facetectomy configurations with F = 0.159 (Fcrit = 3.89) with no statistical difference observed. For the post laminectomy there was a decrease of 35% in anterior bulge compared to the intact specimen. Conclusions Our results show that for grade III disc degeneration the cervical segments bulging for both the laminectomy and facetectomy procedures are not significantly different. In post laminectomy the average anterior and posterior bulges are similar to the average anterior and posterior bulge post facetectomy. PMID:26056628

  15. A biomechanical study of the recovery in spinal stability of flexion/extension and torsion after the resection of different posterior lumbar structures in a sheep model.

    PubMed

    Jia, Haobo; Zhu, Shaowen; Ma, Jianxiong; Wang, Jie; Feng, Rui; Xing, Dan; Yang, Yang; Ma, Baoyi; Chen, Yang; Yu, Jingtao; Ma, Xinlong

    2013-08-01

    Posterior lumbar structures are vital for spinal stability, and many researchers thought that laminectomy and facetectomy would lead to severe spinal instability. However, because living organisms have compensatory repair capacities, their long-term condition after injuries may change over time. To study the changes in the lumbar biomechanical stability of flexion/extension and torsion at different time points after the resection of various posterior structures, as well as to assess the capacity for self-healing, sheep that had undergone laminectomy or facetectomy were used as an experimental animal model. The injured sheep models included three groups: laminectomy only, laminectomy plus left total facetectomy, and laminectomy plus bilateral facetectomy. Eight nonoperative sheep were used as the control group. At 0, 6, 12, 24, and 36 weeks after injury, the lumbar specimens were harvested for biomechanical testing using the Instron 8874 servohydraulic biomechanical testing system. The changes in the injured lumbar spine were also analyzed through radiological examination. The lumbar stability in flexion/extension and torsion was severely decreased after the three types of surgery. After 6 weeks, the flexion/extension mechanical parameters recovered substantially; each parameter had returned to normal levels by 12 weeks and exceeded the intact group by 24 and 36 weeks. Torsional stiffness also recovered gradually over time. All injury groups demonstrated decreased intervertebral space and degeneration or even fusion in the small joints of the surgical segment or in adjacent segments. These results indicate that the body has the ability to repair the mechanical instability to a certain extent. PMID:23695650

  16. Cervical Stenosis, Myelopathy and Radiculopathy

    MedlinePlus

    ... the disc space and a metal plate and screws will be used to stabilize two vertebra. Anterior ... make room for the spinal cord. Occasionally metal screws and plates are used following either of these ...

  17. Amyotrophic cervical myelopathy in adolescence.

    PubMed Central

    Toma, S; Shiozawa, Z

    1995-01-01

    The clinical and radiological features in seven patients who had asymmetric muscular atrophy of the hand and forearm when young are reported and a new hypothesis for its aetiology is proposed. Investigation of body growth curves (a surrogate for velocity of arm growth) showed close relation between (a) the age when the body height increased most rapidly and the onset age of this disorder, and (b) the age when the rapid body growth period ended and the age when symptom progression ceased. Cervical radiological evidence is provided showing asymmetric anterior cord atrophy, disappearance of slackness of dorsal roots in neck extension, and anterior and lateral displacement of the lower cervical cord against the posterior aspects of the vertebral bodies during neck flexion. These results suggest that disproportionate shortening of the dorsal roots is further accentuated during the juvenile growth spurt, which determines the onset and self limited course of the condition, and that repeated neck flexion causes micro-trauma and relative ischaemia of anterior horn cells, which finally results in atrophy of the muscles innervated by motoneurons with long axons. Predisposing anatomical factors are a straight neck due to lack of physiological cervical lordosis and the presence of foreshortened dorsal roots. Images PMID:7823068

  18. C-5 palsy after cerebrospinal fluid diversion in posttraumatic syringomyelia: case report.

    PubMed

    Ghobrial, George M; Beygi, Sara; Viereck, Matthew J; Heller, Joshua E; Sharan, Ashwini; Jallo, Jack; Harrop, James S; Prasad, Srinivas

    2015-04-01

    Syringomyelia is a potentially debilitating disease that involves abnormal CSF flow mechanics; its incidence after traumatic spinal cord injury (SCI) is approximately 15%. Treatment consists of restoration of CSF flow, typically via arachnoidolysis and syrinx decompression. The authors present a case of pronounced syringomyelia in a patient with concomitant severe cervical myelomalacia to demonstrate unilateral C-5 palsy as a potential complication of aggressive syrinx decompression at a remote level. A 56-year-old man with a remote history of SCI at T-11 (ASIA [American Spinal Injury Association] Grade A) presented with complaints of ascending motor and sensory weakness into the bilateral upper extremities that had progressed over 1 year. MRI demonstrated severe distortion of the spinal cord at the prior injury level of T10-11, where an old anterior column injury and prior hook-rod construct was visualized. Of note, the patient had a holocord syrinx with demonstrable myelomalacia. To restore CSF flow and decompress the spinal cord, T-2 and T-3 laminectomies, followed by arachnoidolysis and syringopleural shunt placement, were performed. Postoperatively on Day 1, with the exception of a unilateral deltoid palsy, the patient had immediate improvement in upper-extremity strength and myelopathy. He was discharged from the hospital on postoperative Day 5; however, at his 2-week follow-up visit, a persistent unilateral deltoid palsy was noted. MRI demonstrated a significant reduction in the holocord syrinx, no neural foraminal stenosis, and a significant positional shift of the ventral spinal cord. Further motor recovery was noted at the 8-month follow-up. Syringomyelia is a debilitating disease arising most often as a result of traumatic SCI. In the setting of myelomalacia with a pronounced syrinx, C-5 palsy is a potential complication of syrinx decompression. PMID:25658467

  19. Cervical spondylosis. An update.

    PubMed Central

    McCormack, B M; Weinstein, P R

    1996-01-01

    Cervical spondylosis is caused by degenerative disc disease and usually produces intermittent neck pain in middle-aged and elderly patients. This pain usually responds to activity modification, neck immobilization, isometric exercises, and medication. Neurologic symptoms occur infrequently, usually in patients with congenital spinal stenosis. For these patients, magnetic resonance imaging is the preferred initial diagnostic study. Because involvement of neurologic structures on imaging studies may be asymptomatic, consultation with a neurologist is advised to rule out other neurologic diseases. In most cases of spondylotic radiculopathy, the results of conservative treatment are so favorable that surgical intervention is not considered unless pain persists or unless there is progressive neurologic deficit. If indicated, a surgical procedure may be done through the anterior or posterior cervical spine; results are gratifying, with long-term improvement in 70% to 80% of patients. Cervical spondylotic myelopathy is the most serious and disabling condition of this disease. Because many patients have nonprogressive minor impairment, neck immobilization is a reasonable treatment in patients presenting with minor neurologic findings or in whom an operation is contraindicated. This simple remedy will result in improvement in 30% to 50% of patients. Surgical intervention is indicated for patients presenting with severe or progressive neurologic deficits. Anterior cervical approaches are generally preferred, although there are still indications for laminectomy. Surgical results are modest, with good initial results expected in about 70% of patients. Functional outcome noticeably declines with long-term follow-up, which raises the question of whether, and how much, surgical treatment affects the natural course of the disease. Prospective randomized studies are needed to answer these questions. Images Figure 1. Figure 2. Figure 3. PMID:8855684

  20. Post laminoplasty cervical kyphosis—Case report

    PubMed Central

    Dugoni, D.E.; Mancarella, C.; Landi, A.; Tarantino, R.; Ruggeri, A.G.; Delfini, R.

    2014-01-01

    INTRODUCTION Cervical kyphosis is a progressive cervical sagittal plane deformity that may cause a reduction in the ability to look horizontally, breathing and swallowing difficulties, sense of thoracic oppression and social isolation. Moreover, cervical kyphosis can cause myelopathy due to a direct compression by osteo-articular structures on the spinal cord or to a transitory ischaemic injury. The treatment of choice is surgery. The goals of surgery are: nervous structures decompression, cervical and global sagittal balance correction and vertebral stabilization and fusion. PRESENTATION OF CASE In October 2008 a 35 years old woman underwent surgical removal of a cervical-bulbar ependymoma with C1–C5 laminectomy and a C2–C5 laminoplasty. Five months after surgery, the patient developed a kyphotic posture, with intense neck and scapular girdle pain. The patients had a flexible cervical kyphosis. Therefore, we decided to perform an anterior surgical approach. We performed a corpectomy C4–C5 in order to achieve the anterior decompression; we placed a titanium expansion mesh. DISCUSSION Cervical kyphosis can be flexible or fixed. Some authors have reported the use of anterior surgery only for flexible cervical kyphosis as discectomy and corpectomy. This approach is useful for anterior column load sharing however it is not required for deformity correction. CONCLUSION The anterior approach is a good surgical option in flexible cervical kyphosis. It is of primary importance the sagittal alignment of the cervical spine in order to decompress the nervous structures and to guarantee a long-term stability. PMID:25462050

  1. New Technique for C1 Double-Door Laminoplasty Using Allograft Spacers and Titanium Miniplate Screw Fixation: Technical Report.

    PubMed

    Kim, Seok Woo; Lee, Jae-Hoo; Lee, Ho-Won; Oh, Jae-Keun; Kwak, Yoon-Hae

    2016-03-01

    Although conventional C1 laminectomy is the gold standard for decompression at the atlas, it provides little space for the bone graft to fuse. The fusion area can be extended cranially up to the occipital bone, but it requires sacrificing the function of the craniocervical junction. To date, no reports have focused on surgical techniques for successful decompression and fusion without disruption of the posterior C1 arch while providing enough room for the bone graft to fuse. This study introduces a new technique for C1-C2 fusion and C1 double-door laminoplasty in patients with C1-C2 instability, canal stenosis, and cervical spondylotic myelopathy. A 66-year-old man who had undergone C1-C2 fusion at a local clinic 2 years earlier visited our hospital due to progressive myelopathy. A preoperative computed tomography (CT) scan showed the tip of the odontoid process, extending into the spinal canal. On the axial view of T2-weighted magnetic resonance images, the tip of the odontoid process significantly compressed the spinal cord on the left side. The atlantodental interval was 7 mm on radiography; however, C1-C2 instability was not evident on flexion-extension X-rays due to the previous screw fixation. The patient underwent C1-C2 decompression and fusion surgery with our new surgical technique. The segmental screws were repositioned at C1 and C2, and we performed C1 double-door laminoplasty augmented with an allograft spacer and a titanium miniplate. A marked reduction was seen at postoperative radiograph and CT scan. Neurologic symptoms were relieved dramatically after surgery without any discomfort. No complications were noted. We introduced a new surgical technique that allows bone grafting, decompression, and fusion to be performed without disruption of the posterior C1 arch in the event of C1-C2 canal stenosis combined with instability. This technique may be indicated for other conditions that cause instability and stenosis at the C1-C2 area. PMID:26689563

  2. Detection of HTLV-I in Peripheral Blood Lymphocytes from Patients with Chronic HTLV-I-Associated Myelopathy/Tropical Spastic Paraparesis and Asymptomatic Carriers by PCR-in situ Hybridization.

    PubMed

    Walter, M.J.; Lehky, T.J.; Levin, M.C.; Fox, C.H.; Jacobson, S.

    1997-01-01

    Less than 5% of people infected with human T-lymphotropic virus type I (HTLV-I) develop HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a chronic progressive neurologic disease. A number of factors have been implicated in the development of HAM/TSP including heterogeneity of viral sequences, host-genetic background, viral-specific cellular immune responses and viral load. This study examined the presence of HTLV-1 tax DNA in peripheral blood lymphocytes (PBL) from 2 chronic HAM/TSP patients and 2 asymptomatic HTLV-I carriers by using PCR-in situ hybridization (PCR-ISH) for the in situ presence of proviral HTLV-I tax DNA. By this technique, rare PBL from these HTLV-I-infected individuals contained HTLV-I DNA. PCR-ISH did not detect any difference in the number of infected cells between HAM/TSP patients and asymptomatic carriers. Copyright 1997 S. Karger AG, Basel PMID:11725134

  3. Deep Sequencing Analysis of Human T Cell Lymphotropic Virus Type 1 Long Terminal Repeat 5' Region from Patients with Tropical Spastic Paraparesis/Human T Cell Lymphotropic Virus Type 1-Associated Myelopathy and Asymptomatic Carriers.

    PubMed

    Rego, Filipe Ferreira de Almeida; de Oliveira, Tulio; Giovanetti, Marta; Galvão-Castro, Bernardo; Gonçalves, Marilda de Souza; Alcantara, Luiz Carlos

    2016-03-01

    The aim of this study was to analyze patients by deep sequencing the human T cell lymphotropic virus type 1 (HTLV-1) long terminal repeat (LTR) region in order to determine if minor and/or major mutations in this promoter region might be associated with tropical spastic paraparesis (TSP)/human T cell lymphotropic virus type 1-associated myelopathy (HAM) outcome or proviral load or HTLV-1 expression. This study is a cross-sectional analyze of 29 HTLV-1-infected patients with TSP/HAM or asymptomatic carriers. Proviral DNA from those subjects was submitted to a nested PCR for the HTLV-1 LTR5' region. The HTLV-1 LTR5' purified products were submitted to deep sequencing using the Ion Torrent sequencing technology (Life Technologies, Carlsbad, CA). We found that samples with low proviral load showed more detected minor mutations than the samples with high proviral load. Mutations in 136 positions were found over the 520-bp analyzed fragment of HTLV-1 LTR5' with at least 1% frequency. Eleven mutations were present in the previously determined major transcription factor binding sites (TFBS) and in more than one patient, indicating that there might be a differential HTLV-1 expression comparing individuals or in comparing different cells from the same individual. Three mutations were statistically significant using the Fisher nonparametric test between the groups but were not present in previously determined TFBS (G126C/T, G306C, and C479T). Those mutations that were not present in previously determined TFBS were statistically significant in this study and were most frequent in patients with low proviral load or in asymptomatic carriers. Although those mutations were not present in previously determined TFBS, one of those mutations (G306C/A) was present in an Sp-1 binding site determined by in silico analysis, and its presence abrogated the site for Sp-1 binding and created a new possible ATF binding site. PMID:26472535

  4. Tax Posttranslational Modifications and Interaction with Calreticulin in MT-2 Cells and Human Peripheral Blood Mononuclear Cells of Human T Cell Lymphotropic Virus Type-I-Associated Myelopathy/Tropical Spastic Paraparesis Patients

    PubMed Central

    Medina, Fernando; Quintremil, Sebastian; Alberti, Carolina; Barriga, Andres; Cartier, Luis; Puente, Javier; Ramírez, Eugenio; Ferreira, Arturo; Tanaka, Yuetsu

    2014-01-01

    Abstract The human retrovirus human T cell lymphotropic virus type-I (HTLV-1) is the etiologic agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Axonal degeneration in HAM/TSP patients occurs without neuron infection, with the secreted viral Tax protein proposed to be involved. We previously found that Tax secreted into the culture medium of MT-2 cells (HTLV-1-infected cell line) produced neurite retraction in neuroblastoma cells differentiated to neuronal type. To assess the relevance of Tax posttranslational modifications on this effect, we addressed the question of whether Tax secreted by MT-2 cells and peripheral blood mononuclear cells (PBMCs) of HTLV-1-infected subjects is modified. The interaction of Tax with calreticulin (CRT) that modulates intracellular Tax localization and secretion has been described. We studied Tax localization and modifications in MT-2 cells and its interaction with CRT. Intracellular Tax in MT-2 cells was assessed by flow cytometry, corresponding mainly to a 71-kDa protein followed by western blot. This protein reported as a chimera with gp21 viral protein—confirmed by mass spectrometry—showed no ubiquitination or SUMOylation. The Tax–CRT interaction was determined by confocal microscopy and coimmunoprecipitation. Extracellular Tax from HAM/TSP PBMCs is ubiquitinated according to western blot, and its interaction with CRT was shown by coimmunoprecipitation. A positive correlation between Tax and CRT secretion was observed in HAM/TSP PBMCs and asymptomatic carriers. For both proteins inhibitors and activators of secretion showed secretion through the endoplasmic reticulum–Golgi complex. Tax, present in PBMC culture medium, produced neurite retraction in differentiated neuroblastoma cells. These results suggest that Tax, whether ubiquitinated or not, is active for neurite retraction. PMID:24321043

  5. AIDS-related bone marrow lesions--myelodysplastic features or predominant inflammatory-reactive changes (HIV-myelopathy)? A comparative morphometric study by immunohistochemistry with special emphasis on apoptosis and PCNA-labeling.

    PubMed

    Thiele, J; Zirbes, T K; Bertsch, H P; Titius, B R; Lorenzen, J; Fischer, R

    1996-08-01

    There seems to be general agreement that AIDS-related bone marrow changes are consistent with myelodysplastic features. To re-evaluate this assumption more critically, a comparative study was performed on marrow smears and trephine biopsies in 20 patients presenting manifest stages of AIDS and in 30 patients with primary myelodysplastic syndromes (MDS). For an assessment of cytological atypias enzyme-(naphthol AS-D-chloroacetatesterase) and immuno-histochemical techniques including monoclonal antibodies directed against erythro-(Ret40f) and megakaryopoiesis (CD61), macrophages (PG-M1) and proliferating cell nuclear antigen-PCNA (PC10) were applied and staining results determined by morphometric analysis. The in situ end-labeling (ISEL) technique was used for the demonstration of cells undergoing apoptosis (programmed cell death). In the HIV-infected bone marrow the frequency of erythroid precursors and macrophages exceeded significantly the corresponding counts in MDS. In comparison with a control group, megakaryocytes were increased in both entities under study. However, MDS was characterized by a prevalence of atypical microforms. The small-sized megakaryocytes in MDS revealed striking abnormalities of nuclear-cytoplasmic organization. Severe defects of nuclear lobulation (pseudo-Pelger anomalies) of mature neutrophils or nuclear bridging of erythro-normoblasts were not conspicuous in AIDS. Whereas the incidence of apoptosis was significantly higher in MDS, no such differences could be found comparing the PCNA-labeling index of AIDS and MDS. On the other hand, both parameters were significantly increased in comparison with the controls. In the HIV-infected bone marrow alterations of the myeloid stroma were most prominently expressed. If well defined criteria for the diagnosis of (myelo-) dysplasia were applied, our findings in AIDS were not in keeping with the assumption of significant maturation defects comparable with MDS. Hence, bone marrow lessions accompanying AIDS should be separated from MDS and should be diagnosed as HIV-myelopathy. PMID:8888951

  6. Genes Related to Antiviral Activity, Cell Migration, and Lysis Are Differentially Expressed in CD4+ T Cells in Human T Cell Leukemia Virus Type 1-Associated Myelopathy/Tropical Spastic Paraparesis Patients

    PubMed Central

    Pinto, Mariana Tomazini; Malta, Tathiane Maistro; Rodrigues, Evandra Strazza; Pinheiro, Daniel Guariz; Panepucci, Rodrigo Alexandre; Malmegrim de Farias, Kelen Cristina Ribeiro; Sousa, Alessandra De Paula; Takayanagui, Osvaldo Massaiti; Tanaka, Yuetsu; Covas, Dimas Tadeu

    2014-01-01

    Abstract Human T cell leukemia virus type 1 (HTLV-1) preferentially infects CD4+ T cells and these cells play a central role in HTLV-1 infection. In this study, we investigated the global gene expression profile of circulating CD4+ T cells from the distinct clinical status of HTLV-1-infected individuals in regard to TAX expression levels. CD4+ T cells were isolated from asymptomatic HTLV-1 carrier (HAC) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients in order to identify genes involved in HAM/TSP development using a microarray technique. Hierarchical clustering analysis showed that healthy control (CT) and HTLV-1-infected samples clustered separately. We also observed that the HAC and HAM/TSP groups clustered separately regardless of TAX expression. The gene expression profile of CD4+ T cells was compared among the CT, HAC, and HAM/TSP groups. The paxillin (Pxn), chemokine (C-X-C motif ) receptor 4 (Cxcr4), interleukin 27 (IL27), and granzyme A (Gzma) genes were differentially expressed between the HAC and HAM/TSP groups, regardless of TAX expression. The perforin 1 (Prf1) and forkhead box P3 (Foxp3) genes were increased in the HAM/TSP group and presented a positive correlation to the expression of TAX and the proviral load (PVL). The frequency of CD4+FOXP3+ regulatory T cells (Treg) was higher in HTLV-1-infected individuals. Foxp3 gene expression was positively correlated with cell lysis-related genes (Gzma, Gzmb, and Prf1). These findings suggest that CD4+ T cell activity is distinct between the HAC and HAM/TSP groups. PMID:24041428

  7. Evoked potential versus behavior to detect minor insult to the spinal cord in a rat model.

    PubMed

    Agrawal, Gracee; Thakor, Nitish V; All, Angelo H

    2009-08-01

    Reliable outcome measurement is needed for spinal cord injury research to critically evaluate the severity of injury and recovery thereafter. However, such measurements can sometimes be affected by minor, injury to the spinal cord during surgical procedures, including laminectomy. The open-field Basso, Beattie and Bresnahan (BBB) behavior motor scores are subjective and prone to human error. We investigated somatosensory evoked potential (SEP) as an electrophysiological measure to assess the integrity of the spinal cord after injury. In our experiment, control rats with a minor unintentional spinal cord insult during laminectomy showed a decrease in SEP amplitude by 16% to 18%, which recovered in around 7 days. However, there was no change in the BBB scores for the same animals over the same period. This highlights the sensitivity of SEP to minor insult as compared to BBB. These differences may be beneficial in accurate evaluation of the severity and progression of spinal cord injury, and subsequent recovery. PMID:19419872

  8. Radicular Compression by Intraspinal Epidural Gas Bubble Occurred in Distant Two Levels after Lumbar Microdiscectomy

    PubMed Central

    Yoon, Kang-Jun; Ha, Sang-Soo; Kang, Joon-Ki

    2014-01-01

    The authors report a case of symptomatic epidural gas accumulation 2 weeks after the multi-level lumbar surgery, causing postoperative recurrent radiculopathy. The accumulation of epidural gas compressing the dural sac and nerve root was demonstrated by CT and MRI at the distant two levels, L3-4 and L5-S1, where vacuum in disc space was observed preoperatively and both laminectomy and discectomy had been done. However, postoperative air was not identified at L4-5 level where only laminectomy had been done in same surgical field, which suggested the relationship between postoperative epidural gas and the manipulation of disc structure. Conservative treatment and needle aspiration was performed, but not effective to relieve patient's symptoms. The patient underwent revision surgery to remove the gaseous cyst. Her leg pain was improved after the second operation. PMID:25628816

  9. Study on different surgical approaches for acute Lumber disk protrusion combined with Cauda Equina Syndrome

    PubMed Central

    Shen, Lianbing; Fang, Liangqin; Qiu, Yihua; Xing, Shunming; Chen, Dechun; He, Xiang; Wang, Jinxin; Lai, Jing; Shi, Guohua; Zhang, Jiefeng; Liao, Teng; Tan, Junming

    2014-01-01

    To compare the long and short term effectiveness and complications of different surgical approaches for Lumber disk protrusion combined with Cauda Equina Syndrome and find a better surgical method for the disease. In this study, follow up records of 144 patients received conventional laminectomy and minimally invasive decompression and fenestration 48 hours within acute injury of lumber disk protrusion combined with Cauda Equina Syndrome were analyzed. Surgical outcome immediately and 3, 6, 12, 36 months after the surgery were compared to evaluate the effectiveness two different approaches. The results indicated that there are no significant differences regarding age, sexual proportion, body mass index (BMI), visual analogue scale of pain (VAS) score as well as Frankel scores before the surgery, and significant differences VAS score as well as Frankel scores immediately after the surgery. In conclusion, minimally invasive decompression and fenestration can be of the same effectiveness and less complications comparing with the conventional laminectomy. PMID:25674258

  10. Case Report: A case report highlighting bilateral EDB wasting as a clinical marker for lumbar canal stenosis

    PubMed Central

    Kumar, Bijoy Mohan; Munakomi, Sunil

    2015-01-01

    Herein we discuss a case of a 55 year old male presenting with history suggestive of sciatica on the left leg. Straight leg raising (SLR) test was positive at 45 degrees on the left side. His ankle reflex was absent and the power of extensor hallusus longus (EHL) was 4/5 on the same side. MRI lumbosacral spine revealed left paramedian disc prolapsed on L4/L5 level with spinal canal diameter of 9mm.However since his bilateral extensor digitorm brevis (EDB) were wasted, we suspected associated lumbar canal stenosis and thereby opted for laminectomy and discectomy in this case. Intraoperatively dural wasting, hypertrophied facets and narrow canal were confirmed. Laminectomy, medial facectectomy and discectomy were carried out. The patient recovered uneventfully with resolution of his sciatica-like pain. Bilateral EDB wasting thereby provides a clinical clue to the underlying lumbar canal stenosis and can help in making correct therapeutic decisions. PMID:26535113

  11. Surgical results of sacral perineural (Tarlov) cysts.

    PubMed

    Tanaka, Masato; Nakahara, Shinnosuke; Ito, Yasuo; Nakanishi, Kazuo; Sugimoto, Yoshihisa; Ikuma, Hisanori; Ozaki, Toshifumi

    2006-02-01

    The purpose of this study was to investigate the surgical outcomes and to determine indicators of the necessity of surgical intervention. Twelve consecutive patients harboring symptomatic sacral perineural cysts were treated between 1995 and 2003. All patients were assessed for neurological deficits and pain by neurological examination. Magnetic resonance of imaging, computerized tomography, and myelography were performed to detect signs of delayed filling of the cysts. We performed a release of the valve and imbrication of the sacral cysts with laminectomies in 8 cases or recapping laminectomies in 4 cases. After surgery, symptoms improved in 10 (83%) of 12 patients, with an average follow-up of 27 months. Ten patients had sacral perineural cysts with signs of positive filling defect. Two (17%) of 12 patients experienced no significant improvement. In one of these patients, the filling defect was negative. In conclusion, a positive filling defect may become an indicator of good treatment outcomes. PMID:16508691

  12. Study on different surgical approaches for acute Lumber disk protrusion combined with Cauda Equina Syndrome.

    PubMed

    Shen, Lianbing; Fang, Liangqin; Qiu, Yihua; Xing, Shunming; Chen, Dechun; He, Xiang; Wang, Jinxin; Lai, Jing; Shi, Guohua; Zhang, Jiefeng; Liao, Teng; Tan, Junming

    2014-01-01

    To compare the long and short term effectiveness and complications of different surgical approaches for Lumber disk protrusion combined with Cauda Equina Syndrome and find a better surgical method for the disease. In this study, follow up records of 144 patients received conventional laminectomy and minimally invasive decompression and fenestration 48 hours within acute injury of lumber disk protrusion combined with Cauda Equina Syndrome were analyzed. Surgical outcome immediately and 3, 6, 12, 36 months after the surgery were compared to evaluate the effectiveness two different approaches. The results indicated that there are no significant differences regarding age, sexual proportion, body mass index (BMI), visual analogue scale of pain (VAS) score as well as Frankel scores before the surgery, and significant differences VAS score as well as Frankel scores immediately after the surgery. In conclusion, minimally invasive decompression and fenestration can be of the same effectiveness and less complications comparing with the conventional laminectomy. PMID:25674258

  13. Concurrent occipital hypoplasia, occipital dysplasia, syringohydromyelia, and hydrocephalus in a Yorkshire terrier

    PubMed Central

    Cagle, Laura

    2010-01-01

    Magnetic resonance imaging of a 7.5-year-old neutered male Yorkshire terrier with mild generalized ataxia and intermittent neck scratching led to a diagnosis of caudal occipital malformation and syringohydromyelia. Surgical exploration led to a diagnosis of occipital dysplasia with concurrent occipital hypoplasia. Following a dorsal laminectomy of the first cervical vertebra there was no progression or improvement a month later. PMID:21037897

  14. Neurosurgical procedures, spinal nerve roots - one stage removal of thoracic dumb-bell tumor: role of spinal evoked potential.

    PubMed

    Srivastava, Dharmendra Kumar; Singh, Deepak; Tiwari, Bhuwan Chandra; Awasthi, Namarata; Hussain, Nuzhat

    2014-02-01

    We report a rare case of benign thoracic dumb-bell tumor in the upper posterior mediastinum, which was successfully removed by posterolateral thoracotomy and foraminotomy, using intraoperative monitoring of spinal motor-evoked potentials. This technique has many advantages including minimal morbidity and mortality, a single incision, one-step complete resection with adequate exposure, spinal stabilization, avoidance of laminectomy, nerve root identification, and good predicted postoperative function. PMID:24585801

  15. Tisseel utilized as hemostatic in spine surgery impacts time to drain removal and length of stay

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    Background: Although fibrin sealants (FSs) and fibrin glues (FGs) are predominantly utilized to strengthen repairs of cerebrospinal fluid (CSF) fistulas (deliberate/traumatic) during spinal surgery, they are also increasingly utilized to achieve hemostasis. Here, we investigated whether adding Tisseel (Baxter International Inc., Westlake Village, CA, USA), utilized to address increased bleeding during multilevel lumbar laminectomies with non-instrumented fusions, would reduce or equalize the time to drain removal and length of stay (LOS) without contributing to infections or prolonging time to fusion. Methods: Prospectively, 39 patients underwent multilevel laminectomies and 1-2 level non-instrumented (in situ) fusions to address stenosis/olisthesis; 22 who demonstrated increased intraoperative bleeding received Tisseel, while 17 without such bleeding did not. Results: The 22 receiving versus 17 not receiving Tisseel, with similar clinical parameters, underwent comparable average multilevel laminectomies (4.36 and 4.25) and 1-2 level fusions (1.4 vs. 1.29 levels). As anticipated, for those receiving Tisseel, the average intraoperative estimated blood loss (EBL), total postoperative blood loss, and total perioperative transfusion requirements [red blood cells (RBC), fresh frozen plasma (FFP), platelets] were higher. However, Tisseel had the added benefit of equalizing the time to postoperative drain removal [e.g. 3.41 days (with) vs. 3.38 days (without)] and LOS [e.g. 5.86 days (with) vs. 5.82 days (without)] without increasing the infection rates (e.g. one superficial infection per group) or average times to fusion (e.g. 5.9 vs. 5.5 months). Conclusions: Adding Tisseel for increased bleeding during multilevel laminectomies/in situ fusions contributed to hemostasis by equalizing the average times to drain removal/LOS compared to patients without increased bleeding and not requiring Tisseel. PMID:25289160

  16. Postpartum spinal subdural hematoma: irrelevant epidural blood patch: a case report.

    PubMed

    Choe, Won Joo; Kim, Ji Yeon; Yeo, Hyeok Jae; Kim, Jun Hyun; Lee, Sang-Il; Kim, Kyung-Tae; Park, Jang Su; Kim, Jung Won

    2016-04-01

    We report a healthy patient with postpartum headache and neck stiffness which were diagnosed as symptoms of pseudoaneurysm of vertebral artery. She had received a Cesarean section under the spinal anesthesia, and complaint of headache and neck stiffness. Epidural blood patches were done twice, but symptoms persisted. Eight days later, she experienced sensory disturbance and emergent laminectomy was done. When persistent postpartum headache occurs after epidural blood patch, more precise differential diagnosis should be made and considering other possible pathologies. PMID:27066211

  17. Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

    PubMed Central

    Skovrlj, Branko; Belton, Patrick; Zarzour, Hekmat; Qureshi, Sheeraz A

    2015-01-01

    AIM: To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS). METHODS: A systematic review of previously published studies accessible through PubMed was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant. RESULTS: A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery (177.5 min vs 129.0 min, P = 0.04), shorter LOS (4.3 d vs 5.3 d, P = 0.01) and less perioperative pain (visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients (postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL (352 mL vs 580 mL, P < 0.0001) and LOS (7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain. CONCLUSION: Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find non-inferior perioperative outcomes at this time. PMID:26716097

  18. Asymmetric lumbosacral transitional vertebra and subsequent disc protrusion in a cocker spaniel.

    PubMed

    Archer, Rebecca; Sissener, Thomas; Connery, Neil; Spotswood, Tim

    2010-03-01

    A 10-year-old cocker spaniel bitch presented with severe lumbosacral pain and acute onset left pelvic limb lameness. A diagnosis of asymmetric lumbosacral transitional vertebra with disc protrusion at L6-L7 was made by computed tomography. The cauda equina and left L6 nerve root were surgically decompressed with a dorsal laminectomy and lateral foraminotomy, which led to rapid resolution of the clinical signs. PMID:20514255

  19. One hospital's clinical evaluation of brushless scrubbing.

    PubMed

    Berman, Mara

    2004-02-01

    BRUSHLESS SCRUBBING rapidly is becoming an accepted method for surgical hand scrubbing. AN EVALUATION was undertaken at an acute care hospital in the southeastern United States to examine brushless scrubbing before laminectomy, craniotomy, and colectomy procedures. PATIENTS DID NOT SHOW an increase in postoperative surgical site infections when the brushless scrubbing product was used. SATISFACTION AND COMPLIANCE among users of the product was positive. PMID:15002831

  20. Ruptured spinal dermoid cyst with chemical arachnoiditis and disseminated intracranial lipid droplets.

    PubMed

    Roeder, M B; Bazan, C; Jinkins, J R

    1995-02-01

    A 33-year-old man presented with a 3-month history of gradually progressive leg weakness. Spinal MRI and myelography with CT demonstrated an extensive intradural abnormality suggesting a diffuse inflammatory or neoplastic process. Only after cranial CT and MRI demonstrated lipid droplets was the diagnosis of a ruptured spinal dermoid cyst suggested. Subsequent laminectomy revealed a ruptured intradural dermoid cyst in the lumbar spine, with chemical arachnoiditis. PMID:7761002

  1. Intramedullary tumors in children

    PubMed Central

    Chatterjee, Sandip; Chatterjee, Uttara

    2011-01-01

    Intramedullary tumors of the spinal cord account for 35-40% of intraspinal tumors in children. The biological behavior of these tumors is of slow progression, and hence aggressive surgery has been advocated. Surgical adjuncts include use of intraoperative neurophysiological monitoring, preoperative ultrasound, microsurgical techniques and ultrasonic suction devices. Osteoplastic laminoplasty approaches avoid post-laminectomy deformities in younger children. Postoperative radiotherapy and more recently chemotherapy regimes have been proposed for incompletely resected tumors. PMID:22069435

  2. Delayed Diagnosis of Cauda Eqina Syndrome with Perineural Cyst after Combined Spinal-Epidural Anesthesia in Hemodialysis Patient

    PubMed Central

    Akeda, Koji; Tsujii, Masaya; Sudo, Akihiro

    2013-01-01

    Symptomatic Tarlov (perineural cysts) are uncommon. In the following hemodialysis case, cauda equina syndrome was not detected after combined spinal-epidural anesthesia untilthe patient reported a lack of sensation in the perianal area 14 days postoperatively. She had normal motor function of her extremities. A laminectomy and cyst irrigation was performed. After the operation, her sphincter disturbance subsided gradually and her symptoms had disappeared. PMID:24066221

  3. Postpartum spinal subdural hematoma: irrelevant epidural blood patch: a case report

    PubMed Central

    Yeo, Hyeok Jae; Lee, Sang-Il; Kim, Kyung-Tae; Park, Jang Su; Kim, Jung Won

    2016-01-01

    We report a healthy patient with postpartum headache and neck stiffness which were diagnosed as symptoms of pseudoaneurysm of vertebral artery. She had received a Cesarean section under the spinal anesthesia, and complaint of headache and neck stiffness. Epidural blood patches were done twice, but symptoms persisted. Eight days later, she experienced sensory disturbance and emergent laminectomy was done. When persistent postpartum headache occurs after epidural blood patch, more precise differential diagnosis should be made and considering other possible pathologies. PMID:27066211

  4. Spinal surgery: an unusual case of spinal epidural abscess.

    PubMed

    Vaught, Kevin A

    2009-01-01

    Southeast Missouri Hospital in Cape Girardeau, Missouri, admitted a patient from an outside hospital with back pain and progressive quadriparesis. Imaging revealed an extensive spinal epidural abscess that extended from the craniocervical junction to the sacral spine. Because of the patient's critical condition and the need to minimize the duration of surgery and anesthesia, two surgical teams simultaneously operated on the patient on the day of admission. One team performed a decompressive laminectomy of C1 through C7 and T1 through T6, while the other team performed, through a separate skin incision, a decompressive laminectomy on T11, L2, L3, and L4 as well as partial evacuation of a psoas abscess. The extensive laminectomies were required due to the adherent granulomatous nature of the abscess. Simple irrigation and intraoperative aspiration with suction was ineffective. The patient remained in the hospital for approximately three weeks and was discharged to a long-term acute care facility. Over the next five months her motor function gradually improved and she was discharged to home. Currently, she remains at home, free of significant pain and able to ambulate independently. PMID:19753924

  5. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

    PubMed Central

    Tao, Huiren

    2009-01-01

    Postlaminectomy epidural adhesion is implicated as a main cause of “failed back surgery syndrome” and associated with increased risk of complications during revision surgery. Various materials acting as mechanical barriers to reduce fibroblasts infiltration into epidural space have met with limited success. In present research, amniotic membrane (AM) was studied to investigate its effects on reducing epidural scar adhesion after laminectomy in a canine model. Laminectomy sites were created at L-1, L-3, L-5, and L-7 levels in 24 adult mongrel dogs. Freeze dried AM (FAM), cross-linked AM (CAM), and autologous free fat (AFF) were implanted, respectively, at a randomly assigned site in each dog with the remaining untreated site serving as internal control. The animals were sacrificed at 1, 6, and 12 weeks postoperatively. Then, gross pathologic observation including scar amount and adhesion tenacity, qualitative histology evaluation, and quantitative histology analysis were compared. Gross observation demonstrated that scar amount and adhesion tenacity of CAM group were significantly lower in comparison with those of FAM and non-treatment groups. A white, slightly vascularized CAM layer covered the dura mater without tenacious scar adhesion. The histology analysis also indicated reduced fibroblasts infiltration and consequent epidural fibrosis, which were similar to the results of AFF group. In conclusion, the CAM is effective in reducing epidural fibrosis and scar adhesion after laminectomy in canine model. It is a promising biomaterial for future clinical applications. PMID:19404691

  6. Targeted delivery of pharmacological agents into rat dorsal root ganglion

    PubMed Central

    Puljak, Livia; Kojundzic, Sanja Lovric; Hogan, Quinn H.; Sapunar, Damir

    2009-01-01

    We sought an optimal method for targeted delivery into dorsal root ganglia (DRGs) for experimental studies, in terms of precision of delivery and avoidance of behavioral disturbances. We examined three approaches for injection into rat DRGs: percutaneous injection without surgical exposure, injection after deep exposure, and injection following deep exposure and partial laminectomy. Coomassie blue and Fast Blue were injected into DRGs for validation. At necropsy, the spread of Coomassie blue and Fast Blue was investigated under stereomicroscope and fluorescent microscope, respectively. We found that percutaneous approach did not provide any successful DRG injections. Deep exposure prior to intraganglionic injection provided variable results, but intraganglionic injection after deep exposure plus partial laminectomy was successful in 100% of attempts. Our subsequent skeletal analysis showed that the anatomical location of DRG is not compatible with successful DRG injection without surgical exposure. Neither of the methods using surgical exposure caused behavioral disturbances. Based on these results we conclude that partial laminectomy offers the most precise method of injecting DRG and does not produce behavioral evidence of nerve damage. Intraganglionic injection after deep exposure alone is less predictable, while percutaneous approaches only allow injection in the peripheral nerve. PMID:19027036

  7. Targeted delivery of pharmacological agents into rat dorsal root ganglion.

    PubMed

    Puljak, Livia; Kojundzic, Sanja Lovric; Hogan, Quinn H; Sapunar, Damir

    2009-03-15

    We sought an optimal method for targeted delivery into dorsal root ganglia (DRGs) for experimental studies, in terms of precision of delivery and avoidance of behavioral disturbances. We examined three approaches for injection into rat DRGs: percutaneous injection without surgical exposure, injection after deep exposure, and injection following deep exposure and partial laminectomy. Coomassie blue and Fast Blue were injected into DRGs for validation. At necropsy, the spread of Coomassie blue and Fast Blue was investigated under stereomicroscope and fluorescent microscope, respectively. We found that percutaneous approach did not provide any successful DRG injections. Deep exposure prior to intraganglionic injection provided variable results, but intraganglionic injection after deep exposure plus partial laminectomy was successful in 100% of attempts. Our subsequent skeletal analysis showed that the anatomical location of DRG is not compatible with successful DRG injection without surgical exposure. Neither of the methods using surgical exposure caused behavioral disturbances. Based on these results we conclude that partial laminectomy offers the most precise method of injecting DRG and does not produce behavioral evidence of nerve damage. Intraganglionic injection after deep exposure alone is less predictable, while percutaneous approaches only allow injection in the peripheral nerve. PMID:19027036

  8. Biomechanics of open-door laminoplasty with and without preservation of posterior structures.

    PubMed

    Healy, Andrew T; Lubelski, Daniel; West, James L; Mageswaran, Prasath; Colbrunn, Robb; Mroz, Thomas E

    2016-05-01

    OBJECTIVE Cervical open-door laminoplasty (ODL) is designed to decompress the spinal cord, maintain motion, and prevent postlaminectomy kyphosis. Many traditional laminoplasty techniques involve disruption of the posterior ligamentous structures, most notably the C7-T1 supraspinous ligament and interspinales muscle complex (intraspinous and supraspinous ligaments [ISLs]). METHODS Eight human cervical cadaveric specimens (C2-T1) were used to investigate the subaxial kinematics following ODL with varying degrees of posterior element disruption. Ligamentous integrity was preserved and specimens were tested utilizing force control in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in the native state, and following 1) C3-7 ODL, 2) ODL with terminal ISL resection, 3) ODL with C3-7 spinous process resection, and 4) C3-7 laminectomy. Range of motion (ROM) was measured across C2-T1, "global," and at the segmental level. RESULTS Compared with ODL, sectioning the terminal ISLs resulted in global ROM increases by 7.9% in FE, 2.4% in LB, and 5.6% in AR (p > 0.05), whereas laminectomy increased global ROM by 36.0% in FE (p = 0.002) and a 26.3% increase in AR ROM (p = 0.01). When considering segmental ROM, resection of the terminal ISLs increased ROM in FE by 36.5% at C2-3 (p = 0.019) and 25.4% at C7-T1 (p > 0.05). Segmental increases following C3-7 spinous process resection averaged less than 3% per level, compared with up to 40% increases in ROM per level after laminectomy. CONCLUSIONS Laminectomy resulted in the greatest increase in global cervical ROM. Resection of the ISLs at C2-3 and C7-T1 increased segmental ROM at these specific levels to a similar extent that laminectomy increased ROM at each cervical level. This segmental ROM may contribute to pain or postprocedural deformity and highlights the importance of the ISLs at the terminal ends of the ODL. PMID:26799115

  9. Degenerative leukoencephalopathy and myelopathy in dasyurids.

    PubMed

    Holz, P H; Little, P B

    1995-10-01

    From June 1985 to November 1992 eight eastern quolls (Dasyurus viverrinus) and six Tasmanian devils (Sarcophilus harrisii), held at institutions in Australia and Canada, developed progressive blindness and posterior paresis progressing to paralysis. All were aged individuals. At necropsy white matter tracts, particularly in the spinal cord, optic tracts, and cerebellum, contained evidence of severe axon degeneration with vacuolation and macrophage infiltration. The surrounding tissue had evidence of gliosis. The etiology of the condition is unknown but may be a form of age-related degeneration. PMID:8592382

  10. Risk factors for scoliosis in children with neuroblastoma

    SciTech Connect

    Paulino, Arnold C. . E-mail: apaulino@tmh.tmc.edu; Fowler, B. Zach

    2005-03-01

    Purpose: To determine the risk factors for scoliosis in children treated for neuroblastoma. Methods and materials: From 1957 to 1997, 58 children with neuroblastoma were treated at one institution and have survived a minimum of 5 years. There were 35 boys and 23 girls with a median age of 6 months (range, 2 weeks to 15 years) at initial diagnosis. Primary site was located in the adrenal gland in 25 (43.1%), abdominal/nonadrenal in 16 (27.6%), thoracic in 12 (20.7%), cervical in 3 (5.3%), and pelvic region in 2 (3.5%). The International Neuroblastoma Staging System (INSS) stage was Stage 1 in 10 (17.2%), Stage 2A in 7 (12.1%), Stage 2B in 5 (8.6%), Stage 3 in 22 (37.9%), Stage 4 in 4 (6.9%), and Stage 4S in 10 (17.2%). Thirty-three (56.9%) received chemotherapy whereas 5 (8.6%) had a laminectomy as part of the surgical procedure. Twenty-seven (46.6%) received radiotherapy (RT). Beam energy was 1.25 MV in 11 (41%), 250 kV in 10 (37%), 4 MV in 4 (15%), and 6-MV photons in 1 patient. One patient received 300 cGy in 1 fraction total skin RT using 6-MeV electrons. For the remaining patients, fraction size was 100 cGy in 6 (22%), 150-180 cGy in 11 (41%), 200 cGy in 4 (15%), and 250-300 cGy in 3. Three patients had total body irradiation at 333 cGy for 3 fractions. For all children who received RT, median total dose was 2000 cGy (range, 300-3900 cGy). Patients who were treated with RT had plain films of the irradiated area every 1 to 2 years until at least the age of puberty. Median follow-up was 10 years (range, 5-46 years). Results: The overall 5-, 10-, and 15-year scoliosis-free rates were 87.6%, 79.0%, and 76.0% respectively. Twelve (21%) developed scoliosis at a median time of 51 months (range, 8-137 months). The degree of scoliosis was mild ({<=}20 deg ) in 8 (67%). Four had scoliosis ranging from 30 deg to 66 deg ; 3 of these patients required surgical intervention, whereas 1 had an underlying Duchenne muscular dystrophy which manifested itself 8 years after diagnosis of neuroblastoma. Median time to scoliosis was 23 months (range, 8-54 months) in children who had a laminectomy. On multivariate analysis, both history of laminectomy (p = 0.0005) and use of RT (p = 0.0284) were found to be risk factors for development of scoliosis. Gender, age at diagnosis, INSS stage, primary site, and use of chemotherapy were not found to be significant. Both RT fraction size and beam energy were also not significant, but increasing total RT dose was found to be significant (p = 0.0039). The 15-year scoliosis-free rates were 20% for children who had a laminectomy and 81.3% for those who did not have a laminectomy. The 15-year scoliosis-free rates for children treated with RT doses 0 cGy, 1-1750 cGy, 1751-2300 cGy, and >2300 cGy were 91.7%, 87.5%, 51.4%, and 44.4% respectively. Conclusions: Treatment-related factors, namely laminectomy and radiotherapy, were found to increase the risk of scoliosis in patients with neuroblastoma. Children who had a laminectomy were more likely to manifest scoliosis earlier. Increasing RT dose was found to impact adversely on the development of scoliosis.

  11. More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion: A review

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: In the lumbar spine, do more nerve root injuries occur utilizing minimally invasive surgery (MIS) techniques versus open lumbar procedures? To answer this question, we compared the frequency of nerve root injuries for multiple open versus MIS operations including diskectomy, laminectomy with/without fusion addressing degenerative disc disease, stenosis, and/or degenerative spondylolisthesis. Methods: Several of Desai et al. large Spine Patient Outcomes Research Trial studies showed the frequency for nerve root injury following an open diskectomy ranged from 0.13% to 0.25%, for open laminectomy/stenosis with/without fusion it was 0%, and for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion it was 2%. Results: Alternatively, one study compared the incidence of root injuries utilizing MIS transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) techniques; 7.8% of PLIF versus 2% of TLIF patients sustained root injuries. Furthermore, even higher frequencies of radiculitis and nerve root injuries occurred during anterior lumbar interbody fusions (ALIFs) versus extreme lateral interbody fusions (XLIFs). These high frequencies were far from acceptable; 15.8% following ALIF experienced postoperative radiculitis, while 23.8% undergoing XLIF sustained root/plexus deficits. Conclusions: This review indicates that MIS (TLIF/PLIF/ALIF/XLIF) lumbar surgery resulted in a higher incidence of root injuries, radiculitis, or plexopathy versus open lumbar surgical techniques. Furthermore, even a cursory look at the XLIF data demonstrated the greater danger posed to neural tissue by this newest addition to the MIS lumbar surgical armamentariu. The latter should prompt us as spine surgeons to question why the XLIF procedure is still being offered to our patients? PMID:26904372

  12. More nerve root injuries occur with minimally invasive lumbar surgery: Let's tell someone

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: In a recent study entitled: “More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion (XLIF): A review”, Epstein documented that more nerve root injuries occurred utilizing minimally invasive surgery (MIS) versus open lumbar surgery for diskectomy, decompression of stenosis (laminectomy), and/or fusion for instability. Methods: In large multicenter Spine Patient Outcomes Research Trial reviews performed by Desai et al., nerve root injury with open diskectomy occurred in 0.13–0.25% of cases, occurred in 0% of laminectomy/stenosis with/without fusion cases, and just 2% for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion. Results: In another MIS series performed largely for disc disease (often contained nonsurgical disc herniations, therefore unnecessary procedures) or spondylolisthesis, the risk of root injury was 2% for transforaminal lumbar interbody fusion (TLIF) versus 7.8% for posterior lumbar interbody fusion (PLIF). Furthermore, the high frequencies of radiculitis/nerve root/plexus injuries incurring during anterior lumbar interbody fusions (ALIF: 15.8%) versus extreme lumbar interbody fusions (XLIF: 23.8%), addressing disc disease, failed back surgery, and spondylolisthesis, were far from acceptable. Conclusions: The incidence of nerve root injuries following any of the multiple MIS lumbar surgical techniques (TLIF/PLIF/ALIF/XLIF) resulted in more nerve root injuries when compared with open conventional lumbar surgical techniques. Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients? PMID:26904373

  13. Limited Unilateral Decompression and Pedicle Screw Fixation with Fusion for Lumbar Spinal Stenosis with Unilateral Radiculopathy: A Retrospective Analysis of 25 Cases

    PubMed Central

    Zhang, Li; Miao, Hai-xiong; Wang, Yong; Chen, An-fu; Zhang, Tao

    2015-01-01

    Objective Lumbar spinal stenosis is conventionally treated with surgical decompression. However, bilateral decompression and laminectomy is more invasive and may not be necessary for lumbar stenosis patients with unilateral radiculopathy. We aimed to report the outcomes of unilateral laminectomy and bilateral pedicle screw fixation with fusion for patients with lumbar spinal stenosis and unilateral radiculopathy. Methods Patients with lumbar spinal stenosis with unilateral lower extremity radiculopathy who received limited unilateral decompression and bilateral pedicle screw fixation were included and evaluated using visual analog scale (VAS) pain and the Oswestry Disability Index (ODI) scores preoperatively and at follow-up visits. Ligamentum flavum thickness of the involved segments was measured on axial magnetic resonance images. Results Twenty-five patients were included. The mean preoperative VAS score was 6.6±1.6 and 4.6±3.1 for leg and back pain, respectively. Ligamentum flavum thickness was comparable between the symptomatic and asymptomatic side (p=0.554). The mean follow-up duration was 29.2 months. The pain in the symptomatic side lower extremity (VAS score, 1.32±1.2) and the back (VAS score, 1.75±1.73) significantly improved (p=0.000 vs. baseline for both). The ODI improved significantly postoperatively (6.60±6.5; p=0.000 vs. baseline). Significant improvement in VAS pain and ODI scores were observed in patients receiving single or multi-segment decompression fusion with fixation (p<0.01). Conclusion Limited laminectomy and unilateral spinal decompression followed by bilateral pedicle screw fixation with fusion achieves satisfactory outcomes in patients with spinal stenosis and unilateral radiculopathy. This procedure is less damaging to structures that are important for maintaining posterior stability of the spine. PMID:26279816

  14. Interrater Reliability of the Postoperative Epidural Fibrosis Classification: A Histopathologic Study in the Rat Model

    PubMed Central

    Jirarattanaphochai, Kitti; Sumananont, Chat; Wittayapairoj, Kriangkrai; Sukhonthamarn, Kamolsak

    2015-01-01

    Study Design Agreement study. Purpose To validate the interrater reliability of the histopathological classification of the post-laminectomy epidural fibrosis in an animal model. Overview of Literature Epidural fibrosis is a common cause of failed back surgery syndrome. Many animal experiments have been developed to investigate the prevention of epidural fibrosis. One of the common outcome measurements is the epidural fibrous adherence grading, but the classification has not yet been validated. Methods Five identical sets of histopathological digital files of L5-L6 laminectomized adult Sprague-Dawley rats, representing various degrees of postoperative epidural fibrous adherence were randomized and evaluated by five independent assessors masked to the study processes. Epidural fibrosis was rated as grade 0 (no fibrosis), grade 1 (thin fibrous band), grade 2 (continuous fibrous adherence for less than two-thirds of the laminectomy area), or grade 3 (large fibrotic tissue for more than two-thirds of the laminectomy area). A statistical analysis was performed. Results Four hundred slides were independently evaluated by each assessor. The percent agreement and intraclass correlation coefficient (ICC) between each pair of assessors varied from 73.5% to 81.3% and from 0.81 to 0.86, respectively. The overall ICC was 0.83 (95% confidence interval, 0.81-0.86). Conclusions The postoperative epidural fibrosis classification showed almost perfect agreement among the assessors. This classification can be used in research involving the histopathology of postoperative epidural fibrosis; for example, for the development of preventions of postoperative epidural fibrosis or treatment in an animal model. PMID:26240719

  15. C5 Nerve root palsies following cervical spine surgery: A review

    PubMed Central

    Epstein, Nancy E.; Hollingsworth, Renee

    2015-01-01

    Background: Cervical C5 nerve root palsies may occur in between 0% and 30% of routine anterior or posterior cervical spine operations. They are largely attributed to traction injuries/increased cord migration following anterior/posterior decompressions. Of interest, almost all studies cite spontaneous resolution of these deficits without surgery with 3–24 postoperative months. Methods: Different studies cite various frequencies for C5 root palsies following anterior or posterior cervical spine surgery. In their combined anterior/posterior series involving C4-C5 level decompressions, Libelski et al. cited up to a 12% incidence of C5 palsies. In Gu et al. series, C5 root palsies occurred in 3.1% of double-door laminoplasty, 4.5% of open-door laminoplasty, and 11.3% of laminectomy. Miller et al. observed an intermediate 6.9% frequency of C5 palsies followed by posterior cervical decompressions and fusions (PCDF). Results: Gu et al. also identified multiple risk factors for developing C5 palsies following posterior surgery; male gender, ossification of the posterior longitudinal ligament (OPLL), narrower foramina, laminectomy, and marked dorsal spinal cord drift. Miller et al. also identified an average $1918 increased cost for physical/occupational therapy for patients with C5 palsies. Conclusions: The incidence of C5 root deficits for anterior/posterior cervical surgery at C4-C5 was 12% in one series, and ranged up to 11.3% for laminectomies, while others cited 0–30%. Although identification of preoperative risk factors for C5 root deficits may help educate patients regarding these risks, there is no clear method for their avoidance at this time. PMID:26005577

  16. Evaluation of the results of operative management of lumbar spinal canal stenosis.

    PubMed

    Islam, M S; Ara, R; Salam, M A; Rahman, M W; Alam, M J; Karim, M R; Rahman, M; Alam, M N; Hussain, M F

    2013-10-01

    Lumber spinal canal stenosis is an important cause of low back pain and it frequently presents with low backache with neurogenic claudication. Operative management of lumbar spinal canal stenosis by decompression surgery is an effective method. This prospective interventional (quasi experimental) study was performed in patient having history of characteristic clinical features like low backache with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in the department of Orthopaedic Surgery and Neurosurgery, Dhaka Medical College Hospital and NITOR. Dhaka, from July 2008 to June 2010. Thirty patients were evaluated among those 18(60%) were 50 years and above. Male to female ratio was roughly 9:1. About 87% of the patients had sensory deficit and 50% had neurogenic claudication. Majority (83.3%) of the patients at presentation had a suffering of 12 or >12 months. Diagnosis shows that 3.5% of patients had L4 lesion, 60% L5, 6.5% patients had L4 & L5 and 30% S1. Laminectomy was done in 43.3% of patients, laminectomy and disectomy in 30% and laminectomy, discectomy & foraminal decompression in 26.7% of patients. Relief of symptoms occurred in 25(83.5%) of patients. Over three-quarter (76.7%) of patients exhibited minimal disability and 23.3% moderate disability based on Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001). PMID:24292296

  17. Short communication an interferon-γ ELISPOT assay with two cytotoxic T cell epitopes derived from HTLV-1 tax region 161-233 discriminates HTLV-1-associated myelopathy/tropical spastic paraparesis patients from asymptomatic HTLV-1 carriers in a Peruvian population.

    PubMed

    Best, Ivan; López, Giovanni; Talledo, Michael; MacNamara, Aidan; Verdonck, Kristien; González, Elsa; Tipismana, Martín; Asquith, Becca; Gotuzzo, Eduardo; Vanham, Guido; Clark, Daniel

    2011-11-01

    HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic and progressive disorder caused by the human T-lymphotropic virus type 1 (HTLV-1). In HTLV-1 infection, a strong cytotoxic T cell (CTL) response is mounted against the immunodominant protein Tax. Previous studies carried out by our group reported that increased IFN-γ enzyme-linked immunospot (ELISPOT) responses against the region spanning amino acids 161 to 233 of the Tax protein were associated with HAM/TSP and increased HTLV-1 proviral load (PVL). An exploratory study was conducted on 16 subjects with HAM/TSP, 13 asymptomatic carriers (AC), and 10 HTLV-1-seronegative controls (SC) to map the HAM/TSP-associated CTL epitopes within Tax region 161-233. The PVL of the infected subjects was determined and the specific CTL response was evaluated with a 6-h incubation IFN-γ ELISPOT assay using peripheral blood mononuclear cells (PBMCs) stimulated with 16 individual overlapping peptides covering the Tax region 161-233. Other proinflammatory and Th1/Th2 cytokines were also quantified in the supernatants by a flow cytometry multiplex assay. In addition, a set of human leukocyte antigen (HLA) class I alleles that bind with high affinity to the CTL epitopes of interest was determined using computational tools. Univariate analyses identified an association between ELISPOT responses to two new CTL epitopes, Tax 173-185 and Tax 181-193, and the presence of HAM/TSP as well as an increased PVL. The HLA-A*6801 allele, which is predicted to bind to the Tax 181-193 peptide, was overpresented in the HAM/TSP patients tested. PMID:21453202

  18. Reconstruction of posterior neck and skull with vertical trapezius musculocutaneous flap

    SciTech Connect

    Mathes, S.J.; Stevenson, T.R.

    1988-10-01

    The vertical trapezius musculocutaneous flap has been successfully utilized for reconstruction in 13 patients with complex posterior skull and neck defects. This flap based on its vascular pedicle, the descending branch of the transverse cervical artery, provides well-vascularized tissue for coverage of defects related to chronic osteomyelitis, tumor extirpation, osteoradionecrosis, and dehisced cervical laminectomy wounds. Emphasis on flap design, including the location of the skin island, allows adequate wound coverage, direct donor site closure, and muscle function preservation. With its large size and wide arc of rotation, the vertical trapezius musculocutaneous flap provides reliable coverage for posterior trunk, cervical, and skull defects.

  19. Giant pseudomeningocele after spinal surgery: A case report.

    PubMed

    Srilomsak, Prepram; Okuno, Kazuma; Sakakibara, Toshihiko; Wang, Zhuo; Kasai, Yuichi

    2012-07-18

    Very few reports have described giant pseudomeningoceles ≥ 8 cm in diameter. We report this case of the biggest giant pseudomeningocele at the unusual cervicothoracic level. A 59 year old man who underwent cervicothoracic laminectomy had a giant pseudomeningocele detected and the lesion gradually grew to about 15 cm in diameter by 2 years postoperatively. Cerebrospinal fluid leak closure was performed and the postoperative course was favorable. We present this case, review the literature and discuss the size and portion, mechanism of formation, symptoms and treatments of giant pseudomeningocele. PMID:22816066

  20. Giant Solitary Anterior Cervical Canal Neurofibroma: Case Report and Surgical Technique

    PubMed Central

    Atobatele, Kazeem M.; Soyemi, Sunday O.

    2015-01-01

    Giant solitary anterior cervical canal neurofibroma (GSACCN) is rarely reported in the literature. When the large lesion is ventrally located to the spinal cord, an anterolateral approach may not be ideal due to various technical challenges. In this report, we describe a case of intradural extramedullary GSACCN located at the cervical region extending from the axis to the sixth cervical vertebrae. Here we also describe a posterior technique successfully used to resect the tumour. Therefore, the posterior approach by En bloc decompressive laminectomy and laminoplasty might be used to adequately treat the lesion. PMID:26240721

  1. A contrast-enhancing lumbar ligamentum flavum haematoma

    PubMed Central

    Ghent, Finn; Ye, Xuan; Yan, Max; Mobbs, Ralph J

    2014-01-01

    We present a case of lower back pain with lumbar nerve compromise due to a ligamentum flavum haematoma which was successfully treated surgically. A 62-year-old man was evaluated for lower back pain with associated leg pain and early signs of cauda equina syndrome. MRI of the lumbar spine demonstrated a contrast-enhancing mass adjacent to the lamina of L3 which was causing severe canal stenosis. Surgical excision of the lesion was recommended. The patient underwent an L3 laminectomy with excision of the epidural lesion. Histopathology showed it to be a haematoma of the ligamentum flavum with no untoward features. The patient recovered without complication. PMID:24642178

  2. Pneumocephalus Following Thoracic Surgery with Posterior Chest Wall Resection.

    PubMed

    Müller, Ina; Tönnies, Mario; Pfannschmidt, Joachim; Kaiser, Dirk

    2015-12-01

    Pneumocephalus can be seen after head injury with fracture of the skull-base or in cerebral neoplasm, infection, or after intracranial or spinal surgery. We report on a 69-year-old male patient with pneumocephalus after right-sided lobectomy and en bloc resection of the chest wall for non-small-cell lung cancer. Postoperatively, the patient showed a reduced vigilance level with no response to pain stimuli and anisocoria. The CCT scan revealed an extensive pneumocephalus; following which, the patient underwent neurosurgery with laminectomy and ligature of the transected nerve roots. After operation the patient returned to his baseline mental status. PMID:26693117

  3. Primary pyogenic spinal epidural abscess: How late is too late and how bad is too bad? - A study on surgical outcome after delayed presentation.

    PubMed

    Avanali, Raghunath; Ranjan, Manish; Ramachandran, Sudheesh; Devi, Bhagavatula I; Narayanan, Vinayak

    2016-02-01

    Spinal epidural abscess is a rare clinical entity with considerable morbidity. Even with prompt diagnosis and treatment, many patients are left with persistent residual neurological deficits. The present study details the outcome in 23 patients of primary pyogenic spinal epidural abscess, addressing the outcome following late presentation at a neurological facility. At presentation only 2 patients had relatively preserved neurological status. Eleven patients were paraplegic. All the patients underwent laminectomy and evacuation of abscess. A good functional outcome was observed in almost half of the patients, and there was a significant reduction in the number of the patients with severe disability. Factors influencing the outcome are described in this study. PMID:26158193

  4. Spinal subdural hematoma with cauda equina syndrome: A complication of combined spinal epidural anesthesia

    PubMed Central

    Singhal, Neha; Sethi, Priyanka; Jain, Jitesh Kumar; Agarwal, Saurabh

    2015-01-01

    Combined spinal-epidural anesthesia (CSE) is considered safe in lower limb surgeries. We report a case of sudden neurological deterioration in a stable postoperative patient who was given CSE for total knee replacement and low molecular weight heparin in postoperative period. On the 4th postoperative day, she developed sudden onset weakness in left lower limb along with bladder incontinence. Magnetic resonance imaging spine revealed a subdural hematoma at L2-L3 level. Immediate laminectomy along with cord decompression was done and patient recovered well except for a persistent foot drop on left side. PMID:25948911

  5. Operative treatment of thoraco-lumbar metastases, using methylmetacrylate and Kempf's rods for vertebral replacement and stabilization. Report of 15 cases.

    PubMed

    Lozes, G; Fawaz, A; Devos, P; Wyremblewski, P; Kassiotis, P; Perper, H; Gozet, G; Pruvo, J P; Jomin, M

    1987-01-01

    The authors report their experience in the treatment of 15 cases in thoracolumbar metastases with spinal cord compression. A decompressive laminectomy was routinely performed and followed by a transversoarthropediculectomy. Most part of the neoplastic tissue was removed from the epidural space, vertebral body and retroperitoneal or retro-pleural areas. Complete decompression of the nervous elements was always achieved. Stabilization was obtained by replacement of the neoplastic vertebral body with a methylmetacrylate prothesis and eventually by Kempf's compression instrumentation. The surgical treatment was completed in a single stage operation, by a classical posterolateral approach. Orthopaedic, neurologic and oncologic advantages of this treatment are discussed. PMID:3577855

  6. Dorsal spine osteoblastoma

    PubMed Central

    Bhargava, Pranshu; Singh, Rahul; Garg, Bharat B.

    2016-01-01

    Benign osteoblastoma is a rare primary neoplasm comprising less than 1% of primary bone tumors.[1] We report a case of a 20-year-old female patient presenting with progressive paraparesis over one year and back pain over the dorsal spine gradually increasing in severity over a year. Computerised tomomography (CT) of the spine revealed a well-defined 3.5 × 3.0 cm mass heterodense expansile bony lesion arising from the lamina of the D12 vertebra, having lytic and sclerotic component and causing compromise of the bony spinal canal. D12 laminectomy and total excision of the tumor was done.

  7. Validation of a Score Predicting Post-Treatment Ambulatory Status After Radiotherapy for Metastatic Spinal Cord Compression

    SciTech Connect

    Rades, Dirk; Douglas, Sarah; Huttenlocher, Stefan; Rudat, Volker; Veninga, Theo; Stalpers, Lukas J.A.; Basic, Hiba; Karstens, Johann H.; Hoskin, Peter J.; Adamietz, Irenaeus A.; Schild, Steven E.

    2011-04-01

    Purpose: A score predicting post-radiotherapy (RT) ambulatory status was developed based on 2,096 retrospectively evaluated metastatic spinal cord compression (MSCC) patients. This study aimed to validate the score in a prospective series. Methods and Materials: The score included five factors associated with post-RT ambulatory status: tumor type, interval tumor diagnosis to MSCC, visceral metastases, pre-RT motor function, time developing motor deficits. Patients were divided into five groups: 21-28, 29-31, 32-34, 35-37, 38-44 points. In this study, 653 prospectively followed patients were divided into the same groups. Furthermore, the number of prognostic groups was reduced from five to three (21-28, 29-37, 38-44 points). Post-RT ambulatory rates from this series were compared with the retrospective series. Additionally, this series was compared with 104 patients receiving decompressive surgery plus RT (41 laminectomy, 63 laminectomy plus stabilization of vertebrae). Results: In this study, post-RT ambulatory rates were 10.6% (21-28 points), 43.5% (29-31 points), 71.0% (32-34 points), 89.5% (35-37 points), and 98.5% (38-44 points). Ambulatory rates from the retrospective study were 6.2%, 43.5%, 70.0%, 86.1%, and 98.7%. After regrouping, ambulatory rates were 10.6% (21-28 points), 70.9% (29-37 points), and 98.5% (38-44 points) in this series, and 6.2%, 68.4%, and 98.7% in the retrospective series. Ambulatory rates were 0%, 62.5%, and 90.9% in the laminectomy plus RT group, and 14.3%, 83.9%, and 100% in the laminectomy + stabilization plus RT group. Conclusions: Ambulatory rates in the different groups in this study were similar to those in the retrospective study demonstrating the validity of the score. Using only three groups is simplier for clinical routine.

  8. Posterior fusion of the subaxial cervical spine: indications and techniques.

    PubMed

    Liu, J K; Das, K

    2001-01-01

    The biomechanical stability of the subaxial cervical spine (C3-7) can be compromised by numerous pathological processes, and the restoration of stability may ultimately require fusion and placement of rigid internal fixation devices. A posterior fusion and stabilization procedure is often used to treat cervical instability secondary to traumatic injury, rheumatoid arthritis, ankylosing spondylitis, neoplastic disease, infections, and previous laminectomy. Numerous techniques and advances in spinal instrumentation have evolved over the last 30 years. The authors review the indications and the various methods for stabilizing and fusing the subaxial cervical spine via posterior approaches. PMID:16732634

  9. Large thoracolumbar extradural arachnoid cyst excised by minimal skipped hemilaminectomy: a case report.

    PubMed

    Lee, Hwa Joong; Cho, Won Ho; Han, In Ho; Choi, Byung Kwan

    2013-03-01

    The standard treatment for symptomatic spinal extradural arachnoid cyst (SEAC) is complete surgical removal of cyst and closure of the dural defect. In most cases, total laminectomy has been performed at affected vertebra for complete removal of the SEAC. However, this invasive surgery may result in postoperative kyphosis and back pain. We report a case of large SEAC involving T10-L1 which was excised through the minimal skipped hemilaminectomy, to minimize the risk of postoperative kyphotic deformity. Simultaneously, we closed the dural defect after preoperative precise identification of the site through several radiological studies. PMID:24757454

  10. Cervico-oculo-acoustic (Wildervanck) syndrome: clinicoradiological findings.

    PubMed

    Rihani, Farouk Bassam

    2013-01-01

    We describe a girl presented with facial asymmetry and oral mucosal cleft and with further investigations other anomalies were found including hearing loss, Duane syndrome, Klippel-Feil anomaly, Chiari malformation and accessory bone mass in mandibular ramus leading to the clinical diagnosis of cervico-oculo-acoustic (Wildervanck) syndrome (COAS). The patient underwent surgical occipital decompression by preforming suboccipital craniectomy and C1 posterior laminectomy to relieve the cerebellar tonsillar herniation. Surgical removal of mandibular bony mass was done and the patient is now under orthodontic treatment to correct facial asymmetry and malocclusion. PMID:23616324

  11. Cervico-oculo-acoustic (Wildervanck) syndrome: clinicoradiological findings

    PubMed Central

    Rihani, Farouk Bassam

    2013-01-01

    We describe a girl presented with facial asymmetry and oral mucosal cleft and with further investigations other anomalies were found including hearing loss, Duane syndrome, Klippel-Feil anomaly, Chiari malformation and accessory bone mass in mandibular ramus leading to the clinical diagnosis of cervico-oculo-acoustic (Wildervanck) syndrome (COAS). The patient underwent surgical occipital decompression by preforming suboccipital craniectomy and C1 posterior laminectomy to relieve the cerebellar tonsillar herniation. Surgical removal of mandibular bony mass was done and the patient is now under orthodontic treatment to correct facial asymmetry and malocclusion. PMID:23616324

  12. 18F-FDG Hypermetabolism in Spinal Cord Schistosomiasis.

    PubMed

    Altinyay, Mustafa Erkan; Alharthi, Ashraf; Alassiri, Ali H; Syed, Ghulam Mustafa Shah

    2016-03-01

    A 24-year-old Saudi man presented with progressive lower-back pain for 3 months followed by lower-limb weakness, numbness, and urinary retention. Cerebrospinal fluid examination revealed high-protein, elevated white blood cell count with lymphocyte predominance. MRI scan of the spine demonstrated heterogeneously enhancing longitudinal spinal cord lesion from T6 through T9. FDG-PET/CT demonstrated prominently hypermetabolic lesion in the spinal cord. He had laminectomy and spinal cord (intramedullary) biopsy. Pathology revealed Schistosoma mansoni ova. PMID:26447373

  13. Cavernous angioma of the cauda equina: case report.

    PubMed

    Falavigna, Asdrubal; Righesso Neto, Orlando; dos Santos, Jos Augusto Nasser; Ferraz, Fernando Antonio Patriani

    2004-06-01

    We present a rare case of cavernous angioma of the cauda equina and review the eleven cases available in the literature. A 44-year-old woman presented with low back pain and sciatica associated with bowel and bladder dysfunction and motor weakness of the lower extremity. The MRI revealed an enhancing, heterogeneous and hyperintense intradural lesion compressing the cauda equina roots at the L4 level. Laminectomy at L3-L4 and total removal of the tumor were performed without additional neurological deficit. Pathology revealed a cavernous angioma. The literature, clinical presentation, technical examinations, and treatment are reviewed. PMID:15273858

  14. Recurrent Postoperative Spinal Epidural Hematoma in a Patient with Protein S Deficiency

    PubMed Central

    Anno, Masato; Yamazaki, Takashi; Hara, Nobuhiro; Hayakawa, Keishi

    2015-01-01

    A 71-year-old man underwent cervical laminectomy and developed two symptomatic epidural hematomas during the acute postoperative period. On both occasions, drain obstruction was the predominant cause. Congenital Protein S deficiency was diagnosed postoperatively. Protein S is a vitamin K-dependent natural anticoagulant and is essential for inhibiting thrombosis in microcirculation. We assume that Protein S deficiency followed by perioperative bed-rest and surgical invasiveness led to severe hypercoagulability and subsequent drain obstruction. The present findings suggest that both bleeding disorders and hypercoagulability are risk factors for postoperative symptomatic epidural hematoma. PMID:26236521

  15. Nocardia brasiliensis vertebral osteomyelitis and epidural abscess.

    PubMed

    Johnson, Philip; Ammar, Hussam

    2013-01-01

    Nocardia species exist in the environment as a saprophyte; it is found worldwide in soil and decaying plant matter. They often infect patients with underlying immune compromise, pulmonary disease or history of trauma or surgery. The diagnosis of nocardiosis can be easily missed as it mimics many other granulomatous and neoplastic disease. We report a 69-year-old man who presented with chronic back pain and paraparesis. He was found to have Nocardial brasiliensis vertebral osteomyelitis and epidural abscess. Laminectomy and epidural wash out was performed but with no neurological recovery. This is the second reported case of N brasiliensis vertebral osteomyelitis in the literature. PMID:23585503

  16. Chemonucleolysis in the management of lumbar disc disease. A minimum six-year follow-up evaluation.

    PubMed

    Sutton, J C

    1986-05-01

    Of 208 chemonucleolysis procedures performed between April 1973 and June 1978, 189 (91%) were available for follow-up evaluation by comprehensive questionnaire after six to 11.2 years. Pain relief, activity level, and personal satisfaction are considered in patients otherwise eligible for discectomy. The procedures were done under general anesthesia with 18-gauge single needle technique using biplane image intensification and routine discography prior to Discase injection. Seventy-nine percent of patients were satisfied with their results, 85% males and 65% females. Sixty-two percent of workman's compensation patients and 57% of patients previously treated by laminectomy had a satisfactory result. Ninety-five percent of patients had disc space narrowing postoperatively. Complications were few and of no lasting concern. Of the failures, 12.7% had laminectomies within 18 months of injection while 9.5% had a satisfactory result for at least two years. Disc reexpansion was demonstrated after postinjection narrowing in 14% of 58 cases roentgenographically evaluated, including patients of the 2nd, 3rd, and 4th decade of life. Recurrence rate in the total series was 9.5%. Chemonucleolysis is the least traumatic invasive procedure capable of removing the nucleus pulposus and is most effective when used in the treatment of lumbar disc herniation with objective signs of nerve root compression. In this series, approximately 80% of patients were spared open surgery. PMID:2940044

  17. Surgical methods and efficacies for cervicothoracolumbar spinal schwannoma

    PubMed Central

    DENG, QIANG; TIAN, ZHENG; SHENG, WEIBIN; GUO, HAILONG; DAN, MAI ER

    2015-01-01

    The aim of this study was to investigate the surgical methods and efficacies for cervicothoracolumbar spinal schwannoma (CSS). A total of 52 patients who had undergone treatment for schwannoma were retrospectively analyzed. Two methods were employed for the surgical resection of the thoracic and lumbar schwannomas: Type I (posterior midline approach semi-laminectomy with tumor resection and internal fixation with pedicle screws) was used in 24 cases, and type II (posterior midline approach laminectomy with tumor resection and internal fixation with pedicle screws) was used in 26 cases. Two cases of giant cervical schwannoma were treated via anterior-posterior combined surgery. Histopathological examination confirmed the diagnosis of schwannoma in all cases (n=52). The clinical status of the patients was evaluated pre- and postoperatively using the visual analog scale, Oswestry Disability Index and Japanese Orthopedic Association scale, and the scores associated with the two types of surgical method were compared. Within the follow-up period, which lasted between 6 months and 3 years, no recurrence was detected, and such preoperative symptoms as radicular pain and spinal dysfunction were improved significantly. The numbness and hyperesthesia were relieved to different extents. In conclusion, methods of exposing and surgically treating CSS should be selected according to the growth site of the schwannoma in order to reduce the blood loss and surgery duration and to improve the surgical safety. PMID:26668590

  18. Preventive effect of dexamethasone gelatin sponge on the lumbosacral epidural adhesion

    PubMed Central

    Tian, Fuming; Dou, Changwu; Qi, Songtao; Zhao, Liqun; Chen, Bo; Yan, Haicheng; Zhang, Li

    2015-01-01

    Objective: This study aims to explore the preventive effect of dexamethasone gelatin sponge on the lumbosacral epidural adhesion in the laminectomy. Methods: A total of 36 Wista rats were divided into A, B, C and D groups randomly. Dexamethasone was not used in group A, Dexamethasone was used in group B, Dexamethasone was not used in group C but covered with gelatin sponge, dexamethasone gelatin sponge was used in group D. 3 rats in each group were sacrificed at 4, 8 and 12 weeks after operation respectively and the wound was opened to observe the dural scar formation and the dura adhesion. Immunohistochemical technique was used for histology observation. The expressions of VEGF and VEGFR2 in the epidural scar and surrounding tissues were detected with western blotting and immunohistochemical methods. Results: According to the Rydell score standard, there were different degree of adhesion formation in A, B and C groups while there was no obvious adhesion formation in D group. It was confirmed that the expressions of VEGF and VEGFR2 in group D were lower than that of the other groups. Conclusions: Dexamethasone gelatin sponge could significantly reduce the occurrence of epidural scar tissue hyperplasia and adhesion after laminectomy in rats, and its mechanism may be related to the decreased expression of VEGF and VEGFR2. PMID:26131126

  19. A new minimally-invasive method for microinjection into the mouse spinal dorsal horn

    PubMed Central

    Kohro, Yuta; Sakaguchi, Emi; Tashima, Ryoichi; Tozaki-Saitoh, Hidetoshi; Okano, Hideyuki; Inoue, Kazuhide; Tsuda, Makoto

    2015-01-01

    Noninvasive gene delivery to the spinal dorsal horn (SDH) remains challenging because existing methods to directly microinject vectors require laminectomy, which leads to tissue damage and inflammation. Such responses might hamper accurate readouts of cellular and behavioural effects of an introduced gene. Here we develop a new minimally-invasive SDH microinjection technique without the need of laminectomy in which a microcapillary is inserted into the SDH parenchyma through an intervertebral space. Using this method, we microinjected adeno-associated virus with an astrocytic promoter into the SDH and achieved efficient gene expression in an astrocyte-specific manner without gliosis, neuronal loss or inflammation. Furthermore, astrocytic loss- and gain-of-function of the transcription factor STAT3 by expressing a dominant-negative form and a constitutive-active form of STAT3, respectively, demonstrated the necessity and sufficiency of astrocytic STAT3 in the maintenance of neuropathic pain following peripheral nerve injury, a debilitating chronic pain state in which currently available treatments are frequently ineffective. Thus, our technique enables manipulation of gene expression in cell type- and spatial-specific manners without adverse effects, and may be useful for research in SDH physiology and pathology. PMID:26387932

  20. Changes of the Electrophysiological Study in Dogs with Acute Spinal Cord Injury

    PubMed Central

    Min, Joongkee; Kim, Ji Yun; Seo, Cheong Hoon; Jeon, Sang Ryong; Choi, Kyoung Hyo

    2014-01-01

    Objective This study describes a method for inducing spinal cord injuries in dogs by using balloon catheters via laminectomy and the subsequent changes in the electrophysiological response. Methods Female Beagle (Orient Bio, Seongnam, Korea) dogs weighing 10 kg at the time of injury were used. Under inhalation anesthesia, a posterior midline approach laminectomy was performed. A silicone balloon catheter (size 6 Fr; Sewoon Medical, Cheonan, Korea) was then inserted into the vertebral canal at the center of T10. The balloon was inflated to the maximum volume for 1, 2, or 3 days. Open field testing was performed for evaluating motor functions of the hindlimbs. Motor evoked potentials (MEPs) induced by electrical and magnetic stimulation were recorded before and after spinal cord injury. Results Open field testing yielded locomotor scores of 0 or 1 for dogs subjected to compression for 3 days. These dogs showed no obvious improvement throughout the observation period, and the tonus of their hindlimbs was flaccid. In contrast, motor functions of dogs that had experienced compression for 1 or 2 days were variable, and all dogs showed spastic tonus in their hindlimbs. In dogs subjected to after compression for 3 days, electrically stimulated MEPs for the hindlimbs showed a significant amplitude reduction. Further, hindlimb movements were not evoked by magnetic stimulation of the cervical spine and vertex area. Conclusion Compression for 3 days with a balloon catheter is a safe, reproducible, and reliable method for evaluating electrophysiological changes in a dog model of complete spinal cord injury. PMID:27169024

  1. A Case of Cauda Equina Syndrome in Early-Onset Chronic Inflammatory Demyelinating Polyneuropathy Clinically Similar to Charcot-Marie-Tooth Disease Type 1

    PubMed Central

    Lee, Seung Eun; Ha, Sam Yeol; Nam, Taek Kyun

    2014-01-01

    To present a case of cauda equina syndrome (CES) caused by chronic inflammatory demyelinating polyneuropathy (CIDP) which seemed clinically similar to Charcot-Marie-Tooth disease type1 (CMT1). CIDP is an immune-mediated polyneuropathy, either progressive or relapsing-remitting. It is a non-hereditary disorder characterized by symmetrical motor and sensory deficits. Rarely, spinal nerve roots can be involved, leading to CES by hypertrophic cauda equina. A 34-year-old man presented with low back pain, radicular pain, bilateral lower-extremity weakness, urinary incontinence, and constipation. He had had musculoskeletal deformities, such as hammertoes and pes cavus, since age 10. Lumbar spine magnetic resonance imaging showed diffuse thickening of the cauda equina. Electrophysiological testing showed increased distal latency, conduction blocks, temporal dispersion, and severe nerve conduction velocity slowing (3 m/s). We were not able to find genetic mutations at the PMP 22, MPZ, PRX, and EGR2 genes. The pathologic findings of the sural nerve biopsy revealed thinly myelinated nerve fibers with Schwann cells proliferation. We performed a decompressive laminectomy, intravenous IgG (IV-IgG) and oral steroid. At 1 week after surgery, most of his symptoms showed marked improvements except foot deformities. There was no relapse or aggravation of disease for 3 years. We diagnosed the case as an early-onset CIDP with cauda equine syndrome, whose initial clinical findings were similar to those of CMT1, and successfully managed with decompressive laminectomy, IV-IgG and oral steroid. PMID:25237436

  2. A simple and effective semi-invasive method for inducing local hypothermia in rat spinal cord.

    PubMed

    Bazley, Faith A; Pashai, Nikta; Kerr, Candace; Thakor, Nitish; All, Angelo H

    2013-01-01

    Hypothermia has been shown to be an effective treatment for spinal cord injury. Local hypothermia is advantageous because it avoids inducing systemic side effects of general hypothermia while providing the opportunity for greater temperature reduction at the site of injury, which may contribute to increased neuroprotection. We report a new semi-invasive method for inducing local hypothermia in rats' spinal cords. Our method does not require laminectomy or penetration of the dura and is more effective at cooling the cord than transcutaneous approaches. We show that we were successfully able to cool the spinal cord to 30.2 ± 0.3°C for 2 hours with rectal temperature maintained at 37.3 ± 0.3°C after a spinal cord contusion injury. We also validated our method in control rats that received only a laminectomy. Furthermore, this method was able to reliably cool and rewarm the cord at a steady rate (Δ5.5°C in 30 min, or 0.2°C/min). Future work will include validating long-term functional improvements of injured rats after treatment and to apply local cooling to other spinal cord injury models, such as compression injuries. PMID:24111186

  3. Evaluation of the stress distribution change at the adjacent facet joints after lumbar fusion surgery: a biomechanical study.

    PubMed

    Ma, Jianxiong; Jia, Haobo; Ma, Xinlong; Xu, Weiguo; Yu, Jingtao; Feng, Rui; Wang, Jie; Xing, Dan; Wang, Ying; Zhu, Shaowen; Yang, Yang; Chen, Yang; Ma, Baoyi

    2014-07-01

    Spinal fusion surgery has been widely applied in clinical treatment, and the spinal fusion rate has improved markedly. However, its postoperative complications, especially adjacent segment degeneration, have increasingly attracted the attention of spinal surgeons. The most common pathological condition at adjacent segments is hypertrophic degenerative arthritis of the facet joint. To study the stress distribution changes at the adjacent facet joint after lumbar fusion with pedicle screw fixation, human cadaver lumbar spines were used in the present study, and electrical resistance strain gauges were attached on L1-L4 articular processes parallel or perpendicular to the articular surface of facet joints. Subsequently, electrical resistance strain gauge data were measured using anYJ-33 static resistance strain indicator with three types of models: the intact model, the laminectomy model, and the fusion model with pedicle screw fixation. The strain changes in the measurement sites indirectly reflect the stress changes. Significant differences in strain were observed between the normal and laminectomy state at all facet joints. Significant differences in strain were observed between the normal and the pedicle screw fixation fusion state at the L1/2 and L3/4 facet joints. The increased stress on the facet joints after lumbar fusion with pedicle screw fixation may be the cause of adjacent segment degeneration. PMID:24963037

  4. “No Clinical Puzzles More Interesting”: Harvey Cushing and Spinal Trauma, The Johns Hopkins Hospital 1896-1912

    PubMed Central

    Dasenbrock, Hormuzdiyar H.; Pendleton, Courtney; Cohen-Gadol, Aaron A.; Witham, Timothy F.; Gokaslan, Ziya L.; Quinones-Hinojosa, Alfredo; Bydon, Ali

    2015-01-01

    Although Harvey Cushing played a central role in the establishment of neurosurgery in the United States, his work on the spine remains largely unknown. This article is not only the first time that Cushing's spinal cases while he was at Johns Hopkins have been reported, but also the first time his management of spinal trauma has been described. We report on 12 patients that Cushing treated from 1898 to 1911 who have never been reported before, including blunt and penetrating injuries, complete and incomplete spinal cord lesions, and both immediate and delayed presentations. Cushing performed laminectomies within 24 hours on patients with immediate presentations—both complete and incomplete spinal cord lesions. Among those with delayed presentations, Cushing did laminectomies on patients with incomplete spinal cord injuries. By the end of his tenure at Hopkins, Cushing advocated nonoperative treatment for all patients with complete spinal cord lesions. Four patients died while an inpatient, with meningitis and cystitis leading to the death of 1 and 3 patients, respectively. Cystitis was treated with intravesicular irrigation; an indwelling catheter was placed by a suprapubic cystostomy in four. Cushing was one of the first to report the use of x-ray in a spine patient, in a case that may have been one factor leading to his interest in the nervous system; Cushing also routinely obtained radiographs in those with spinal trauma. These cases illustrate Cushing's dedication to and rapport with his patients, even in the face of a dismal prognosis. PMID:21135734

  5. Ultrasonography of the brain and vertebral canal in dogs and cats: 15 cases (1988-1993).

    PubMed

    Gallagher, J G; Penninck, D; Boudrieau, R J; Schelling, S H; Berg, J

    1995-11-15

    Medical records of 3 cats and 12 dogs with lesions of the brain (3 cats, 2 dogs) or vertebral canal (10 dogs) that underwent intraoperative ultrasonography were reviewed. Ultrasonography was performed after craniotomy, a ventral slot procedure, or laminectomy, using a real-time sector scanner with a 7.5- or 10-MHz transducer. In the 3 cats and 2 dogs with brain lesions, cerebral masses were hyperechoic, compared with normal brain, and were easily located. In the 2 dogs, ultrasonography was necessary to localize deep-seated cerebral lesions that could not be seen following craniotomy. In 7 dogs that underwent a ventral slot procedure because of prolapse of an intervertebral disk, ultrasonography was successfully used to assess completeness of disk removal. The remaining 3 dogs underwent dorsal laminectomy because intradural enlargement of the spinal cord (1 dog) or an intradural mass (2 dogs) could be seen myelographically. In the 2 dogs with intradural masses, intraoperative ultrasonography helped to delineate the extent of the tumor. In the third dog, spinal cord swelling was seen ultrasonographically; the histologic diagnosis was spinal cord edema. PMID:7591927

  6. Syringomyelia secondary to “occult” dorsal arachnoid webs: Report of two cases with review of literature

    PubMed Central

    Sayal, Parag P; Zafar, Arif; Carroll, Thomas A

    2016-01-01

    In a certain group of patients with syringomyelia, even with the advent of sophisticated magnetic resonance imaging (MRI), no associated abnormality or cerebrospinal fluid (CSF) block is easily identified. This type of syringomyelia is often termed idiopathic. Current literature has less than 10 reports of arachnoid webs to be the causative factor. We present our experience in the management of two cases of syringomyelia secondary to arachnoid webs. Both our patients presented with progressive neurological deterioration with MRI scans demonstrating cervical/thoracic syrinx without Chiari malformation or low-lying cord. There was no history of previous meningitis or trauma. Both patients underwent myelography that demonstrated dorsal flow block implying CSF obstruction. Cord displacement/change in caliber was also noted and this was not evident on MRI scans. Both patients underwent thoracic laminectomy. After opening the dura, thickened/abnormal arachnoid tissue was found that was resected thus widely communicating the dorsal subarachnoid space. Postoperatively at 6 months, both patients had significant symptomatic improvement with follow-up MRI scans demonstrating significant resolution of the syrinx. In patients with presumed idiopathic syringomyelia, imaging studies should be closely inspected for the presence of a transverse arachnoid web. We believe that all patients with idiopathic symptomatic syringomyelia should have MRI CSF flow studies and/or computed tomography (CT) myelography to identify such arachnoid abnormalities that are often underdiagnosed. Subsequent surgery should be directed at the establishment of normal CSF flow by laminectomy and excision of the offending arachnoid tissue.

  7. Optimum electrode geometry for spinal cord stimulation: the narrow bipole and tripole.

    PubMed

    Holsheimer, J; Wesselink, W A

    1997-09-01

    A computer model is used to calculate the optimum geometry of an epidural electrode, consisting of a longitudinal contact array, for spinal cord stimulation in the management of chronic, intractable pain. 3D models of the spinal area are used for the computation of stimulation induced fields, and a cable model of myelinated nerve fibre is used for the calculation of the threshold stimulus to excite large dorsal column and dorsal root fibres. The criteria for the geometry of the longitudinal contact array are: a low threshold for the stimulation of dorsal column fibres compared with dorsal root fibres; and a low stimulation voltage (and current). For both percutaneous and laminectomy electrodes, the contact length should be approximately 1.5 mm, and the optimum contact separation, as determined by the computer model, is 2-2.5 mm. The contacts for a laminectomy electrode should be approximately 4 mm wide. This electrode geometry is applicable to all spinal levels where the dorsal columns can be stimulated (C1-2 down to L1). The stimulating electrode should preferably be used as a tripole with one (central) cathode. PMID:9374053

  8. An interesting case of primary spinal arachnoiditis.

    PubMed

    Vaughan, Denis; Bolger, Ciaran; O'Brien, Donncha Finbar

    2012-08-01

    Spinal arachnoiditis describes inflammation of the meninges, subarachnoid space and, in most cases, also involve the pial layer. The vast majority of cases described are secondary and are preceded by a known event, for example,. trauma, infections or irritative substances. Here, we present the case of primary spinal arachnoiditis. A 35-year-old lady was referred to the neurosurgical services in Dublin, Ireland with a 15-month history of progressive, right lower limb weakness. Magnetic resonance imaging revealed cystic distortion of the lumbar spinal canal extending up to the conus. Initially, an L2-L4 laminectomy was performed revealing thickened and adherent arachnoid with a large cyst in the spinal canal. Four months after initial operation, the patient represented with bilateral lower limb weakness and loss of detrusor function. Repeat magnetic resonance imaging was performed, which showed the development of a syrinx in the patient's thoracic spine. We then performed a T9-T10 laminectomy, midline myelotomy and insertion of a syringe-arachnoid shunt. Post-operative imaging showed resolution of the syrinx and a vast improvement in lower limb power. The patient also regained bladder control. In conclusion, spinal arachnoiditis is a clearly defined pathological and radiological entity with a highly variable clinical presentation. It is exceedingly difficult to treat as there is no recognised treatment currently, with most interventions aimed at symptomatic relief. PMID:22369357

  9. CCN5 attenuates profibrotic phenotypes of fibroblasts through the Smad6-CCN2 pathway: Potential role in epidural fibrosis

    PubMed Central

    XU, HONGHAI; LIU, CONG; SUN, ZHENGMING; GUO, XIONG; ZHANG, YUELIN; LIU, MENGTING; LI, PENG

    2015-01-01

    Epidural fibrosis is characterized by the development of dense and thick scar tissue adjacent to the dural mater and ranked as the major contributor for post-operative pain recurrence after laminectomy or discectomy. Recently, CCN5 exhibited an inhibitory effect on connective tissue growth factor (CTGF)/CCN2 (a critical regulator for fibrotic disease)-mediated fibrogenesis. However, its function in epidural fibrosis and the underlying mechanisms involved remain to be determined. In this study, an obvious downregulation of CCN5 was observed in scar tissues from laminectomized rats, concomitant with a marked upregulation of CCN2, suggesting a potential negative regulatory role of CCN5 in fibrogenesis. Furthermore, CCN5 overexpression notably mitigated transforming growth factor-β1-enhanced fibroblast viability and proliferation. Of note, CCN5 upregulation inhibited the switch of fibroblasts into myofibroblasts as its overexpression abrogated the expression of the myofibroblast marker, α-smooth muscle actin (α-SMA). CCN5 upregulation also reduced an increase in collagen type I, α1 (COL1A1) and total collagen concentrations. Additionally, CCN5 over expression decreased CCN2 expression and increased Smad6 phosphorylation. Mechanism analysis revealed that blocking Smad6 signaling significantly ameliorated the inhibitory effect of CCN5 on the CCN2 levels, accompanied by the reduction in cell proliferation and collagen production. These results confirm that CCN5 exerts an anti-fibrotic function by regulating the Smad6-CCN2 pathway, thereby indicating a potential approach for ameliorating epidural fibrosis after laminectomy. PMID:25901787

  10. Effects of Rapamycin on Reduction of Peridural Fibrosis: An Experimental Study

    PubMed Central

    Luo, Like; Zhang, Chifei; Zhao, Jinmin; Wei, Qingjun; Li, Xiaofeng

    2015-01-01

    Background Peridural fibrosis (PF) is a normal complication after lumbar surgery. It is a challenge for both surgeons and patients. Rapamycin (RPM), a novel antibiotic with anti-proliferative and immunosuppressive properties, has been shown to be effective in preventing uncontrolled scar proliferation diseases. The object of the present research was to investigate the effects of RPM on inhibiting PF in vitro and in vivo. Material/Methods In vitro, the fibroblasts collected and isolated from the rat tail skin were cultured with/without RPM and cell counting was performed. In vivo, the double-blinded study was conducted in 60 healthy Wistar rats divided randomly into 3 groups: 1) RPM treatment group; 2) Vehicle treatment group; 3) Control group. Rats underwent a L1-L2 level laminectomy with a satisfactory anesthetization. Four weeks post-operatively, the Rydell score, histological analysis, hydroxyproline content, vimentin expressional level, and inflammatory cytokines expressional levels were assessed. Results In vitro, RPM showed ability to prevent fibroblast proliferation. In vivo, the laminectomy was well tolerated by all rats, which were killed 4 weeks post-operatively. The Rydell score, histological evaluation, hydroxyproline content, vimentin expression level, and inflammatory activity showed the positive effect of RPM in preventing peridural adhesion, inhibiting fibrotic formation and collagen synthesis, and down-regulating inflammation. Conclusions In the present primary study, RPM showed good efficacy in preventing the proliferation of fibroblasts. RPM can prevent rat peridural adhesion through inhibiting collagen synthesis, fibroblasts proliferation, and inflammatory activity. PMID:25677111

  11. Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability.

    PubMed

    Tan, Guo-qing; He, Ji-liang; Fu, Bai-sheng; Li, Lian-xin; Wang, Bo-min; Zhou, Dong-sheng

    2012-08-01

    Sacral fractures with both transverse and bilateral vertical fracture components are by definition multiplanar fractures, and often present with spinopelvic instability and cauda equina deficits. The treatment is challenging. Between 2006 and 2009, we treated nine such patients at our trauma centre. There were six men and three women, with a mean age of 32.2 years. Preoperative neurologic deficits were noted in seven patients; four patients had complete cauda equina paralysis, and three patients had incomplete cauda equina syndrome. All patients were treated using lumbopelvic instrumented fixation without other devices for their multiplanar sacral fractures. Six patients who had neurological deficits and sacral canal compression underwent decompression laminectomy. The mean postoperative follow-up time was 21.7 months (range, 14-32 months). All fractures went on to union without loss of reduction or hardware failure. The mean Gibbons score improved from 3.5 preoperatively to 2.3 postoperatively among the patients who underwent decompression laminectomy. Eight out of nine patients had fair or better results based on radiographic criteria and the Majeed pelvic fracture outcome score. Our experience suggests lumbopelvic fixation can be used for the treatment of multiplanar sacral fractures with spinopelvic instability with a low rate of complications. Neurologic improvement can be expected, but whether surgical decompression results in substantially better neurologic recovery than conservative treatment remains uncertain. PMID:22632803

  12. Balantidium coli: an unrecognized cause of vertebral osteomyelitis and myelopathy.

    PubMed

    Dhawan, Shashi; Jain, Deepali; Mehta, Veer Singh

    2013-03-01

    Balantidium coli is a ciliated protozoan parasite that primarily infects primates and pigs. It is the largest protozoan to infect humans and is a well-known cause of diarrhea and dysentery. Extraintestinal disease is uncommon, and extraintestinal spread to the peritoneal cavity, appendix, genitourinary tract, and lung has rarely been reported. The authors describe a case of vertebral osteomyelitis with secondary cervical cord compression caused by B. coli. The patient was a 60-year-old immunocompetent man presenting with quadriplegia of short duration. Magnetic resonance imaging of the cervical spine showed extradural and prevertebral abscess at the C3-4 level. Drainage of the abscess, C3-4 discectomy, and iliac bone grafting were performed. Histologically B. coli was confirmed in an abscess sample. To the best of the authors' knowledge, involvement of bone by B. coli has never been reported, and this case is the first documented instance of cervical cord compression due to B. coli osteomyelitis of the spine in the literature. PMID:23259539

  13. Lumbar Disk Herniation Surgery: Outcome and Predictors

    PubMed Central

    Sedighi, Mahsa; Haghnegahdar, Ali

    2014-01-01

    Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire–Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population. Predictive factors for ineffective surgical treatment for lumbar disk herniation were female sex and negative preoperative straight leg raising. Age, level of education, and preoperative VAS for low back pain were other factors that showed prediction power. PMID:25396104

  14. Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years

    PubMed Central

    Tosteson, Anna N.A.; Lurie, Jon D.; Tosteson, Tor D.; Skinner, Jonathan S.; Herkowitz, Harry; Albert, Todd; Boden, Scott D.; Bridwell, Keith; Longley, Michael; Andersson, Gunnar B.; Blood, Emily A.; Grove, Margaret R.; Weinstein, James N.

    2009-01-01

    Background The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain. Objective To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis. Design Prospective cohort study. Data Sources Resource utilization, productivity, and EuroQol EQ-5D score measured at 6 weeks and at 3, 6, 12, and 24 months after treatment among SPORT participants. Target Population Patients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis. Time Horizon 2 years. Perspective Societal. Intervention Nonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis). Outcome Measures Cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis Among 634 patients with stenosis, 394 (62%) had surgery, most often decompressive laminectomy (320 of 394 [81%]). Stenosis surgeries improved health to a greater extent than nonoperative care (QALY gain, 0.17 [95% CI, 0.12 to 0.22]) at a cost of $77 600 (CI, $49 600 to $120 000) per QALY gained. Among 601 patients with degenerative spondylolisthesis, 368 (61%) had surgery, most including fusion (344 of 368 [93%]) and most with instrumentation (269 of 344 [78%]). Degenerative spondylolisthesis surgeries significantly improved health versus non-operative care (QALY gain, 0.23 [CI, 0.19 to 0.27]), at a cost of $115 600 (CI, $90 800 to $144 900) per QALY gained. Result of Sensitivity Analysis Surgery cost markedly affected the value of surgery. Limitation The study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment non-adherence among randomly assigned participants. Conclusion The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon. PMID:19075203

  15. Osteoporotic spinal burst fracture in a young adult as first presentation of systemic mastocytosis.

    PubMed

    Ble, Christina; Tsitsopoulos, Parmenion P; Anestis, Dimitrios M; Hadjileontiadou, Sofia; Koletsa, Triantafyllia; Papaioannou, Maria; Tsonidis, Christos

    2016-01-01

    Osteoporotic vertebral fractures are uncommon in young adults and usually indicate an underlying disease. Systemic mastocytosis is a myeloproliferative neoplasm, which can be associated with osteoporosis. A previously healthy 30-year-old man presented with an L4 burst fracture after lifting a heavy object. He was operated with laminectomy and posterior lumbar instrumentation. During surgery, abnormally soft bone was noted. Postoperatively, osteoporosis was confirmed with measurement of bone mineral density. Further investigation revealed elevated serum tryptase levels while bone marrow biopsy findings showed systemic mastocytosis. He was also tested positive for D816V KIT mutation. Treatment with biphosphonates and interferon was initiated. No extraskeletal involvement was noted up to the last checkup, 18 months after the first presentation. Abrupt vertebral fractures in apparently healthy young individuals should raise the suspicion of an underlying pathology. Prompt identification and treatment of systemic mastocytosis is crucial in order to avoid unexpected sequelae. PMID:27141048

  16. Posterior Trans-Dural Repair of Iatrogenic Spinal Cord Herniation after Resection of Ossification of Posterior Longitudinal Ligament

    PubMed Central

    Kim, Hong-Ki; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2016-01-01

    Iatrogenic spinal cord herniation is a rare complication following spinal surgery. We introduce a posterior trans-dural repair technique used in a case of thoracic spinal cord herniation through a ventral dural defect following resection of ossification of the posterior longitudinal ligament (OPLL) in the cervicothoracic spine. A 51-year-old female was suffering from paraplegia after laminectomy alone for cervicothoracic OPLL. Magnetic resonance imaging revealed a severely compressed spinal cord with pseudomeningocele identified postoperatively. Cerebrospinal fluid leak and iatrogenic spinal cord herniation persisted despite several operations with duroplasty and sealing agent. Finally, the problems were treated by repair of the ventral dural defect with posterior trans-dural duroplasty. Several months after surgery, the patient could walk independently. This surgical technique can be applied to treat ventral dural defect and spinal cord herniation. PMID:27114779

  17. The Use of Plastic Plates for Fixation of Spinal Fractures in the Dog

    PubMed Central

    Dulisch, Mary L.; Withrow, S. J.

    1979-01-01

    Plastic plates are a rapid and easy method to realign and stabilize the spinal column following a traumatic injury and may give greater bone-to-plate contact than metal plates. They distribute the pressure on the spinous processes over a larger surface area although plate slippage and spinous process fractures can occur as with any plate. Laminectomies should not be a routine procedure with plating but each patient should be evaluated individually and autogenous bone grafts may be used to advantage to promote fusion of vertebral bodies. In the two cases presented, the plastic plates achieved their purpose. However, it is essential that fusion of the vertebrae occurs before the plates slip or the spinous processes fracture. ImagesFigure 1.Figure 2.Figure 3AFigure 3BFigure 4.Figure 5.Figure 6. PMID:526904

  18. Usefulness of Intraoperative Monitoring during Microsurgical Decompression of Cervicomedullary Compression Caused by an Anomalous Vertebral Artery

    PubMed Central

    Kim, Sung Tae; Jeong, Dong Mun; Lee, Kun Soo

    2014-01-01

    We report a case of cervicomedullary compression by an anomalous vertebral artery treated using microsurgical decompression with intraoperative monitoring. A 68-year-old woman presented with posterior neck pain and gait disturbance. MRI revealed multiple abnormalities, including an anomalous vertebral artery that compressed the spinal cord at the cervicomedullary junction. Suboccipital craniectomy with C1 laminectomy was performed. The spinal cord was found to be compressed by the vertebral arteries, which were retracted dorsolaterally. At that time, the somatosensory evoked potential (SSEP) changed. After release of the vertebral artery, the SSEP signal normalized instantly. The vertebral artery was then lifted gently and anchored to the dura. There was no other procedural complication. The patient's symptoms improved. This case demonstrates that intraoperative monitoring may be useful for preventing procedural complications during spinal cord microsurgical decompression. PMID:25628814

  19. [A Case of Spinal Epidural Hematoma Presenting with Transient Hemiplegia].

    PubMed

    Komai, Takanori; Nakashima, Kazuya; Tominaga, Takashi; Nogaki, Hidekazu

    2016-04-01

    We report a rare case of a patient with spinal epidural hematoma who presented with transient hemiplegia. A 90-year-old man awakened from sleep due to sudden neck pain. Fifteen minutes later, the man experienced progressively worsening weakness in his left hand, and was transported in an ambulance to our hospital. At the hospital, he presented with hemiplegia, and we suspected intracranial disease. Therefore, we performed magnetic resonance imaging(MRI), which revealed no intracranial lesions. Shortly after the MRI, the patient showed no signs of hemiplegia. However, since the severe neck pain persisted, we performed cervical MRI, which showed a high-intensity area at the C2-C5 level, predominantly on the left side. Despite recovery from hemiplegia, we performed a laminectomy of C3-C5 with evacuation of a hematoma at the C2-C6 level. After the surgery, the patient had no neck pain. PMID:27056873

  20. [IgD-paraproteinemia in lymphoplasmacytoid immunocytoma].

    PubMed

    Seewann, H L; Tilz, G P; Becker, H; Lehnert, M

    1982-11-19

    Laminectomy was performed in a 54-year-old patient who had a hemicauda syndrome. An epidural tumour, extending into the spongiosa of the third lumbar vertebra was found. Histologically it was a lymphoplasmacytoid lymphoma. Subsequent haematological investigation revealed a multilocular involvement (stage IV) and paraproteinaemia of the IgD-kappa-type. There was no Bence-Jones protein in the urine. After irradiation of the affected lumbar vertebra the patient was treated with a combination of chlorambucil and prednisone, later on with COP and VMCP regimens. A rapid downhill course set in 16 months after diagnosis and the patient died from intracerebral expansion of the immunocytoma. The clinical diagnosis was confirmed at autopsy. The generalized lymphoplasmacytoid immunocytoma contained evidence of terminal transformation into the polymorph subtype. PMID:7140559

  1. Spontaneous ventral spinal epidural hematoma in a child: A case report and review of literature.

    PubMed

    Ratre, Shailendra; Yadav, Yadram; Choudhary, Sushma; Parihar, Vijay

    2016-01-01

    Spontaneous spinal epidural hematoma is very uncommon cause of spinal cord compression. It is extremely rare in children and is mostly located in dorsal epidural space. Ventral spontaneous spinal epidural hematoma (SSEH) is even rarer, with only four previous reports in childrens. We are reporting fifth such case in a 14 year old male child. He presented with history of sudden onset weakness and sensory loss in both lower limbs with bladder bowel involvment since 15 days. There was no history of trauma or bleeding diasthesis. On clinical examination he had spastic paraplegia. Magnetic resonance imaging (MRI) of dorsal spine was suggestive of ventral spinal epidural hematoma extending from first to sixth dorsal vertebrae. Laminectomy of fourth and fifth dorsal vertebrae and complete evacuation of hematoma was done on the same day of admission. Postoperatively the neurological status was same. PMID:27114667

  2. Osteoporotic spinal burst fracture in a young adult as first presentation of systemic mastocytosis

    PubMed Central

    Ble, Christina; Tsitsopoulos, Parmenion P.; Anestis, Dimitrios M.; Hadjileontiadou, Sofia; Koletsa, Triantafyllia; Papaioannou, Maria; Tsonidis, Christos

    2016-01-01

    Osteoporotic vertebral fractures are uncommon in young adults and usually indicate an underlying disease. Systemic mastocytosis is a myeloproliferative neoplasm, which can be associated with osteoporosis. A previously healthy 30-year-old man presented with an L4 burst fracture after lifting a heavy object. He was operated with laminectomy and posterior lumbar instrumentation. During surgery, abnormally soft bone was noted. Postoperatively, osteoporosis was confirmed with measurement of bone mineral density. Further investigation revealed elevated serum tryptase levels while bone marrow biopsy findings showed systemic mastocytosis. He was also tested positive for D816V KIT mutation. Treatment with biphosphonates and interferon was initiated. No extraskeletal involvement was noted up to the last checkup, 18 months after the first presentation. Abrupt vertebral fractures in apparently healthy young individuals should raise the suspicion of an underlying pathology. Prompt identification and treatment of systemic mastocytosis is crucial in order to avoid unexpected sequelae. PMID:27141048

  3. DTI for assessing axonal integrity after contusive spinal cord injury and transplantation of oligodendrocyte progenitor cells.

    PubMed

    Bazley, Faith A; Pourmorteza, Amir; Gupta, Siddharth; Pashai, Nikta; Kerr, Candace; All, Angelo H

    2012-01-01

    We describe the feasibility of using diffusion tensor magnetic resonance imaging (DT-MRI) to study a contusive model of rat spinal cord injury following human stem cell transplantation at and around the site of injury. Rats receiving either a laminectomy or contusion injury were transplanted with oligodendrocyte precursor cells (OPCs). During the course of the study, bioluminescence imaging (BLI; up to 100 days) and somatosensory evoked potentials (SSEPs; up to 42 days) were used to evaluate cell survival and functional outcomes. Spinal cords were then analyzed ex vivo upon termination using diffusion tensor imaging (DTI). Improvements in fractional anisotropy (FA) at day 100 post-transplantation corresponded with cell survival and functional SSEP improvements. Thus, we illustrate the feasibility of DTI for evaluating axonal integrity in SCI after cell replacement therapies, and we provide examples utilizing OPC transplantations in a contusion rat model. PMID:23365837

  4. Spinal Intradural Schwannoma with Acute Intratumoural Haemorrhage: Case Report and Review

    PubMed Central

    Kongwad, Lakshman I.; Valiathan, Manna G.

    2016-01-01

    Schwannomas account for around half of all intradural spinal tumours, with chronic progressive symptoms as the most common presenting features. Intratumoural haemorrhage as a presenting feature of spinal schwannoma is very rare and only 11 cases have been reported till date. Authors here report a previously asymptomatic 40-year-old male who presented with acute onset paraplegia 12 hours after a minor trauma. MR imaging revealed a C7-D3 intradural-extramedullary lesion with features of acute blood and showing no enhancement. Emergency laminectomy and complete removal of the mass was performed and histopathology revealed features of schwannoma with haemorrhage. Patient had modest improvement of his neurological deficits at a follow-up of 6 months. Pertinent literature is reviewed in brief. PMID:26894121

  5. Surgical treatment of giant cell tumor of the cervicothoracic spine with combined anterior and posterior approaches

    PubMed Central

    Habibou, M.L.; Boutarbouch, M.; Oudghiri, M.Y.; Mchome, L.; Louraoui, M.; Derraz, S.; El Ouahabi, A.

    2015-01-01

    Generally, giant cell tumors are rare and their localization in the spine is even more so. They are locally aggressive leading to spine instability and neurologic deficits. Radical excision is highly advocated. A role of radiotherapy in these tumors is controversial. We report the case of a giant cell tumor localized in D1 and D2 on a 39-year-old patient, presented with interscapular back pain, paraparesis grade 3/5 and sphincter dysfunction. Thoracic spine computed tomogarphy and magnetic resonance imaging showed a vertebral body tumor in D1 and D2, compressing the spinal cord at the same level. The patient initially underwent decompressive laminectomy of affected levels and stabilized with laminar hooks and rods. Second surgery performed through an anterior approach whereby tumor excision together with corpectomy of D1 and D2 carried out, autograft was placed and plate applied. Three weeks postoperatively, the patient's neurologic deficit recovered fully and back pain subsided. PMID:25687442

  6. Thoracic Extradural Cavernous Hemangioma Mimicking a Dumbbell-Shaped Tumor

    PubMed Central

    Jeong, Won Joo; Choi, Il; Seong, Han Yu

    2015-01-01

    Dumbbell-shaped spinal extradural cavernous hemangioma is rare. The differential diagnosis of dumbbell-shaped spinal tumors based on magnetic resonance imaging includes schwannoma and lymphoma. Here, we report a dumbbell-shaped spinal extradural cavernous hemangioma with intrathoracic growth on T2-3 in a 64-year-old man complaining of right side infrascapular area back pain with no neurologic deficit. The cavernous hemangioma was resected through combined video-assisted thoracoscopy and laminectomy without a fusion procedure. The patient had tolerable operative wound pain with no neurologic deficit after surgery. Based on magnetic resonance imaging findings and a review of the literature, we discuss cavernous hemangioma among the differential diagnosis of paravertebral dumbbell-shaped spinal tumors and the importance of complete resection. PMID:26279817

  7. Retrocerebellar arachnoid cyst resulting in syringomyelia in a patient without tonsillar herniation: successful surgical treatment with reconstruction of CSF flow in the foramen magnum region.

    PubMed

    Sun, Liyong; Emich, Stephan; Fu, Wenzhuo; Chen, Zan; Hao, Wu; Ling, Feng; Jian, Fengzeng

    2016-04-01

    A retrocerebellar arachnoid cyst causing syringomyelia is extremely rare without tonsillar herniation. The authors present a 44-year-old woman with symptoms of foramen magnum compression and syringomyelia. Magnetic resonance imaging demonstrated a large retrocerebellar arachnoid cyst with a large cervicothoracic syrinx but no signs of tonsillar herniation or hydrocephalus. The patient underwent a foramen magnum decompression with C1 laminectomy, microsurgical fenestration of the cyst, and duraplasty. After successful reconstruction of CSF flow, the patient experienced a relief of symptoms and a significant reduction of the syrinx. The intraoperative findings support the theory of a piston mechanism in the development of syringomyelia. Additional arachnoidal adhesions may also obstruct the CSF flow around the craniocervical junction. We recommend the surgical treatment should consist of an adequate decompression of the foramen magnum, wide microsurgical arachnoidal debridement, and duraplasty with autologous grafts sutured in a watertight way. PMID:26728365

  8. Paraspinal and Extensive Epidural Abscess: The Great Masqueraders of Abdominal Pain

    PubMed Central

    Chu, Andrew; Aung, Thu Thu; Shankar, Uday

    2015-01-01

    Paraspinal and epidural abscesses are rare conditions often diagnosed later in the disease process that can have significant morbidity and mortality. Predisposing risk factors include diabetes, human immunodeficiency virus, intravenous drug abuse, and previous history of spinal surgery or injection. They can threaten the spinal cord by compressive effect, leading to sensory motor deficits and ultimately paralysis and death. Diagnosis may be a challenge due to the delayed presentation of nonspecific back pain or radicular pain such as chest pain or abdominal pain. We present a rare case on a patient with periumbilical pain, constipation, and urinary retention who was ultimately diagnosed with a paraspinal abscess extending into the epidural space from T1 to S2. He underwent decompressive laminectomy with incision and drainage of the abscesses. The patient made an excellent recovery postoperatively, and repeat magnetic resonance imaging at six weeks showed resolution of the abscess. PMID:26770847

  9. Unilateral Pedicle Stress Fracture in a Long-Term Hemodialysis Patient with Isthmic Spondylolisthesis

    PubMed Central

    Maruo, Keishi; Tachibana, Toshiya; Inoue, Shinichi; Arizumi, Fumihiro; Yoshiya, Shinichi

    2015-01-01

    Most unilateral pedicle stress fractures occur on the contralateral side of patients with unilateral spondylolysis. However, there are few reports of unilateral pedicle stress fractures in patients with bilateral spondylolysis and spondylolisthesis. We report a unique case of unilateral pedicle stress fracture in a long-term hemodialysis patient with isthmic spondylolisthesis. A 65-year-old man who had undergone hemodialysis presented with lower back pain that had persisted for several years. The patient experienced severe right lower extremity pain with no history of trauma. Computed tomography revealed unilateral pedicle fracture with bilateral L5 spondylolysis and spondylolisthesis with progression of scoliosis. The patient underwent Gill laminectomy of L5 with pedicle screw fixation at L4-S1 and interbody fusion at L5-S1. The patient's leg pain ceased immediately, and he began walking without leg pain. In our present patient, development of scoliosis caused by destructive spondyloarthropathy may have contributed to a unilateral pedicle fracture. PMID:25737789

  10. Multiple recurrent postoperative spinal infections due to an unrecognized presacral abscess following placement of bicortical sacral screws: case report.

    PubMed

    Bloom, Laura; Burks, S Shelby; Levi, Allan D

    2016-03-01

    Postoperative wound infections in spinal surgery remain an important complication to diagnose and treat successfully. In most cases of deep infection, even with instrumentation, aggressive soft-tissue debridement followed by intravenous antibiotics is sufficient. This report presents a patient who underwent L3-S1 laminectomy and pedicle screw placement including bicortical sacral screws. This patient went on to develop multiple (7) recurrent infections at the operative site over a 5-year period. Continued investigation eventually revealed a large presacral abscess, which remained the source of recurrent bacterial seeding via the remaining bone tracts of the bicortical sacral screws placed during the original lumbar surgery. Two years after drainage of this presacral collection via a retroperitoneal approach, the patient remains symptom free. PMID:26613281

  11. Pycnodysostosis with Multi-Segmental Spinal Canal Stenosis due to Ossification of the Yellow Ligament.

    PubMed

    Wada, Keiji; Kanaya, Koichi; Murata, Yasuaki; Kato, Yoshiharu

    2015-04-01

    Pycnodysostosis is an autosomal recessive disorder characterized by osteosclerosis, small stature, acro-osteolysis of the distal phalanges, loss of the mandibular angle, separated cranial sutures with open fontanels, and frequent fractures. One identified cause of the disease is reduced activity of the cysteine protease cathepsin K. A 48-year-old woman with a history of frequent fractures presented with a severe gait disturbance. Radiography, computed tomography, magnetic resonance imaging, and gene analysis were performed. Physical examination revealed open fontanels, and radiographs showed increased bone density. DNA sequence analysis revealed a deletion mutation of the cathepsin K gene. We diagnosed pycnodysostosis based on these findings. The magnetic resonance and computed tomography images demonstrated multilevel spinal canal stenosis due to ossification of the yellow ligament. We performed a laminectomy, and the patient's neurological signs and symptoms improved. To our knowledge, this is the first case of pycnodysostosis with ossification of the yellow ligament. PMID:25901243

  12. Intravital Imaging of Axonal Interactions with Microglia and Macrophages in a Mouse Dorsal Column Crush Injury

    PubMed Central

    Evans, Teresa A.; Barkauskas, Deborah S.; Myers, Jay T.; Huang, Alex Y.

    2014-01-01

    Traumatic spinal cord injury causes an inflammatory reaction involving blood-derived macrophages and central nervous system (CNS)-resident microglia. Intra-vital two-photon microscopy enables the study of macrophages and microglia in the spinal cord lesion in the living animal. This can be performed in adult animals with a traumatic injury to the dorsal column. Here, we describe methods for distinguishing macrophages from microglia in the CNS using an irradiation bone marrow chimera to obtain animals in which only macrophages or microglia are labeled with a genetically encoded green fluorescent protein. We also describe a injury model that crushes the dorsal column of the spinal cord, thereby producing a simple, easily accessible, rectangular lesion that is easily visualized in an animal through a laminectomy. Furthermore, we will outline procedures to sequentially image the animals at the anatomical site of injury for the study of cellular interactions during the first few days to weeks after injury. PMID:25489963

  13. 1,4-Butanediol diglycidyl ether-cross-linked hyaluronan inhibits fibrosis in rat primary tenocytes by down-regulating autophagy modulation.

    PubMed

    Hsu, Dur-Zong; Jou, I-Ming

    2016-05-01

    Epidural fibrosis, an inevitable part of the postoperative healing process, is one of the important causes of failed back surgery syndrome after spinal surgery. The aim of this study was to examine the inhibitory effect of a novel material 1,4-butanediol diglycidyl ether-cross-linked hyaluronan (cHA) on fibrosis in primary tenocytes. cHA inhibited migration, cell proliferation, and suppressed the expression of fibronectin, but not transforming growth factor-β, in primary tenocytes. cHA significantly increased matrix metalloproteinase-3 but decreased collagen-1 and microtubule-associated protein light chain 3-II expression in a dose-dependent manner compared with control groups. We therefore concluded that suppressing autophagy activity may be involved in the anti-fibrotic effect of cHA in primary tenocytes. Further, cHA may have the potential for preventing epidural fibrosis and subsequent failed back syndrome in patients with laminectomy in the future. PMID:26968759

  14. Stereotaxic Injection of a Viral Vector for Conditional Gene Manipulation in the Mouse Spinal Cord

    PubMed Central

    Inquimbert, Perrine; Moll, Martin; Kohno, Tatsuro; Scholz, Joachim

    2013-01-01

    Intraparenchymal injection of a viral vector enables conditional gene manipulation in distinct populations of neurons or particular regions of the central nervous system. We demonstrate a stereotaxic injection technique that allows targeted gene expression or silencing in the dorsal horn of the mouse spinal cord. The surgical procedure is brief. It requires laminectomy of a single vertebra, providing for quick recovery of the animal and unimpaired motility of the spine. Controlled injection of a small vector suspension volume at low speed and use of a microsyringe with beveled glass cannula minimize the tissue lesion. The local immune response to the vector depends on the intrinsic properties of the virus employed; in our experience, it is minor and short-lived when a recombinant adeno-associated virus is used. A reporter gene such as enhanced green fluorescent protein facilitates monitoring spatial distribution of the vector, and the efficacy and cellular specificity of the transfection. PMID:23542888

  15. Cervical Ligamentum Flavum Hematoma: A Case Report

    PubMed Central

    Haghnegahdar, Ali; Sedighi, Mahsa; Rahmanian, Abdolkarim; Baghban, Fahim

    2015-01-01

    Study Design Case report. Objective To report the first case of ligamentum flavum hematoma after cervical spine instrumentation 11 years after the index surgery. Methods After performing bilateral C3 and C4 laminectomy, we observed a dark greenish discoloration over the ligamentum flavum, which was opened. We evacuated 15 mL of subacute hematoma. Results The first ligamentum flavum hematoma of the cervical spine that occurred after spinal instrumentation with sublaminar hooks. Conclusion Ligamentum flavum hematoma might happen even after a long delay (in our case, 11 years) from spinal instrumentation (sublaminar hooks). In symptomatic patients, evacuation is the treatment of choice. In cases of instrument adhesion to the surrounding intracanal tissues, removal should be done meticulously after performing a complete release. PMID:26835213

  16. Medical treatment of acute spinal cord injuries.

    PubMed

    Ceylan, S; Kalelioğlu, M; Aktürk, G; Aktürk, F; Ceylan, S

    1990-01-01

    The injury was performed with 600 g-cm/weight on the spinal cord of 40 cats with T8-9 laminectomy in this study. Ten cats were given 10 mg/kg naloxone i.v. 1 h after injury. Ten cats were given 2 mg/kg thyrotropin-releasing hormone (TRH) i.v. 1 h after injury followed by 1 mg/kg per hour for 4 h. Intravenous lidocaine was begun 30 min after injury in ten cats, administered as 1.5 mg/kg over the initial 5 min, 3 mg/kg over the next 30 min and 1 mg/kg every 30 min for 4 h. The remaining ten cats were given only saline (control group). TRH-treated cats showed significantly better histopathological scores than either naloxone- or lidocaine-treated animals (KW:13.65, P less than 0.50). PMID:2112263

  17. A Modified Approach of Percutaneous Endoscopic Lumbar Discectomy (PELD) for Far Lateral Disc Herniation at L5-S1 with Foot Drop

    PubMed Central

    Chun, Eun Hee

    2016-01-01

    Foraminal or extraforaminal Far Lateral Disc Herniations (FLDH) extending into or beyond the foraminal zone have been recognized as between 7-12% of all lumbosacral disc herniations. Conventional posterior laminectomy may not provide good access to a herniation that lies far lateral to the lateral margin of the pedicle. Use of the endoscopic technique through a percutaneous approach to treat such FLDH patients can decrease the surgical morbidity while achieving better outcomes. We made an effort to utilize the advantages of percutaneous endoscopic lumbar discectomy (PELD) and to determine the appropriate approach for FLDH at the level between the 5th Lumbar and first Sacral vertebrae(L5-S1). The authors present a case of an endoscopically resected lumbar extruded disc of the left extraforaminal zone with superior foraminal migration at the level of L5-S1, which had led to foot drop, while placing the endoscope in the anterior epidural space without facetectomy. PMID:26839673

  18. Anterior cervical arachnoid cyst.

    PubMed

    Rahimizadeh, Abolfazl; Sharifi, Give

    2013-06-01

    This report is composed of two patients with anteriorly located cervical intradural arachnoid cyst and review of 24 cases in Englishlanguage literature. Both of our patients were in the first two decades of life with neck pain and motor weakness. With suspicious diagnosis of anterior arachnoid cyst surgery was carried out in both cases, though laminectomy in one and laminoplasty in the other. The cyst wall was widely fenestrated with subsequent subtotal excision of the cyst. Both cases had good long-term outcome. The review disclosed male predominance. 73% of the patients were diagnosed within the first two decades of life. Neck pain and motor weakness were the dominant signs and symptoms of this pathology. Magnetic resonance imaging showing a cerebrospinal fluid (CSF) containing cyst was the best mode of diagnosis. Wide cyst fenestration with waying CSF into subarachnoid cyst was the most appropriate and applied surgery with optimal outcome. PMID:23741550

  19. Amelioration of caudal thoracic syringohydromyelia following surgical management of an adjacent arachnoid cyst.

    PubMed

    Oxley, W; Pink, J

    2012-01-01

    A nine-year-old male, neutered, pug was presented for investigation of progressive ambulatory paraparesis and pelvic limb ataxia of three months' duration. Magnetic resonance imaging was suggestive of caudal thoracic syringohydromyelia with an adjacent intradural arachnoid cyst. The cyst was marsupialised following dorsal laminectomy. Neurological status had improved 10 weeks following surgery when repeat magnetic resonance imaging revealed reduced spinal cord compression both as a result of resolution of the cyst and reduction in size of the syringohydromyelia. At 17 months following surgery, the dog showed further improvements in neurological status, exhibiting mild pelvic limb ataxia and proprioceptive deficits. Improved cerebrospinal fluid flow following surgery may have played a role in the improvement in both conditions. The presence of syringohydromyelia in this context does not preclude a favourable clinical outcome following surgical management. PMID:22122126

  20. Correction of clivoaxial angle deformity in the setting of suboccipital craniectomy: technical note.

    PubMed

    Felbaum, Daniel; Spitz, Steven; Sandhu, Faheem A

    2015-07-01

    A subset of patients with Chiari Type I malformation may develop neurological dysfunction secondary to an abnormally obtuse clivoaxial angle (CXA) and clivoaxial deformity causing deformative stress injury to the neural axis. Clivoaxial deformity can occur after initial standard suboccipital craniectomy, duraplasty, and C-1 laminectomy for brainstem compression, or severe clivoaxial deformity may be present in conjunction with a Chiari malformation. Clivoaxial deformity and abnormal CXA can be treated with an occipitocervical fusion (OCF). Performing OCF in the setting of a cranial defect can be challenging with currently available instrumentation. The authors describe their recent experience and outcomes in 3 consecutive pediatric patients using the "inside-out" technique for treating clivoaxial deformity and abnormal CXA in the setting of a craniectomy defect to restore stability to the craniocervical junction, while correcting the CXA. PMID:25860518

  1. Tarlov cyst: Case report and review of literature.

    PubMed

    Prashad, Bhagwat; Jain, Anil K; Dhammi, Ish K

    2007-10-01

    We describe a case of sacral perineural cyst presenting with complaints of low back pain with neurological claudication. The patient was treated by laminectomy and excision of the cyst. Tarlov cysts (sacral perineural cysts) are nerve root cysts found most commonly in the sacral roots, arising between the covering layer of the perineurium and the endoneurium near the dorsal root ganglion. The incidence of Tarlov cysts is 5% and most of them are asymptomatic, usually detected as incidental findings on MRI. Symptomatic Tarlov cysts are extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. Tarlov cysts should be considered in the differential diagnosis of patients presenting with these complaints. PMID:21139800

  2. Tarlov cyst: Case report and review of literature

    PubMed Central

    Prashad, Bhagwat; Jain, Anil K; Dhammi, Ish K

    2007-01-01

    We describe a case of sacral perineural cyst presenting with complaints of low back pain with neurological claudication. The patient was treated by laminectomy and excision of the cyst. Tarlov cysts (sacral perineural cysts) are nerve root cysts found most commonly in the sacral roots, arising between the covering layer of the perineurium and the endoneurium near the dorsal root ganglion. The incidence of Tarlov cysts is 5% and most of them are asymptomatic, usually detected as incidental findings on MRI. Symptomatic Tarlov cysts are extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. Tarlov cysts should be considered in the differential diagnosis of patients presenting with these complaints. PMID:21139800

  3. Dorsal Extradural Lumbar Disc Herniation Causing Cauda Equina Syndrome : A Case Report and Review of Literature

    PubMed Central

    Lee, Sang-Ho; Arbatti, Nikhil J.

    2010-01-01

    A 73-year-old male presented with a rare dorsally sequestrated lumbar disc herniation manifesting as severe radiating pain in both leg, progressively worsening weakness in both lower extremities, and urinary incontinence, suggesting cauda equina syndrome. Magnetic resonance imaging suggested the sequestrated disc fragment located in the extradural space at the L4-L5 level had surrounded and compressed the dural sac from the lateral to dorsal sides. A bilateral decompressive laminectomy was performed under an operating microscope. A large extruded disc was found to have migrated from the ventral aspect, around the thecal sac, and into the dorsal aspect, which compressed the sac to the right. After removal of the disc fragment, his sciatica was relieved and the patient felt strength of lower extremity improved. PMID:20379476

  4. Symptomatic Tarlov cyst: report and review.

    PubMed

    Chaiyabud, Pradit; Suwanpratheep, Kitti

    2006-07-01

    Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion. The cysts are relatively rare and most of them are asymptomatic. Some Tarlov cysts can exert pressure on nerve elements resulting in pain, radiculopathy and even multiple radiculopathy of cauda equina. There is no consensus on the appropriate therapeutic options of Tarlov cysts. The authors present a case of two sacral cysts diagnosed with magnetic resonance imaging. The initial symptoms were low back pain and sciatica and progressed to cauda equina syndrome. Surgical treatment was performed by sacral laminectomy and wide cyst fenestration. The neurological deficits were recovered and had not recurred after a follow-up period of nine months. The literature was reviewed and discussed. This is the first reported case in Thailand. PMID:16881441

  5. Melanotic cyst of L5 spinal root: A case report and review of literature.

    PubMed

    Chakravarthy, Hariprakash

    2012-10-01

    Till date, 85 cases of melanotic schwannoma and 11 cases of spinal root melanoma have been reported in literature. We are reporting a case of a 45-year-old lady who presented with primary low back pain, and magnetic resonance imaging of lumbo-sacral spine showed at left L5-S1 foraminal lesion extending to the para-spinal compartment. Hemi-laminectomy, facetectomy, and excision of the lesion were done. It was primarily a cystic lesion with attachment to the exiting spinal nerve root. Histopathology of the cyst wall showed a fibro-collagenous stroma with no specific cell lining containing melanin pigment suggestive of a melanotic cyst. The patient was completely relieved of the back pain, and had no recurrence over a follow-up period of one and half years. This case is probably the first reported predominantly cystic, pigmented lesion, affecting the spinal root. PMID:23559992

  6. Salmonella Typhi Vertebral Osteomyelitis and Epidural Abscess

    PubMed Central

    Chua, Ying Ying; Chen, John L. T.

    2016-01-01

    Salmonella vertebral osteomyelitis is an uncommon complication of Salmonella infection. We report a case of a 57-year-old transgender male who presented with lower back pain for a period of one month following a fall. Physical examination only revealed tenderness over the lower back with no neurological deficits. MRI of the thoracic and lumbar spine revealed a spondylodiscitis at T10-T11 and T12-L1 and right posterior epidural collection at the T9-T10 level. He underwent decompression laminectomy with segmental instrumentation and fusion of T8 to L3 vertebrae. Intraoperatively, he was found to have acute-on-chronic osteomyelitis in T10 and T11, epidural abscess, and discitis in T12-L1. Tissue and wound culture grew Salmonella Typhi and with antibiotics susceptibility guidance he was treated with intravenous ceftriaxone for a period of six weeks. He recovered well with no neurological deficits. PMID:27034871

  7. Primary intradural sacral epidermoid in a nondysraphic spine: Case report and review of literature

    PubMed Central

    Sivaraju, Laxminadh; Thakar, Sumit; Ghosal, Nandita; Hegde, Alangar S

    2016-01-01

    The occurrence of epidermoids within the spinal canal is uncommon. Most of the reported spinal epidermoids (SEs) have been described in the thoracic or lumbar regions. They occur either following trauma or in the setting of coexistent spinal dysraphism. The authors describe an unusual case of a 28-year-old lady who presented with long-standing back pain and urinary incontinence. Magnetic resonance imaging (MRI) of her spine demonstrated a sacral SE without any coexistent spinal dysraphism. The diagnosis of an epidermoid was confirmed by histopathological examination following laminectomy and excision. To the authors’ best knowledge, this is the third case of a sacral SE occurring in a non-dysraphic spine. The case is discussed in the light of a relevant literature review. PMID:27217657

  8. Minimally invasive space shuttle laminotomy for degenerative lumbar spinal canal stenosis

    PubMed Central

    Asamoto, Shunji; Muto, Jun; Jimbo, Hiroyuki

    2016-01-01

    Study Design: Technical note. Objectives: To show microsurgical technique, considering the meticulous anatomy of the ligamentum flavum (LF). Background: Different methods are available for treating lumbar spinal canal stenosis (LSCS). A minimally invasive surgery, namely, space shuttle laminotomy, has recently been proposed. Here, we describe the surgical method for this novel technique. To conduct this surgery accurately, surgeons must have perfect knowledge of anatomy, especially regarding the LF. Materials and Methods and Results: We use this interlaminectomy technique for all cases of LSCS. All patients with LSCS recovered from their neurological deficits in shorter hoslital stays than regular laminectomy. Conclusion: Minimally invasive space shuttle laminotomy (MISSL), which involves a microsurgical technique, is a safe, complication-free procedure. PMID:27041887

  9. Salmonella Typhi Vertebral Osteomyelitis and Epidural Abscess.

    PubMed

    Khoo, Hau Wei; Chua, Ying Ying; Chen, John L T

    2016-01-01

    Salmonella vertebral osteomyelitis is an uncommon complication of Salmonella infection. We report a case of a 57-year-old transgender male who presented with lower back pain for a period of one month following a fall. Physical examination only revealed tenderness over the lower back with no neurological deficits. MRI of the thoracic and lumbar spine revealed a spondylodiscitis at T10-T11 and T12-L1 and right posterior epidural collection at the T9-T10 level. He underwent decompression laminectomy with segmental instrumentation and fusion of T8 to L3 vertebrae. Intraoperatively, he was found to have acute-on-chronic osteomyelitis in T10 and T11, epidural abscess, and discitis in T12-L1. Tissue and wound culture grew Salmonella Typhi and with antibiotics susceptibility guidance he was treated with intravenous ceftriaxone for a period of six weeks. He recovered well with no neurological deficits. PMID:27034871

  10. Spontaneous ventral spinal epidural hematoma in a child: A case report and review of literature

    PubMed Central

    Ratre, Shailendra; Yadav, Yadram; Choudhary, Sushma; Parihar, Vijay

    2016-01-01

    Spontaneous spinal epidural hematoma is very uncommon cause of spinal cord compression. It is extremely rare in children and is mostly located in dorsal epidural space. Ventral spontaneous spinal epidural hematoma (SSEH) is even rarer, with only four previous reports in childrens. We are reporting fifth such case in a 14 year old male child. He presented with history of sudden onset weakness and sensory loss in both lower limbs with bladder bowel involvment since 15 days. There was no history of trauma or bleeding diasthesis. On clinical examination he had spastic paraplegia. Magnetic resonance imaging (MRI) of dorsal spine was suggestive of ventral spinal epidural hematoma extending from first to sixth dorsal vertebrae. Laminectomy of fourth and fifth dorsal vertebrae and complete evacuation of hematoma was done on the same day of admission. Postoperatively the neurological status was same. PMID:27114667

  11. Lumbosacral Plexopathy Caused by Presacral Recurrence of Colon Cancer Mimicking Degenerative Spinal Disease: A Case Report

    PubMed Central

    Jo, Se Yeong; Jeong, Je Hoon; Cha, Jang Gyu

    2015-01-01

    Radiculopathy triggered by degenerative spinal disease is the most common cause of spinal surgery, and the number of affected elderly patients is increasing. Radiating pain that is extraspinal in origin may distract from the surgical decision on how to treat a neurological presentation in the lower extremities. A 54-year-old man with sciatica visited our outpatient clinic. He had undergone laminectomy and discectomy to treat spinal stenosis at another hospital, but his pain remained. Finally, he was diagnosed with a plexopathy caused by late recurrence of colorectal cancer, which compressed the lumbar plexus in the presacral area. This case report illustrates the potential for misdiagnosis of extraspinal plexopathy and the value of obtaining an accurate history. Although the symptoms are similar, spinal surgeons should consider both spinal and extraspinal origins of sciatica. PMID:26217393

  12. Longitudinal in vivo coherent anti-Stokes Raman scattering imaging of demyelination and remyelination in injured spinal cord

    NASA Astrophysics Data System (ADS)

    Shi, Yunzhou; Zhang, Delong; Huff, Terry B.; Wang, Xiaofei; Shi, Riyi; Xu, Xiao-Ming; Cheng, Ji-Xin

    2011-10-01

    In vivo imaging of white matter is important for the mechanistic understanding of demyelination and evaluation of remyelination therapies. Although white matter can be visualized by a strong coherent anti-Stokes Raman scattering (CARS) signal from axonal myelin, in vivo repetitive CARS imaging of the spinal cord remains a challenge due to complexities induced by the laminectomy surgery. We present a careful experimental design that enabled longitudinal CARS imaging of de- and remyelination at single axon level in live rats. In vivo CARS imaging of secretory phospholipase A2 induced myelin vesiculation, macrophage uptake of myelin debris, and spontaneous remyelination by Schwann cells are sequentially monitored over a 3 week period. Longitudinal visualization of de- and remyelination at a single axon level provides a novel platform for rational design of therapies aimed at promoting myelin plasticity and repair.

  13. Treatment of Costal Osteochondroma Causing Spinal Cord Compression by Costotransversectomy: Case Report and Review of the Literature

    PubMed Central

    Mazur, Marcus D.; Mumert, Michael L.; Schmidt, Meic H.

    2015-01-01

    In laminectomies for costal osteochondroma causing spinal cord compression, visualization of the extraforaminal part of the tumor is limited. The authors describe using a costotransversectomy to resolve spinal cord compression by a costal osteochondroma invading through the neural foramen. A 21-year-old woman with hereditary multiple exostoses presented with hand numbness and progressive neck and upper back pain. Plain radiographs identified a large lesion of the T2 and T3 pedicles, with encroachment on the T2-3 neural foramen causing ~50% spinal canal stenosis. Costotransversectomy was performed to resect the cartilaginous portions of the osteochondroma, debulk the mass, and decompress the spinal canal. A mass of mature bone was left, but no appreciable cartilaginous tumor. At five-year follow-up, the patient had improvement of neck pain, no new neurological deficits. a stable residual mass, and no new osteochondromas, indicating that appropriate surgical management can yield good results and no evidence of recurrence. PMID:26236451

  14. The tethered spinal cord: an overview.

    PubMed

    Patterson, P

    1989-12-01

    The growing child with a tethered spinal cord experiences serious neurological deficits as a result of traction on the conus medullaris. Children with tethered cords most commonly present with pain in the lower back, with motor or sensory loss in the lower limbs, with bowel or bladder dysfunction, or with scoliosis. Often, the neurological basis of these symptoms is overlooked. Surgical release of tethering arrests neurological deterioration. Without surgical intervention symptoms will progressively worsen and may become irreversible. Preoperatively the nurse must prepare the child and his family for neurological investigations and for surgery. Postoperatively the nurse must be skilled in assessing spinal cord function, providing pain management, and assisting in ambulation. This presentation will review the pathophysiology of the tethered spinal cord, the preparation of the school-aged child for surgery, and the postoperative nursing care of the pediatric laminectomy patient. PMID:2688738

  15. Interventional spinal procedures in the presence of a Chiari malformation: a potential contraindication.

    PubMed

    Smith, Jason A; Cuccurullo, Sara J; Protzman, Nicole M; Kooch, Jason E

    2014-08-01

    Although Chiari malformations are much more prevalent than once believed, no study has described treatment with an interventional spinal procedure. The purpose of this report was to discuss the clinical course of a patient who was diagnosed with a Chiari malformation and treated with three cervical epidural injections. In 2012, a 50-yr-old woman presented to a neurology clinic with chronic suboccipital headaches, diplopia, and increasing numbness/tingling in her upper extremities. Magnetic resonance imaging confirmed a type I Chiari malformation and a cervical syrinx. The patient was treated with three cervical epidural injections, after which her symptoms exacerbated. Consequently, a posterior fossa suboccipital craniectomy with C1 laminectomy and excision of extradural and intradural adhesions was performed. After surgical intervention, notable neurologic improvements were observed. Given the marked worsening of symptoms, the present report suggests that interventional spinal procedures may be a contraindication in the presence of a Chiari malformation with a syrinx. PMID:24743463

  16. Spinal intramedullary arachnoid cyst in a 4-year-old girl: a rare cause of treatable acute quadriparesis: case report.

    PubMed

    Sharma, Alok; Karande, Sunil; Sayal, Parag; Ranadive, Nilima; Dwivedi, Nishant

    2005-05-01

    The authors report their experience in successfully treating a 4-year-old girl who presented with sudden onset of quadriparesis that lasted for 20 days. Magnetic resonance (MR) imaging of the spine revealed an intramedullary cystic lesion extending from C-4 to C-6. A C4-6 laminectomy was performed followed by a median myelotomy. The cyst was decompressed and most of the cyst wall was excised. The histopathological findings were consistent with those of an arachnoid cyst. By postoperative Day 3, power had gradually returned to normal in all her limbs. On follow-up reviews at 2 and 17 months, the results of her neurological examinations remained normal. Follow-up MR imaging of the spine at 17 months revealed an intramedullary residual cystic lesion extending from C-5 to C-6, without any mass effect. An intramedullary arachnoid cyst should be considered in the differential diagnosis of an intramedullary cystic lesion. PMID:15926392

  17. Valproic Acid Increases Expression of Neuronal Stem/Progenitor Cell in Spinal Cord Injury

    PubMed Central

    Bang, Woo-Seok; Cho, Dae-Chul; Kim, Hye-Jeong; Sung, Joo-Kyung

    2013-01-01

    Objective This study investigates the effect of valproic acid (VPA) on expression of neural stem/progenitor cells (NSPCs) in a rat spinal cord injury (SCI) model. Methods Adult male rats (n=24) were randomly and blindly allocated into three groups. Laminectomy at T9 was performed in all three groups. In group 1 (sham), only laminectomy was performed. In group 2 (SCI-VPA), the animals received a dose of 200 mg/kg of VPA. In group 3 (SCI-saline), animals received 1.0 mL of the saline vehicle solution. A modified aneurysm clip with a closing force of 30 grams was applied extradurally around the spinal cord at T9, and then rapidly released with cord compression persisting for 2 minutes. The rats were sacrificed and the spinal cord were collected one week after SCI. Immunohistochemistry (IHC) and western blotting sample were obtained from 5 mm rostral region to the lesion and prepared. We analyzed the nestin immunoreactivity from the white matter of ventral cord and the ependyma of central canal. Nestin and SOX2 were used for markers for NSPCs and analyzed by IHC and western blotting, respectively. Results Nestin and SOX2 were expressed significantly in the SCI groups but not in the sham group. Comparing SCI groups, nestin and SOX2 expression were much stronger in SCI-VPA group than in SCI-saline group. Conclusion Nestin and SOX2 as markers for NSPCs showed increased expression in SCI-VPA group in comparison with SCI-saline group. This result suggests VPA increases expression of spinal NSPCs in SCI. PMID:24044073

  18. Prophylactic inferior vena cava filter placement prior to lumbar surgery in morbidly obese patients: Two-case study and literature review

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: Preoperative “prophylactic” placement of inferior vena cava (IVC) filters in morbidly obese patients (e.g., body mass index [BMI] >40 or BMI over 35 with hypertension/diabetes) undergoing multilevel decompressive lumbar laminectomies may reduce the risk of postoperative pulmonary embolism (PE), and death. Methods: Two patients, ages 69 and 68, with morbid obesity (BMI's of 40.4 and 37.5 both with hypertension and diabetes), received prophylactic IVC filters prior to L1–S1 laminectomies. Intraoperatively and postoperatively, both received alternating compression stocking prophylaxis, and received subcutaneous heparin 5000 U q12 h 48 h after surgery until discharge; none developed deep venous thrombosis (DVT) or PE, and both filters were uneventfully removed within 3 postoperative months. Results: The spinal surgical literature largely supports the placement of IVC filters for major risk factors; obesity (BMI >40), a history of DVT/PE, cancer, fusions, hypercoagulation syndromes, pulmonary/circulatory disorders, preoperative/postoperative immobility, staged procedures (five spinal levels), combined anterior-posterior surgery, iliocaval manipulation, age >80, and prolonged surgery (e.g., >261 min vs. >8 h). Although the safety and efficacy of prophylactic IVC filters for spine surgery in patients with morbidly obesity are well substantiated, those for bariatric patients are less clear. Conclusions: Prophylactic IVC filters were successfully placed/retrieved in 2 morbidly obese patients, ages 68 and 69, undergoing L1–S1 lumbar decompressions. Although the spine surgery literature documents the safety/efficacy of prophylactic IVC filters in patients with morbid obesity, the bariatric literature still has major concerns. PMID:26605108

  19. Enhancement of bilateral cortical somatosensory evoked potentials to intact forelimb stimulation following thoracic contusion spinal cord injury in rats.

    PubMed

    Bazley, Faith A; Maybhate, Anil; Tan, Chuen Seng; Thakor, Nitish V; Kerr, Candace; All, Angelo H

    2014-09-01

    The adult central nervous system is capable of significant reorganization and adaptation following neurotrauma. After a thoracic contusive spinal cord injury (SCI) neuropathways that innervate the cord below the epicenter of injury are damaged, with minimal prospects for functional recovery. In contrast, pathways above the site of injury remain intact and may undergo adaptive changes in response to injury. We used cortical somatosensory evoked potentials (SSEPs) to evaluate changes in intact forelimb pathways. Rats received a midline contusion SCI, unilateral contusion SCI, or laminectomy with no contusion at the T8 level and were monitored for 28 days post-injury. In the midline injury group, SSEPs recorded from the contralateral forelimb region of the primary somatosensory cortex were 59.7% (CI 34.7%, 84.8%; c(2) = 21.9; dof = 1; p = 2.9 ×10(-6)) greater than the laminectomy group; SSEPs from the ipsilateral somatosensory cortex were 47.6% (CI 18.3%, 77%; c(2) = 10.1; dof = 1; p = 0.001) greater. Activation of the ipsilateral somatosensory cortex was further supported by BOLD-fMRI, which showed increased oxygenation at the ipsilateral hemisphere at day seven post-injury. In the unilateral injury group, ipsilesional side was compared to the contralesional side. SSEPs on day 14 (148%; CI 111%, 185%) and day 21 (137%; CI 110%, 163%) for ipsilesional forelimb stimulation were significantly increased over baseline (100%). SSEPs recorded from the hindlimb sensory cortex upon ipsilesional stimulation were 33.9% (CI 14.3%, 53.4%; c(2) = 11.6; dof = 1; p = 0.0007) greater than contralesional stimulation. Therefore, these results demonstrate the ability of SSEPs to detect significant enhancements in the activation of forelimb sensory pathways following both midline and unilateral contusive SCI at T8. Reorganization of forelimb pathways may occur after thoracic SCI, which SSEPs can monitor to aid the development of future therapies. PMID:24801738

  20. Dysregulation of Kv3.4 Channels in Dorsal Root Ganglia Following Spinal Cord Injury

    PubMed Central

    Ritter, David M.; Zemel, Benjamin M.; Hala, Tamara J.; O'Leary, Michael E.; Lepore, Angelo C.

    2015-01-01

    Spinal cord injury (SCI) patients develop chronic pain involving poorly understood central and peripheral mechanisms. Because dysregulation of the voltage-gated Kv3.4 channel has been implicated in the hyperexcitable state of dorsal root ganglion (DRG) neurons following direct injury of sensory nerves, we asked whether such a dysregulation also plays a role in SCI. Kv3.4 channels are expressed in DRG neurons, where they help regulate action potential (AP) repolarization in a manner that depends on the modulation of inactivation by protein kinase C (PKC)-dependent phosphorylation of the channel's inactivation domain. Here, we report that, 2 weeks after cervical hemicontusion SCI, injured rats exhibit contralateral hypersensitivity to stimuli accompanied by accentuated repetitive spiking in putative DRG nociceptors. Also in these neurons at 1 week after laminectomy and SCI, Kv3.4 channel inactivation is impaired compared with naive nonsurgical controls. At 2–6 weeks after laminectomy, however, Kv3.4 channel inactivation returns to naive levels. Conversely, Kv3.4 currents at 2–6 weeks post-SCI are downregulated and remain slow-inactivating. Immunohistochemistry indicated that downregulation mainly resulted from decreased surface expression of the Kv3.4 channel, as whole-DRG-protein and single-cell mRNA transcript levels did not change. Furthermore, consistent with Kv3.4 channel dysregulation, PKC activation failed to shorten the AP duration of small-diameter DRG neurons. Finally, re-expressing synthetic Kv3.4 currents under dynamic clamp conditions dampened repetitive spiking in the neurons from SCI rats. These results suggest a novel peripheral mechanism of post-SCI pain sensitization implicating Kv3.4 channel dysregulation and potential Kv3.4-based therapeutic interventions. PMID:25609640

  1. Medicare payment data for spine reimbursement; important but flawed data for evaluating utilization of resources

    PubMed Central

    Menger, Richard P.; Wolf, Michael E.; Kukreja, Sunil; Sin, Anthony; Nanda, Anil

    2015-01-01

    Background: Medicare data showing physician-specific reimbursement for 2012 were recently made public in the mainstream media. Given the ongoing interest in containing healthcare costs, we analyze these data in the context of the delivery of spinal surgery. Methods: Demographics of 206 leading surgeons were extracted including state, geographic area, residency training program, fellowship training, and academic affiliation. Using current procedural terminology (CPT) codes, information was evaluated regarding the number of lumbar laminectomies, lumbar fusions, add-on laminectomy levels, and anterior cervical fusions reimbursed by Medicare in 2012. Results: In 2012 Medicare reimbursed the average neurosurgeon slightly more than an orthopedic surgeon for all procedures ($142,075 vs. $110,920), but this was not found to be statistically significant (P = 0.218). Orthopedic surgeons had a statistical trend illustrating increased reimbursement for lumbar fusions specifically, $1187 versus $1073 (P = 0.07). Fellowship trained spinal surgeons also, on average, received more from Medicare ($125,407 vs. $76,551), but again this was not statistically significant (P = 0.112). A surgeon in private practice, on average, was reimbursed $137,495 while their academic counterparts were reimbursed $103,144 (P = 0.127). Surgeons performing cervical fusions in the Centers for Disease Control West Region did receive statistically significantly less reimbursement for that procedure then those surgeons in other parts of the country (P = 0.015). Surgeons in the West were reimbursed on average $849 for CPT code 22,551 while those in the Midwest received $1475 per procedure. Conclusion: Medicare reimbursement data are fundamentally flawed in determining healthcare expenditure as it shows a bias toward delivery of care in specific patient demographics. However, neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and interpret these data as it will affect healthcare reimbursement and delivery moving forward. PMID:26425400

  2. Experimental research on the effect of mitomycin C fibrin gel on spinal peridural scar tissue in rats.

    PubMed

    Liu, Wenping

    2014-09-01

    This paper aimed to study the best working concentration of mitomycin C (MMC) fibrin gel on spinal peridural scar tissue in rats and the sustained release function of peridural adhesion after laminectomy of rats. 96 SD rats were divided into four groups. They were conducted L1 laminectomy and sprayed FG-MMC. The concentration of MMC was detected and the best working concentration of MMC was selected. Then other 48 SD rats were divided into four groups to construct L1 vertebral plate excision model. Materials were drawn 4 weeks after the operation for Rydell grading. In addition, we observed HE staining and fibroblast proliferation and collagen distribution situation after Masson staining. And concentration of hydroxyproline was also detected. The best working concentration of MMC experiment showed that except experimental group C, the other groups all appeared drug release peak in the 4th week after the operation. MMC concentration of group C appeared drug release peak in the 5th week besides the 2nd week. Moreover, adhesion of endorhachis and peripheral tissue in group A was the most obvious while the group C was the weakest. Experiment on the slow-release effect of different adhesion materials on peridural adhesion showed that compared to the contrast group and group F, Rydell grading in group E and G was Level 0 and with low adhesion degree, little fibroblast and fibrocyte, low collagen content, regular collagen fibers arrangement and no inflammatory cells after HE staning and Masson staining. In addition, content of hydroxyproline(HOP) decreased significantly especially the group of FG-MMC mixture. It was concluded that MMC fibrin gel mixture had a good slow-release effect on adhesion of spinal peridural scar tissue in rats and the best working concentration was 0.5 mg FG-MMC/ml. PMID:25262518

  3. Effect of carnosine, methylprednisolone and their combined application on irisin levels in the plasma and brain of rats with acute spinal cord injury.

    PubMed

    Albayrak, Serdal; Atci, İbrahim Burak; Kalayci, Mehmet; Yilmaz, Musa; Kuloglu, Tuncay; Aydin, Suna; Kom, Mustafa; Ayden, Omer; Aydin, Suleyman

    2015-08-01

    Spinal cord injury (SCI) might occur to anybody at any time and any age. In its treatment, methylprednisolone (MP) is a first choice worldwide, but there is still no significant breakthrough in truly beneficial treatment due to SCI's complex pathophysiology. We investigated the effect of carnosine, methylprednisolone (MP) and its combination on irisin levels in the plasma, brain and medulla spinalis tissues in SCI using a rat model. The rats were divided into 6 groups: I (Control, saline); II (sham animals with laminectomy without cross-clamping); III (SCI); IV (SCI treated with 150mg/kg carnosine); V (SCI treated with 30mg/kg methylprednisolone); and VI (SCI treated with a combination of carnosine and MP). The animals were given traumatic SCI after laminectomy, using 70-g closing force aneurysm clips (Yasargil FE 721). Irisin concentration was measured by ELISA. The distribution of irisin in brain and spinal cord tissues was examined by immunochemistry. Irisin was mainly expressed in the astrocytes and microglia of brain tissues, and multipolar neurones of the anterior horn of spinal cord tissue in rats of all groups, indicating that irisin is physiologically indispensable. MP and carnosine and the combination of the two, significantly increased irisin in plasma and were accompanied by a significant rise in irisin immunoreactivity of brain and spinal cord tissues of the injured rats compared with control and sham. This finding raises the possibility that methylprednisolone and carnosine regulate the brain and spinal cord tissues in SCI by inducing irisin expression, and may therefore offer a better neurological prognosis. PMID:26142757

  4. Intra-operative vertebroplasty combined with posterior cord decompression. A report of twelve cases.

    PubMed

    Allegretti, Luca; Mavilio, Nicola; Fiaschi, Pietro; Bragazzi, Roberto; Pacetti, Mattia; Castelletti, Lara; Saitta, Laura; Castellan, Lucio

    2014-10-31

    Percutaneous vertebroplasty (VP) is a minimally invasive technique for the treatment of vertebral pathology providing early vertebral stabilization and pain relief. In cases of vertebral pathology complicated by spinal cord compression with associated neurological deficits, VP alone cannot be performed free of risks. We describe a combined approach in which decompressive laminectomy and intra-operative vertebroplasty (IVP) are performed during a single session. Among the 252 VP performed in our centre in the past three years, 12 patients (12 vertebral levels) with different pathologies (six symptomatic haemangiomas, two metastatic fractures, four osteoporotic fractures) were treated with an open procedure combined with surgery. All cases were treated with decompressive laminectomy and IVP (mono/bipeduncular or median-posterior trans-somatic access). Five patients with symptomatic haemangiomas were treated with endovascular embolization prior to the combined approach. A visual analogue scale (VAS) was applied to assess pain intensity before and after surgery. The neurological deficits were evaluated with an ASIA impairment scale. In all cases benefit from pain and neurological deficits was observed. The mean VAS score decreased from 7.8 to 2.5 after surgery. The ASIA score improved in all cases (five cases from D to E and five cases from C to D). No clinical complications were observed. In one case a CT scan performed after the procedure showed a foraminal accumulation of PMMA, but the patient referred no symptoms. IVP can be successfully applied in different pathologies affecting the vertebrae. In our limited series this approach proved safe and efficient to provide decompression of spinal cord and dural sac and vertebral body stabilization in a single session. PMID:25363261

  5. Preoperative retrolisthesis as a risk factor of postdecompression lumbar disc herniation.

    PubMed

    Takenaka, Shota; Tateishi, Kosuke; Hosono, Noboru; Mukai, Yoshihiro; Fuji, Takeshi

    2016-04-01

    OBJECT In this study, the authors aimed to identify specific risk factors for postdecompression lumbar disc herniation (PDLDH) in patients who have not undergone discectomy and/or fusion. METHODS Between 2007 and 2012, 493 patients with lumbar spinal stenosis underwent bilateral partial laminectomy without discectomy and/or fusion in a single hospital. Eighteen patients (herniation group [H group]: 15 men, 3 women; mean age 65.1 years) developed acute sciatica as a result of PDLDH within 2 years after surgery. Ninety patients who did not develop postoperative acute sciatica were selected as a control group (C group: 75 men, 15 women; mean age 65.4 years). Patients in the C group were age and sex matched with those in the H group. The patients in the groups were also matched for decompression level, number of decompression levels, and surgery date. The radiographic variables measured included percentage of slippage, intervertebral angle, range of motion, lumbar lordosis, disc height, facet angle, extent of facet removal, facet degeneration, disc degeneration, and vertebral endplate degeneration. The threshold for PDLDH risk factors was evaluated using a continuous numerical variable and receiver operating characteristic curve analysis. The area under the curve was used to determine the diagnostic performance, and values greater than 0.75 were considered to represent good performance. RESULTS Multivariate analysis revealed that preoperative retrolisthesis during extension was the sole significant independent risk factor for PDLDH. The area under the curve for preoperative retrolisthesis during extension was 0.849; the cutoff value was estimated to be a retrolisthesis of 7.2% during extension. CONCLUSIONS The authors observed that bilateral partial laminectomy, performed along with the removal of the posterior support ligament, may not be suitable for lumbar spinal stenosis patients with preoperative retrolisthesis greater than 7.2% during extension. PMID:26654340

  6. Preliminary study showing safety/efficacy of nanoss bioactive versus vitoss as bone graft expanders for lumbar noninstrumented fusions

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: The lateral fusion mass for multilevel lumbar laminectomies with noninstrumented posterolateral fusions now often utilizes lamina autograft and bone marrow aspirate (BMA) mixed with one of two bone graft expanders: either Vitoss (Orthovita, Malvern, PA, USA) or NanOss Bioactive (Regeneration Technologies Corporation: RTI, Alachua, FL, USA). Methods: Here, we compared two sequential prospective the times to fusion, fusion rates, complications, and infection rates for two prospective cohorts of patients utilizing either Vitoss (first 213 patients) or NanOss (subsequent 45 patients) respectively, undergoing multilevel lumbar laminectomies (average 4.6 vs. 4.5 levels) with noninstrumented fusions (average 1.3 vs. 1.2 levels). Surgery addressed stenosis/ossification of the yellow ligament (OYL) (all patients), with subsets exhibiting degenerative spondylolisthesis synovial cysts, and disc disease. Fusion was documented by two independent neuroradiologists blinded to the study design, utilizing dynamic X-rays and two dimensional computed tomography (2D-CT) studies up to 6 months postoperatively, and up to 1 year where indicated. Results: Comparison of patients receiving Vitoss versus NanOss as bone graft expanders revealed nearly comparable; times to fusion (5.3 months vs. 4.8 months), fusion rates (210 [98.6%] vs. 45 [100%] patients), pseudarthroses (3 [1.4%] vs. 0), postoperative seromas (2 [0.94%] vs. 0), and deep wound infections (2 [0.94%] vs. 0). Conclusion: In this preliminary study of patients undergoing multilevel lumbar lamienctomies with posterolateral noninstrumented fusions, results were nearly comparable utilizing Vitoss or NanOss as bone graft expanders. Although the number of NanOss patients was substantially lower, the comparable efficacy and absence of postoperative complications for noninstrumented fusions is promising. PMID:26167369

  7. Single-stage posterior midline approach for dumbbell tumors of the thoracic spine, with intraoperative CT guidance

    PubMed Central

    Thorat, Jayant D.; Rajendra, T.; Thirugnanam, Agasthian; Ng, Ivan H. B.

    2011-01-01

    Background: Several different procedures have been advocated for thoracic spine dumbbell tumor resection, combining thoracic and neurosurgical approaches, in single and multiple stages, using various incisions and positions. These have led to controversies in the ideal management. The authors report their analysis of a series of 11 patients successfully treated through a one-step midline approach for complete resection and instrumentation when indicated under intraoperative CT (ICT) guidance. Methods: The patients’ clinical presentations, imaging results, operative findings and follow-up were reviewed in 11 patients (age ranged from 11 to 62 years), over the period from August 2007 to May 2010. A single-stage, posterior midline incision approach with laminectomy, facetectomy, costotransversectomy, for complete resection of intraspinal and paraspinal components of tumor was used. Spinal instrumentation under ICT guidance was also carried out in relevant (six) cases with tumors involving junctional spinal regions such the cervico-thoracic or thoraco-lumbar region. Results: The initial clinical presenting symptom was pain in eight patients and paresthesia in one, while two patients were detected incidentally on routine chest X-rays. Total excision was achieved in 10 patients (9 schwanommas, 1 neurofibroma) with the exception of one patient who had a recurrent malignant peripheral nerve sheath tumor adherent to the vertebral artery. No significant postoperative complications occurred and an early mobilization/discharge was achieved in all patients with an average hospital stay of 5 days. Conclusions: A one-step approach through a posterior midline incision is feasible, safe and efficient for complete excision of thoracic dumbbell tumors. This approach facilitates laminectomy, facetectomy, costotransversectomy and instrumentation under ICT guidance, while limiting muscle damage, blood loss, operative time, postoperative pain, thus enabling early mobilization with a reduced hospital stay. PMID:21541199

  8. Interspinous Spacers Compared to Decompression or Fusion for Lumbar Stenosis: Complications and Repeat Operations in the Medicare Population

    PubMed Central

    Deyo, Richard A.; Martin, Brook I.; Ching, Alex; Tosteson, Anna N. A.; Jarvik, Jeffrey G.; Kreuter, William; Mirza, Sohail K.

    2013-01-01

    Study Design Retrospective cohort analysis of Medicare claims for 2006-2009. Objective To examine whether interspinous distraction procedures are used selectively in patients with more advanced age or comorbidity; and whether they are associated with fewer complications, lower costs, and less revision surgery than laminectomy or fusion surgery. Summary of Background Data A manufacturer-sponsored randomized trial suggested an advantage of interspinous spacer surgery over non-surgical care, but there are few comparisons with other surgical procedures. Furthermore, there are few population-based data evaluating patterns of use of these devices. Methods We used Medicare inpatient claims data to compare age and comorbidity for patients with spinal stenosis having surgery (n=99,084) with (1) an interspinous process spacer alone; (2) laminectomy and a spacer; (3) decompression alone; or (4) lumbar fusion (1-2 level). We also compared these four groups for cost of surgery and rates of revision surgery, major medical complications, wound complications, mortality, and 30-day readmission rates. Results Patients who received spacers were older than those receiving decompression or fusion, but had little evidence of greater comorbidity. Patients receiving a spacer alone had fewer major medical complications than those undergoing decompression or fusion surgery (1.2% versus 1.8% and 3.3% respectively), but had higher rates of further inpatient lumbar surgery (16.7% versus 8.5% for decompression and 9.8% for fusion at 2 years). Hospital payments for spacer surgery were greater than for decompression alone, but less than for fusion procedures. These associations persisted in multivariate models adjusting for patient age, sex, comorbidity score, and previous hospitalization. Conclusions Compared to decompression or fusion, interspinous distraction procedures pose a trade-off in outcomes: fewer complications for the index operation, but higher rates of revision surgery. This information should help patients make more informed choices, but further research is needed to define optimal indications for these new devices. PMID:23324936

  9. Neuroprotective effects of sildenafil in experimental spinal cord injury in rabbits

    PubMed Central

    Kara, Hasan; Degirmenci, Selim; Ak, Ahmet; Bayir, Aysegul; Kayis, Seyit Ali; Uyar, Mehmet; Akinci, Murat; Acar, Demet; Kocacan, Metin; Akyurek, Fikret

    2015-01-01

    Neuroprotective agents such as methylprednisolone and sildenafil may limit damage after spinal cord injury. We evaluated the effects of methylprednisolone and sildenafil on biochemical and histologic changes after spinal cord injury in a rabbit model. Female New Zealand rabbits (32 rabbits) were allocated to 4 equal groups: laminectomy only (sham control) or laminectomy and spinal trauma with no other treatment (trauma control) or treatment with either methylprednisolone or sildenafil. Gelsolin and caspase-3 levels in cerebrospinal fluid and plasma were determined, and spinal cord histology was evaluated at 24 hours after trauma. There were no differences in mean cerebrospinal fluid or plasma levels of caspase-3 between the groups or within the groups from 0 to 24 hours after injury. From 0 to 24 hours after trauma, mean cerebrospinal fluid gelsolin levels significantly increased in the sildenafil group and decreased in the sham control and the trauma control groups. Mean plasma gelsolin level was significantly higher at 8 and 24 hours after trauma in the sildenafil than other groups. Histologic examination indicated that general structural integrity was better in the methylprednisolone in comparison with the trauma control group. General structural integrity, leptomeninges, white and grey matter hematomas, and necrosis were significantly improved in the sildenafil compared with the trauma control group. Caspase-3 levels in the cerebrospinal fluid and blood were not increased but gelsolin levels were decreased after spinal cord injury in trauma control rabbits. Sildenafil caused an increase in gelsolin levels and may be more effective than methylprednisolone at decreasing secondary damage to the spinal cord. PMID:25725143

  10. Postural hypotension in a patient with cervical myelopathy due to craniovertebral anomaly.

    PubMed

    Misra, U K; Kalita, J; Kapoor, R

    1997-10-01

    We report a patient with craniovertebral anomaly leading to cervical cord compression who presented with disabling postural hypotension. A 60-year-old electrician presented with progressive weakness of the upper and lower limbs, which had started 7 years previously. He had difficulty in holding urine for the previous year and had blacked out on standing for the past 3 months. He had upper limb wasting and lower limb spasticity, with impaired joint position sense. Autonomic dysfunctions included postural hypotension, absence of sinus arrhythmia, impaired Valsalva ratio, and lack of increase in blood pressure on cold immersion and isometric contraction. Cervical spine radiograph and magnetic resonance imaging revealed atlantoaxial dislocation, Klippel-Feil syndrome and osteophytes, resulting in cord compression at C2-C4. Partial and selective damage to the descending autonomic fibres may be responsible for postural hypotension in this patient. PMID:9370068

  11. Neuronal vacuolation, myelopathy and laryngeal neuropathy in a mixed-breed dog.

    PubMed

    Salvadori, C; Tartarelli, C L; Baroni, M; Arispici, M; Cantile, C

    2007-10-01

    A bilateral and symmetrical neuronal vacuolation associated with spinal cord white matter degeneration and laryngeal neuropathy was observed in a 12-week-old male mixed-breed dog with a history of progressive pelvic limbs ataxia. On clinical examination, signs included inspiratory stridor, spinal ataxia, tetraparesis, and proprioceptive deficits more severe in the pelvic limbs. Examination of the larynx showed bilateral laryngeal paralysis and electromyography revealed fibrillation potentials restricted to the intrinsic laryngeal muscles. Clinical and pathological findings resembled the syndrome of neuronal vacuolation and spinocerebellar degeneration described in Rottweiler dogs. This is the first report of a similar disorder in a dog different from Rottweiler. PMID:17877588

  12. Cervical myelopathy caused by soft-tissue mass in diffuse idiopathic skeletal hyperostosis.

    PubMed

    Storch, Max-Jürgen; Hubbe, Ulrich; Glocker, Franz Xaver

    2008-09-01

    A rare case of cervical spinal cord compression in diffuse idiopathic skeletal hyperostosis (DISH or Forestier's Disease) caused by a craniocervical mass of soft-tissue is reported. The objective is to describe an uncommon mechanism of spinal cord compression in DISH. Three weeks after a cardiac infarction a 69-year-old man slowly developed spastic tetraparesis. Magnetic resonance tomography showed a craniocervical tumor compressing the spinal cord and a massive DISH of the cervical spine. An extended mass of yellowish amorphous material was removed from between the dura, the posterior odontoid process and the posterior aspect of vertebral body C2 reaching to the upper part of C3.The histologic appearance indicated connective tissue and cell-degenerated cartilaginous tissue. There was no inflammatory component and no evidence of neoplasia. No ossification of the posterior longitudinal ligament (OPLL) was found. After removal and craniocervical stabilization the patient's neurologic function improved remarkably. The increase of mechanical stress on the atlantoaxial segment and enhanced proliferation reaction of the connective tissue in DISH are suggested as the underlying pathomechanisms in the formation of this soft-tissue mass. PMID:17922151

  13. AUTOIMMUNE STIFF PERSON SYNDROME AND RELATED MYELOPATHIES: UNDERSTANDING OF ELECTROPHYSIOLOGICAL AND IMMUNOLOGICAL PROCESSES

    PubMed Central

    Rakocevic, Goran; Floeter, Mary Kay

    2011-01-01

    Stiff Person Syndrome (SPS) is a disabling autoimmune CNS disorder characterized by progressive muscle rigidity and gait impairment with superimposed painful spasms that involve axial and limb musculature, triggered by heightened sensitivity to external stimuli. Impaired synaptic GABAergic inhibition resulting from intrathecal B-cell-mediated clonal synthesis of autoantibodies against various presynaptic and synaptic proteins in the inhibitory neurons of the brain and spinal cord is believed to be an underlying pathogenic mechanism. SPS is most often idiopathic, but it can occur as a paraneoplastic condition. Despite evidence that anti-GAD and related autoantibodies impair GABA synthesis, the exact pathogenic mechanism of SPS is not fully elucidated. The strong association with several MHC-II alleles and improvement of symptoms with immune-modulating therapies support an autoimmune etiology of SPS. In this review, we discuss the clinical spectrum, neurophysiological mechanisms, and therapeutic options, including a rationale for agents that modulate B cell function in SPS. PMID:22499087

  14. Cortical bone facet spacers for cervical spine decompression: effects on intervertebral kinetics and foraminal area.

    PubMed

    Maulucci, Christopher M; Sansur, Charles A; Singh, Vaneet; Cholewczynski, Alexandra; Shetye, Snehal S; McGilvray, Kirk; Puttlitz, Christian M

    2016-01-01

    OBJECT Nerve root decompression to relieve pain and radiculopathy remains one of the main goals of fusion-promoting procedures in the subaxial cervical spine. The use of allograft facet spacers has been suggested as a potential alternative for performing foraminotomies to increase the space available for the cervical nerve roots while providing segmental stiffening. Therefore, the goal of this cadaveric biomechanical study was to determine the acute changes in kinetics and foraminal area after the insertion of cortical bone facet spacers into the subaxial cervical spine. METHODS Allograft spacers (2 mm in height) were placed bilaterally into cadaveric cervical spine specimens (C2-T1, age of donors 57.5 9.5 years, n = 7) at 1 (C4-5) and 3 (C3-6) levels with and without laminectomies and posterior lateral mass screw fixation. Standard stereophotogrammetry under pure moment loading was used to assess spinal kinetics. In addition, the authors performed 3D principal component analysis of CT scans to determine changes in foraminal cross-sectional area (FCSA) available for the spinal nerve roots. RESULTS Generally, the introduction of 2-mm-height facet spacers to the cervical spine produced mild, statistically insignificant reductions in motion with particular exceptions at the levels of implantation. No significant adjacent-level motion effects in any bending plane were observed. The addition of the posterior instrumentation (PI) to the intact spines resulted in statistically significant reductions in motion at all cervical levels and bending planes. The same kinetic results were obtained when PI was added to spines that also had facet spacers at 3 levels and spines that had been destabilized by en bloc laminectomy. The addition of 2-mm facet spacers at C3-4, C4-5, and C5-6 did produce statistically significant increases in FCSA at those levels. CONCLUSIONS The addition of allograft cervical facet spacers should be considered a potential option to accomplish indirect foraminal decompression as measured in this cadaveric biomechanical study. However, 2-mm spacers without supplemental instrumentation do not provide significantly increased spinal segmental stability. PMID:26407085

  15. Are there a guidelines for implantable spinal cord stimulator therapy in patients using chronic anticoagulation therapy? - A review of decision-making in the high-risk patient

    PubMed Central

    Ghaly, Ramsis F.; Lissounov, Alexei; Candido, Kenneth D.; Knezevic, Nebojsa Nick

    2016-01-01

    Background: Spinal cord stimulators (SCSs) are gaining increasing indications and utility in an expanding variety of clinical conditions. Complications and initial expenses have historically prevented the early use of SCS therapy despite ongoing efforts to educate and promote its utilization. At present, there exists no literature evidence of SCS implantation in a chronically anticoagulated patient, and neuromodulation manufacturers are conspicuously silent in providing warnings or recommendations in the face of anticoagulant use chronically. It would appear as through these issues demand scrutiny and industry as well as neuromodulation society advocacy and support in terms of the provision of coherent guidelines on how to proceed. Case Description: A 79-year-old male returned to the neurosurgical clinic with persistent low back pain and leg heaviness due to adjacent level degenerative spondylosis and severe thoracic spinal stenosis. The patient had a notable history of multiple comorbidities along with atrial fibrillation requiring chronic anticoagulation. On initial presentation, he was educated with three choice of conservative medical therapy, intrathecal drug delivery system implantation, or additional lumbar decompression laminectomy with instrumented fusion of T10-L3 and a palliative surgical lead SCS implantation. Description: A 79-year-old male returned to the neurosurgical clinic with persistent low back pain and leg heaviness due to adjacent level degenerative spondylosis and severe thoracic spinal stenosis. The patient had a notable history of multiple comorbidities along with atrial fibrillation requiring chronic anticoagulation. On initial presentation, he was educated with three choice of conservative medical therapy, intrathecal drug delivery system implantation, or additional lumbar decompression laminectomy with instrumented fusion of T10-L3 and a palliative surgical lead SCS implantation. Conclusion: Our literature search did not reveal any evidence of SCS therapy among patients with chronic anticoagulation. This case illustrated a complicated clinical case scenario wherein a percutaneous SCS implantation would normally be contraindicated due to severe thoracic spinal stenosis and chronic anticoagulation which could lead to possible paralysis or even a lethal consequences associated with the possible formation of a thoracic epidural hematoma. PMID:27127698

  16. The Significance of Removing Ruptured Intervertebral Discs for Interbody Fusion in Treating Thoracic or Lumbar Type B and C Spinal Injuries through a One-Stage Posterior Approach

    PubMed Central

    Zhang, Qian-Shi; Lü, Guo-Hua; Wang, Xiao-Bin; Li, Jing

    2014-01-01

    Objectives To identify the negative effect on treatment results of reserving damaged intervertebral discs when treating type B and type C spinal fracture-dislocations through a one-stage posterior approach. Methods This is a retrospective review of 53 consecutive patients who were treated in our spine surgery center from January 2005 to May 2012 due to severe thoracolumbar spinal fracture-dislocation. The patients in Group A (24 patients) underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression. In Group B (29 patients), the patients underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression evacuating of the ruptured disc and inserting of a bone graft into the evacuated disc space for interbody fusion. The mean time between injury and operation was 4.1 days (range 2–15 days). The clinical, radiologic and complication outcomes were analyzed retrospectively. Results Periodic follow-ups were carried out until an affirmative union or treatment failure took place. A progressive kyphosis angle larger than 10°, loss of disc height, pseudoarthrosis, recurrence of dislocation or subluxation, or instrument failure before fusion were considered treatment failures. Treatment failures were detected in 13 cases in Group A (failure rate was 54.2%). In Group B, there were 28 cases in which definitive bone fusion was demonstrated on CT scans, and CT scans of the other cases demonstrated undefined pseudoarthrosis without hardware failure. There were statistically significant differences between the two groups (p<0.001 chi-square test). The neurologic recoveries, assessed by the ASIA scoring system, were not satisfactory for the neural deficit patients in either group, indicating there was no significant difference with regard to neurologic recovery between the two groups (p>0.05 Fisher's exact test). Conclusion Intervertebral disc damage is a common characteristic in type B and C spinal fracture-dislocation injuries. The damaged intervertebral disc should be removed and substituted with a bone graft because reserving the damaged disc in situ increases the risk of treatment failure. PMID:24827733

  17. Decompression alone versus decompression with limited fusion for treatment of degenerative lumbar scoliosis in the elderly patient

    PubMed Central

    Daubs, Michael D.; Lenke, Lawrence G.; Bridwell, Keith H.; Cheh, Gene; Kim, Yongjung J.; Stobbs, Georgia

    2012-01-01

    Study design: Retrospective cohort study. Objective: To analyze the surgical results of a group of patients older than 65 years treated for mild degenerative lumbar scoliosis (<30°) with stenosis, treated with decompression alone or decompression and limited fusion. Methods: We evaluated 55 patients, all older than 65 years from our prospectively collected database with mild degenerative scoliosis (<30°) and stenosis who underwent surgery. Laminectomy alone was performed in 16 patients, and laminectomy and limited fusion in 39 patients. Mean follow-up was 4.6 years in the decompression group and 5.0 years in the fusion group. Clinical results were graded by patients' self-reported satisfaction and length of symptom-free period to recurrence. Results: In the decompression alone group, 6 (37%) of 16 patients developed recurrent stenosis at the previously decompressed level and five developed recurrence within 6 months postoperatively versus the decompression and fusion group where 3 (8%) of 39 (P = .0476) developed symptomatic stenosis supra adjacent to the fusion. Of 16 patients in the decompression alone group, 12 (75%) had recurrence of symptoms by the 5-year follow-up period versus only 14 (36%) patients in the decompression and fusion group (P = .016). Adjacent segment degenerative changes were common in the fusion group, but only 7% developed symptomatic stenosis. Conclusions: Decompression with limited fusion prevents early return of stenotic symptoms compared with decompression alone in the setting of mild degenerative scoliosis (<30°) and symptomatic stenosis in patients 65 years and older. Final class of evidence–prognosis Study design  RCT  Cohort •  Case control  Case series Methods  Concealed allocation (RCT)  Intention to treat (RCT)  Blinded/independent evaluation of primary outcome  F/U ≥ 85% •  Adequate sample size  Control for confounding Overall class of evidence III The definiton of the different classes of evidence is available on page 67. PMID:23531707

  18. In vitro biomechanical evaluation of internal fixation techniques on the canine lumbosacral junction

    PubMed Central

    Dillard, Stacy; Roe, Simon

    2015-01-01

    Few biomechanical studies have evaluated the effect of internal stabilization techniques after decompressive surgery on the stability of the canine lumbosacral junction. The purpose of this canine cadaver study is to evaluate the stability of the canine lumbosacral (LS) spine in flexion and extension following laminectomy and discectomy and then stabilization with each of the three techniques: pins and polymethylmethacrylate (P/PMMA), two dorsal locking plates (SOP) or bilateral transarticular facet screws (FACET).Using a cantilever biomechanical system, bending moments were applied to the LS and range of motion (ROM) was recorded via a rotational potentiometer. With 3 Nm, the ROM (n = 4 in each group) for P/PMMA, SOP and FACET were 1.92 ± 0.96°, 2.56 ± 0.55°and 3.18 ± 1.14°, respectively. With moments up to 35 Nm, the P/PMMA specimens appeared stable. Sacroiliac motion in the SOP and FACET groups invalidated further comparisons. Each of the stabilization techniques (P/PMMA, SOP, and FACET) significantly decreased the range of motion in flexion and extension for low bending moments. PMID:26312169

  19. Posterior reversible encephalopathy syndrome: temporary visual loss after spinal deformity surgery.

    PubMed

    Kueper, Janina; Loftus, Michael L; Boachie-Adjei, Oheneba; Lebl, Darren

    2015-11-01

    Posterior reversible encephalopathy syndrome (PRES) is a rare cause of temporary postoperative visual loss (POVL) after spinal deformity surgery. We report on 2 patients diagnosed with PRES after spinal deformity surgery, who were closely examined postoperatively. A 78-year-old woman with severe disability due to degenerative lumbar spondylosis after laminectomy was treated with transpsoas lumbar interbody fusion from L1 to L4 and posterior spinal fusion from T10 to pelvis. She developed confusion and bilateral visual loss on postoperative day 7. A second patient, a 51-year-old woman with progressive pain and decompensation caused by adult scoliosis, was treated with posterior spinal fusion from T3 to pelvis and interbody fusion from L4 to S1 via a presacral interbody fusion approach. She developed bilateral visual loss on postoperative day 15. Both patients achieved a complete recovery of their vision after medical management of PRES. Timely diagnosis of PRES and prompt intervention allow for a good patient prognosis and complete recovery of eyesight. PMID:26566564

  20. Digital multimedia books produced using iBooks Author for pre-operative surgical patient information.

    PubMed

    Briggs, Matthew; Wilkinson, Caroline; Golash, Aprajay

    2014-10-01

    Presenting patients with medical information and ensuring informed consent can be difficult due to patients with varying levels of literacy, physical and mental disabilities and spoken languages. Patients obtaining information from external sources, such as the internet, can also be problematic as the information can be irrelevant, inaccurate or misleading. A patient satisfaction study was performed in order to assess the effectiveness of using ebooks in order to communicate pre and post surgical information to neurosurgical patients. 3 digital books were produced using iBooks Author (a free desktop publishing program designed by Apple) including ACDF (anterior cervical discectomy and fusion), lumbar laminectomy and lumbar discectomy. Each book contained written information organised into sections and chapters along with an array of multimedia elements including 3D animations, interactive diagrams, 3D models of anatomy and patient experience videos. 32 volunteer patients were then presented with the digital books via an iPad during their preoperative assessment and then asked to complete a questionnaire. The results demonstrated a demand for this type of digital presentation of medical information and also showed patients no longer felt the need to seek further information from external sources. PMID:25390936

  1. [Ossification of ligamentum flavum unmasked by acute paraplegia].

    PubMed

    Rivierez, M; Vally, P

    2001-12-01

    A 30-year-old black man presented sudden-onset paraplegia during a foot-ball match, after a movement of hyperextension of the trunk. Moreover, the patient exhibited an hypoesthesia below the T11 level, with sphincter disturbances. The MRI and the CT-scan showed a stenosis of the spinal canal related to an ossification of hypertrophied ligamenta flava from T10 to T12. Intramedullary abnormal signals on MRI images were compatible with a spinal cord hemorrhage. A laminectomy with removal of abnormal ligamenta flava was carried out, and their endochondral ossification was confirmed by pathological examination. Two months later, the patient was able to walk alone and exhibited a mild spasticity associated to sensory disturbances of lower limbs. Ossification of ligamenta flava is usually observed in Japanese patients, sometimes in Caucasians, more rarely in black people. Its mechanism is unclear except when associated with metabolic or endocrine diseases. The patients usually present with clinical features of chronic spinal cord compression. Our case seems to be the first one disclosed by an acute spinal cord injury on ossified ligamenta flava. In this patient, because of remaining adjacent ossified ligamenta flava and the development on postoperative MRI of an intramedullary cavity, a long-term clinical and radiological follow-up is particularly necessary. PMID:11915618

  2. Acute compartment syndrome of the forearm and hand in a patient of spine surgery -A case report-

    PubMed Central

    Lee, Jung-Ah; Jeon, Yeon Soo; Jung, Hong Soo; Kim, Hyung-Gun

    2010-01-01

    A 38-year-old woman underwent a 4-hour operation in the prone position for a laminectomy at C4-7 and posterior cervical decompressive fusion at C7-T1 under general anesthesia. After undraping at the end of surgery, considerable swelling with many blisters of the left forearm and hand was observed. The chest roll at the left side had moved cephalad into the axilla and compressed the axillary structures. An emergency fasciotomy to decompress the compartments of the forearm and dorsal surface of the hand was performed. In the post anesthesia care unit, the radial pulse of the left hand was palpable and the level of oxygen saturation was normal. Forearm and hand edema subsided gradually over several days and the patient was discharged with full function of her left arm. This compartment syndrome suggests careful attention should be paid to the position of the chest roll when the prone position is established for a long duration. PMID:20652000

  3. Chronic spinal cord injury impairs primary antibody responses, but spares existing humoral immunity in mice

    PubMed Central

    Oropallo, Michael A.; Held, Katherine S.; Goenka, Radhika; Ahmad, Sifat A.; ONeill, Patrick J.; Steward, Oswald; Lane, Thomas E.; Cancro, Michael P.

    2012-01-01

    Spinal cord injury (SCI) results in immune depression. To better understand how injury inhibits humoral immunity, the effects of chronic thoracic SCI on B cell development and immune responses to thymus-independent (TI) type-2 and thymus-dependent (TD) antigens were determined. Mice received complete crush injury or control laminectomy at either thoracic level 3 (T3), which disrupts descending autonomic control of the spleen, or at T9, which conserves most splenic sympathetic activity. Although mature B cell numbers were only mildly reduced, bone marrow B cell production was transiently but profoundly depressed immediately after injury. Despite the return of normal B cell production four weeks after SCI, mice receiving T3-injury showed a significant reduction in their ability to mount primary TI-2 or TD immune responses. The latter were marked by decreases in germinal center B cells as well as class switched high-affinity antibody secreting cells. Importantly, injury did not affect affinity maturation per se, pre-existing B cell memory, or secondary humoral immune responses. Together, these findings show that chronic high thoracic SCI impairs the ability to mount optimal antibody responses to new antigenic challenges, but spares previously established humoral immunity. PMID:22523388

  4. Epidural needle with embedded optical fibers for spectroscopic differentiation of tissue: ex vivo feasibility study

    PubMed Central

    Desjardins, Adrien E.; Hendriks, Benno H.W.; van der Voort, Marjolein; Nachabé, Rami; Bierhoff, Walter; Braun, Guus; Babic, Drazenko; Rathmell, James P.; Holmin, Staffan; Söderman, Michael; Holmström, Björn

    2011-01-01

    Epidural injection is commonly used to provide intraoperative anesthesia, postoperative and obstetric analgesia, and to treat acute radicular pain. Identification of the epidural space is typically carried out using the loss of resistance (LOR) technique, but the usefulness of this technique is limited by false LOR and the inability to reliably detect intravascular or subarachnoid needle placement. In this study, we present a novel epidural needle that allows for the acquisition of optical reflectance spectra from tissue close to the beveled surface. This needle has optical fibers embedded in the cannula that deliver and receive light. With two spectrometers, light received from tissue is resolved across the wavelength range of 500 to 1600 nm. To determine the feasibility of optical tissue differentiation, spectra were acquired from porcine tissues during a post mortem laminectomy. The spectra were processed with an algorithm that derives estimates of the hemoglobin and lipid concentrations. The results of this study suggest that the optical epidural needle has the potential to improve the accuracy of epidural space identification. PMID:21698009

  5. Solitary spinal dural syphilis granuloma mimicking a spinal meningioma.

    PubMed

    Zhou, Heng-Jun; Zhan, Ren-Ya; Chen, Man-Tao; Cao, Fei; Zheng, Xiu-Jue

    2014-01-01

    Dural granuloma is extremely rare. To our knowledge, there has no case reported solitary spinal dural syphilis granuloma worldwide so far. Here we report our findings in a 49-year-old woman, who presented with 10-year progressive left lower-limb numbness and two weeks of right lower-limb numbness. Magnetic resonance imaging (MRI) suggested a homogeneous enhanced spindle-shaped lesion, 2.9 × 1.5 cm in size, occupying the spinal intradural extramedullary space, at the level of Thoracic (T)-2/3, which mimicked the appearance of spinal meningioma. The Treponema pallidum particle agglutination (TPPA) test titer of 1:8, and the venereal diseases research laboratory of cerebral spinal fluid (VDRL-CSF) was reactive, so confirmed neurosyphilis was considered. After formal anti-syphilis treatment, posterior laminectomy surgery was performed, and the lesion was completely separated and extirpated. Final histopathologic diagnosis of the lesion was confirmed as chronic granulomatous inflammation, combined with the neurosyphilis history, spinal dural syphilis granuloma was finally diagnosed. Postoperatively, the patient recovered without any further treatment. PMID:24831378

  6. Mechanism of Forelimb Motor Function Restoration after Cervical Spinal Cord Hemisection in Rats: A Comparison of Juveniles and Adults

    PubMed Central

    Hasegawa, Atsushi; Takahashi, Masahito; Satomi, Kazuhiko; Ohne, Hideaki; Takeuchi, Takumi; Sato, Shunsuke; Ichimura, Shoichi

    2016-01-01

    The aim of this study was to investigate forelimb motor function after cervical spinal cord injury in juvenile and adult rats. Both rats received a left segmental hemisection of the spinal cord after C3-C4 laminectomy. Behavioral evaluation of motor function was monitored and assessed using the New Rating Scale (NRS) and Forelimb Locomotor Scale (FLS) and by measuring the range of motion (ROM) of both the elbow and wrist. Complete left forelimb motor paralysis was observed in both rats. The NRS showed motor function recovery restored to 50.2 ± 24.7% in juvenile rats and 34.0 ± 19.8% in adult rats. FLS was 60.4 ± 26.8% in juvenile rats and 46.5 ± 26.9% in adult rats. ROM of the elbow and wrist were 88.9 ± 20.6% and 44.4 ± 24.1% in juvenile rats and 70.0 ± 29.2% and 40.0 ± 21.1% in adult rats. Thus, the NRS and ROM of the elbow showed a significant difference between age groups. These results indicate that left hemisection of the cervical spinal cord was not related to right-sided motor functions. Moreover, while motor paralysis of the left forelimb gradually recovered in both groups, the improvement was greater in juvenile rats.

  7. The Retrospective Analysis of Posterior Short-Segment Pedicle Instrumentation without Fusion for Thoracolumbar Burst Fracture with Neurological Deficit

    PubMed Central

    Zou, Hui; Ping, Ansong; Wang, Yongzhi; Ai, Qiyong

    2014-01-01

    This study aims to investigate the efficacy of posterior short-segment pedicle instrumentation without fusion in curing thoracolumbar burst fracture. All of the 53 patients were treated with short-segment pedicle instrumentation and laminectomy without fusion, and the restoration of retropulsed bone fragments was conducted by a novel custom-designed repositor (RRBF). The mean operation time and blood loss during surgery were analyzed; the radiological index and neurological status were compared before and after the operation. The mean operation time was 93 min (range: 62–110 min) and the mean intraoperative blood loss was 452 mL in all cases. The average canal encroachment was 50.04% and 10.92% prior to the surgery and at last followup, respectively (P < 0.01). The preoperative kyphotic angle was 17.2 degree (±6.87 degrees), whereas it decreased to 8.42 degree (±4.99 degrees) at last followup (P < 0.01). Besides, the mean vertebral body height increased from 40.15% (±9.40%) before surgery to 72.34% (±12.32%) at last followup (P < 0.01). 45 patients showed 1-2 grades improvement in Frankel's scale at last followup. This technique allows for satisfactory canal clearance and restoration of vertebral body height and kyphotic angle, and it may promote the recovery of neurological function. However, further research is still necessary to confirm the efficacy of this treatment. PMID:24723809

  8. Cervical chondroid chordoma in a standard dachshund: a case report

    PubMed Central

    2011-01-01

    A ten-year-old male standard dachshund was presented with a history of neck pain and progressive gait disturbances. Following a neurological examination and diagnostic imaging, including CT, a neoplastic lesion involving the third and fourth cervical vertebrae was suspected. The lesion included an extradural mass on the right side of the spinal canal causing a local compression of the cervical cord. Surgery, using a modified dorsal laminectomy procedure, was performed in order to decompress the cervical spinal cord. Histopathological examination of the extradural mass indicated that the tumour was a chondroid chordoma. Following discharge, the quality of life for the dog was very good for a sustained period, but clinical signs recurred at 22 months. The dog was euthanased 25 months post-surgery. On post-mortem examination, a regrowth of neoplastic tissue was found to have infiltrated the bone and spinal cord at C3-C4. This is the first report to show that palliative surgery can offer successful long-lasting treatment of chondroid chordoma of the cervical spine in the dog. PMID:22017812

  9. Influence of intravascular low level He-Ne laser irradiation on iNOS, total-NOS, and ET-1 in acute spinal cord-injured rabbits

    NASA Astrophysics Data System (ADS)

    Yin, Zhenchun; Dong, Yinghai; Zhu, Jing

    2005-07-01

    Objective To research the influence of intravascular low level Laser irradiation (ILLLI) on total NOS, iNOS, and ET-1 in spinal cord following acute spinal cord injury (ASCI), and discuss the protective effects of ILLLI on neurons .Methods 72 rabbits were randomly divided into 3 groups: treatment group, injury group and control group. In treatment group and injury group, after laminectomy at the level of T-13, ASCI was performed by using Allen"s method with slight modification (6g×10cm) on rabbits. After injury, rabbits were treated immediately with He-Ne laser (power 5 mW, 1 hour per day for 10 days). At the day of 10th after treatment, total-NOS, iNOS, and ET-1 in spinal cord tissues were measured. Results The expression level of total-NOS, iNOS, and ET-1 in spinal cord in injury group were significantly higher than those in control group (P<0.05), while after ILLLI the level of these index in treatment group decreased statistically significantly compared with those in injury group (P<0.05). Conclusion ILLLI can significantly decrease the expression level of total-NOS, iNOS, and ET-1 in spinal cord. It indicates that ILLLI can relieve the overexpression of total-NOS, iNOS, and ET-1 ,and thus can perform protective effects on neurons in the course of secondary spinal cord injury (SSCI) following ASCI

  10. Nondysraphic Intramedullary Cervical Cord Lipoma with Exophytic Component: Case Report

    PubMed Central

    Ahmed, Osama; Zhang, Shihao; Thakur, Jai Deep; Nanda, Anil

    2015-01-01

    Introduction Spinal intradural lipoma is a rare condition, accounting for < 1% of all spinal cord tumors. Spinal cord lipomas are frequently associated with dysraphism and occur in the thoracic spine. Another common finding is that spinal cord lipomas tend to present in the pediatric population. Isolated nondysraphic cervical lipomas are a rare entity. We discuss a case of nondysraphic cervical lipoma with an exophytic component. Case A 31 year-old woman presented with bilateral numbness in her hands and a burning and aching sensation in her arms for ∼ 6 months. The patient did not have any weakness or myelopathic signs. Magnetic resonance imaging T1 showed a T1 hyperintense, T2 hypointense, non–contrast-enhancing mass on the dorsal aspect of the spinal cord with significant compression. The patient underwent a dorsal cervical laminectomy with subtotal resection of an isolated cervical lipoma with an exophytic component. The pathology confirmed the diagnosis of a lipoma. Conclusions Surgical management of this rare pathology has a wide variety of options. Depending on the neurologic deficits, observation to gross total resection may be reasonable options. In our case, a subtotal resection was achieved with no further worsening of neurologic symptoms. PMID:26251820

  11. Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression.

    PubMed Central

    Langmayr, J J; Ortler, M; Dessl, A; Twerdy, K; Aichner, F; Felber, S

    1995-01-01

    Spinal cord compression due to extradural and subdural haemorrhage is a neurosurgical emergency. Differences in clinical presentation in relation to localisation of the haematoma, value of MRI as a diagnostic tool, surgical treatment, and prognosis were investigated in a retrospective case series of eight patients with extradural (n = four) and subdural (n = four) haematomas. Results of MRI were compared with operative findings and proved to be of high sensitivity in defining the type of bleeding and delineating craniocaudal extension and ventrodorsal location. Surgical treatment by decompressive laminectomy, haematoma evacuation, and postoperative high dose corticosteroids resulted in resolution of symptoms in five patients and improvement in the clinical situation in two patients. One patient with a chronic subdural haematoma had a second operation because of arachnoidal adhesions. One patient presented with a complete cord transection syndrome due to an acute subdural haematoma and remained paraplegic. It is concluded that prompt, reliable, and non-invasive diagnosis by MRI leads to efficient surgical treatment and a favourable outcome in this rare condition. Images PMID:7561928

  12. Challenges in early operative approaches to intramedullary spinal cord tumors: Harvey Cushing's perspective.

    PubMed

    Pendleton, Courtney; Rincon-Torroella, Jordina; Gokaslan, Ziya L; Jallo, George I; Quinones-Hinojosa, Alfredo

    2015-10-01

    Although Harvey Cushing was mostly known for his contributions to brain tumor surgery, he was also a pioneer in the development of spinal cord surgery. This lesser known facet of Cushing's career can provide a fresh and unique perspective into how the founders of neurosurgery surmounted early challenges in the field. The authors bring to light and examine for the first time Cushing's unpublished writing "Technique of Laminectomy" along with his first 3 documented intramedullary spinal cord tumor (IMSCT) cases at the Johns Hopkins Hospital. The authors draw lessons from the challenges in pathological classification, preoperative diagnosis, tumor localization, and surgical technique of that time. Although Cushing's attempts at exploration and resection of IMSCT as described here were of limited success, his ability to adapt his clinical and surgical technique to the challenges of the time, as well as develop skills to successfully manipulate the spinal cord during these exploratory procedures without the patients incurring neurological damage, postoperative infection, or complications, is a testament to his determination to advance the field and his meticulous operative technique. In spite of the limitations imposed on the pioneer neurosurgeons, Harvey Cushing and his contemporaries persevered through many of the challenges and built an essential part of neurosurgery's common story. PMID:26115026

  13. Pneumomediastinum, subcutaneous emphysema, and tracheal tear in the early postoperative period of spinal surgery in a paraplegic achondroplastic dwarf.

    PubMed

    Kahraman, Sinan; Enercan, Meriç; Demirhan, Ozkan; Sengül, Türker; Dalar, Levent; Hamzaoğlu, Azmi

    2013-01-01

    Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia. Spinal manifestations include thoracolumbar kyphosis, foramen magnum, and spinal stenosis. Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal. The deficits are typically progressive, presenting as an insidious onset of paresthesia, followed by the inability to walk and then by urinary incontinence. Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone. Surgical treatment consists of posterior instrumentation, fusion with total wide laminectomy at stenosis levels, and anterior interbody support. Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal. Pedicle lengths are significantly shorter, and 20-25 mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles. Tracheal injury due to inappropriate pedicle screw length is a rare complication. We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period. PMID:24455372

  14. Lateral retroperitoneal transpsoas interbody fusion in a patient with achondroplastic dwarfism.

    PubMed

    Staub, Blake N; Holman, Paul J

    2015-02-01

    The authors present the first reported use of the lateral retroperitoneal transpsoas approach for interbody arthrodesis in a patient with achondroplastic dwarfism. The inherent anatomical abnormalities of the spine present in achondroplastic dwarfism predispose these patients to an increased incidence of spinal deformity as well as neurogenic claudication and potential radicular symptoms. The risks associated with prolonged general anesthesia and intolerance of significant blood loss in these patients makes them ideal candidates for minimally invasive spinal surgery. The patient in this case was a 51-year-old man with achondroplastic dwarfism who had a history of progressive claudication and radicular pain despite previous extensive lumbar laminectomies. The lateral retroperitoneal transpsoas approach was used for placement of interbody cages at L1/2, L2/3, L3/4, and L4/5, followed by posterior decompression and pedicle screw instrumentation. The patient tolerated the procedure well with no complications. Postoperatively his claudicatory and radicular symptoms resolved and a CT scan revealed solid arthrodesis with no periimplant lucencies. PMID:25415482

  15. Solitary fibrous tumor of the spinal cord: a clinicopathologic study of two cases.

    PubMed

    Pizzolitto, Stefano; Falconieri, Giovanni; Demaglio, Giovanna

    2004-10-01

    Two cases of solitary fibrous tumor of the spinal cord are described. The patients were two men, 36 and 47 years old. Clinically, they sought medical care because of progressive paresthesias or urinary incontinence caused by a nodular, fairly circumscribed intraspinal tumor of the cervical and thoracic spinal cord, respectively. Preoperative magnetic resonance images suggested meningioma. In both cases, laminectomy with tumor resection was carried out. Microscopically, the tumors featured short spindle cells haphazardly enmeshed in a collagenized ground substance. No atypia, necrosis, or significant mitotic activity was recognized. Tumor cells were positive for CD34, bcl2, vimentin, and, in one case, CD99. Both patients recovered from symptoms and are alive and well 12 and 18 months, respectively, after surgical resection. The differential diagnosis includes meningioma, schwannoma, and hemangiopericytoma, all of which may occur in the spinal canal. A careful morphologic approach and the judicious use of immunohistochemistry may assist in distinguishing among these conditions, although some irreducible difficulties may be posed by hemangiopericytoma. Although solitary fibrous tumor of the spinal cord presents with fairly comparable clinical, instrumental, and pathologic patterns, we believe that compilation of more cases is needed to segregate it as a distinct clinicopathologic entity. PMID:15494932

  16. Intradural Neurocysticercosis of Lumbar Spine: A Case Report.

    PubMed

    Ganesan, Sudhir; Acharya, Shankar; Kalra, K L; Chahal, Rupinder

    2015-08-01

    Study Design Case report. Objective Cysticercosis (parasitic infection caused by Taenia solium) is the most common parasitic infection of the nervous system. However, spinal neurocysticercosis is rare. It can present as an extraspinal or intraspinal lesion, with intramedullary being the rarest location. The symptoms can vary from vague backache and radiculopathy to cauda equine syndrome. Methods We report a 32-year-old man who presented with neurocysticercosis in the lumbar spine and cauda equine syndrome. He had low backache for 1 month, hesitancy in micturition, and decreased perianal sensation for the previous 2 days. Magnetic resonance imaging revealed an intradural extramedullary lesion extending from L2-S1 that was hyperintense in T2- and hypointense in T1-weighted images. Results Because the patient presented with cauda equine syndrome, urgent decompressive laminectomy was done from L2-S1, and the thin-walled cysts with clear fluid were removed. Histopathologic examination confirmed neurocysticercosis. The perianal sensation and the bladder control recovered completely. Conclusion Neurocysticercosis should be considered in the differential diagnosis in patients presenting with a similar picture, and urgent surgical decompression should be attempted to prevent further worsening of the neurologic symptoms. PMID:26225286

  17. Utility of a Computed Tomography-Based Navigation System (O-Arm) for En Bloc Partial Vertebrectomy for Lung Cancer Adjacent to the Thoracic Spine: Technical Case Report

    PubMed Central

    Kobayashi, Kazuyoshi; Ito, Zenya; Ando, Kei; Yokoi, Kohei; Ishiguro, Naoki

    2016-01-01

    We describe successful vertebrectomy from a posterior approach using a computed tomography (CT)-based navigation system (O-arm) in a 53-year-old man with adenocarcinoma of the posterior apex of the right lung with invasion of the adjacent rib, thoracic wall, and T2 and T3 vertebral bodies. En bloc partial vertebrectomy for lung cancer adjacent to the thoracic spine was planned using O-arm. First, laminectomy was performed from right T2 to T3, and pedicles and transverse processes of T2 to T3 were resected. O-arm was used to confirm the location of the cutting edge in the T2 to 3 right vertebral internal body, and osteotomy to the anterior cortex was performed with a chisel. Next, the patient was placed in a left decubitus position. The surgical specimen was extracted en bloc. This case shows that O-arm can be used reliably and easily in vertebrectomy from a posterior approach and can facilitate en bloc resection. PMID:27114780

  18. In vitro biomechanical evaluation of internal fixation techniques on the canine lumbosacral junction.

    PubMed

    Early, Peter; Mente, Peter; Dillard, Stacy; Roe, Simon

    2015-01-01

    Few biomechanical studies have evaluated the effect of internal stabilization techniques after decompressive surgery on the stability of the canine lumbosacral junction. The purpose of this canine cadaver study is to evaluate the stability of the canine lumbosacral (LS) spine in flexion and extension following laminectomy and discectomy and then stabilization with each of the three techniques: pins and polymethylmethacrylate (P/PMMA), two dorsal locking plates (SOP) or bilateral transarticular facet screws (FACET).Using a cantilever biomechanical system, bending moments were applied to the LS and range of motion (ROM) was recorded via a rotational potentiometer. With 3 Nm, the ROM (n = 4 in each group) for P/PMMA, SOP and FACET were 1.92 ± 0.96°, 2.56 ± 0.55°and 3.18 ± 1.14°, respectively. With moments up to 35 Nm, the P/PMMA specimens appeared stable. Sacroiliac motion in the SOP and FACET groups invalidated further comparisons. Each of the stabilization techniques (P/PMMA, SOP, and FACET) significantly decreased the range of motion in flexion and extension for low bending moments. PMID:26312169

  19. A refugee's perspective on their neurosurgical care in North America

    PubMed Central

    Honey, C. Michael; Poologaindran, Anujan; Mayhew, Maureen; Steen, Laura Vander; Gillis, Christopher Charles

    2015-01-01

    Background: There is a growing population of refugees within North America and an increasing awareness of their unique medical requirements. These requirements include both a well-recognized need to understand the different pathologies that can present in these patients as well as the rarely described need to understand their unique perspective and how this can impact their medical care, especially for routine neurosurgical conditions. This paper highlights a refugee's perspective toward the medical system in North America and documents how several aspects of this unique perspective hindered or delayed the care for the management of this patient with a cervical cord tumor. Case Description: A 34-year-old female Somalian refugee presented with an ependymoma to Vancouver General Hospital 3 days after arriving in North America. The tumor was removed through a standard posterior cervical laminectomy approach. The patient and her care workers were interviewed 6 months postoperatively to determine if any aspects of care were negatively impacted by her refugee status. Problems related to communication, medical history, mistrust of care workers, familial support, and access to follow-up care were recognized and recommendations for improvements provided. Conclusions: It is well known that the North American physicians must be familiar with the unique spectrum of medical conditions within the refugee community. This paper highlights that physicians must also be aware that refugees may have a unique perspective on our health care system that can negatively influence their care for even routine neurosurgical conditions. PMID:26629394

  20. Rapid regrowth of a capillary hemangioma of the thoracic spinal cord.

    PubMed

    Kaneko, Yoichi; Yamabe, Kazutoshi; Abe, Masamitsu

    2012-01-01

    A 48-year-old man presented with a 2-week history of progressive gait disturbance. Neurological examinations showed mild weakness in his lower extremities and depreciation of deep sensation. Magnetic resonance (MR) imaging showed an intradural extramedullary enhanced lesion at the levels of the T10 and T11 vertebrae. Laminectomy of the T10 and T11 vertebrae was performed, and the vascular tumor on the spinal cord surface was completely resected. Histological analysis indicated that the lesion was a capillary hemangioma with an elevated proliferative index. Postoperatively, the patient showed rapid motor and sensory improvement. However, 6 months after the operation, MR imaging showed regrowth of the tumor although the clinical symptoms of the patient had not deteriorated. The patient has shown no tumor regrowth 9 years after the second operation. Capillary hemangiomas in the skin and soft tissues are often associated with high proliferative activity, and recurrence/regrowth is not infrequent. On the other hand, recurrence/regrowth of capillary hemangioma in the neuraxis after tumor resection has rarely been observed, even in cases of incomplete resection. The present case illustrates the treatment of recurrent capillary hemangioma of the spinal cord. PMID:23006883

  1. Postinjury treatment with magnesium sulfate attenuates neuropathic pains following spinal cord injury in male rats.

    PubMed

    Farsi, Leila; Afshari, Khashayar; Keshavarz, Mansoor; NaghibZadeh, Maryam; Memari, Fereidoon; Norouzi-Javidan, Abbas

    2015-04-01

    Spinal cord injury (SCI) has a number of severe and disabling consequences including chronic pain. Approximately 40% of patients experience neuropathic pain, which appears to be persistent. Previous studies have demonstrated the neuroprotective effects of magnesium sulfate (MgSO4). We aimed to investigate the effect of MgSO4 on neuropathic pains following SCI in male rats. Thirty-two adult male rats (weight 300-350 g) were used. After laminectomy, a complete SCI was induced by compression of the spinal cord for 1 min with an aneurysm clip. A single dose of 300 or 600 mg/kg MgSO4 was injected intraperitoneally. Tail-flick latency and acetone drop test scores were evaluated before surgery and once a week for 4 weeks after surgery. Rats in groups SCI+Mg300 and SCI+Mg600 showed significantly higher mean tail-flick latencies and lower mean scores in the acetone test compared with those in the SCI+veh group 4 weeks after surgery (P<0.05). These findings revealed that systemic single-dose administration of MgSO4 can attenuate thermal hyperalgesia and cold allodynia induced by SCI in rats. PMID:25369748

  2. Incidence of Deep Vein Thrombosis in Patients Undergoing Degenerative Spine Surgery onProphylactic Dalteparin; A Single Center Report

    PubMed Central

    Moayer, AlirezaFarid; Mohebali, Navideh; Razmkon, Ali

    2016-01-01

    Objective: To determine the incidence of deep vein thrombosis (DVT)in patients undergoing spinal surgeries receiving prophylactic doses of Deltaparin in a single center in central Iran. Method: This cross-sectional study was conducted in Shariatee hospital of Isfahan during a 12-month period. We included all the patients undergoing elective spinal surgeries in our center during the study period who received prophylactic dosages of subcutaneous Dalteparin (5000unit daily) thefirst postoperative day. Those with absolute contraindications of anticoagulation therapy were not included in the study. Patients were followed for 3 months clinically and the incidence of DVT was recorded. DVT was suspected clinically and was confirmed by color Doppler sonography. Results: Overall we included 120 patients with mean age of 44.8 ± 12.6years among whom there were 54 (45%) men and 66 (55%) women. Lumbar discectomy (32.9%)and laminectomy (20.2%)were the most common performed procedures. DVT was detected in 1 (0.83%) patient in postoperative period. None of the patients developed pulmonary embolism and none hemorrhagic adverse event was recorded. The patient was treated with therapeutic unfractionated heparin and was discharged with warfarin.  Conclusion: Our results shows the efficacy of LMWH (Dalteparin) in reducing the incidence of DVT to 0.83%. These results also show the safety of Dalteparin in spine surgery because of lack of bleeding complication. PMID:27162925

  3. MULTIPLE SEGMENTAL OSTEOTOMIES TO THE KYPHOSIS CORRECTION

    PubMed Central

    da Silva Herrero, Carlos Fernando Pereira; Porto, Maximiliano Aguiar; Barbosa, Marcello Henrique Nogueira; Defino, Helton Luiz Aparecido

    2015-01-01

    Objective: To evaluate the results of the surgical treatment of the spinal Kyphosis using the Ponte's technique (multiple posterior osteotomies). Methods: Ten patients (8 with Scheuermann's kyphosis and 2 with kyphosis after laminectomy) submitted to surgical correction of kyphotic deformity greater than 70° were retrospectively assessed. The age at the surgical time ranged from 12 to 20 years old (mean age16.8 years ± 2.89). The radiographic parameters evaluated were the kyphosis, the lordosis and the scoliosis – whenever present. The presence of proximal and distal junctional kyphosis, loss of correction, and complications as implants loosening and breakage were also assessed. The radiographic parameters were evaluated at the preoperative, early postoperative and late postoperative time. Results: The patients were followed through a period that ranged from 24 to 144 months (65.8 ±39.92). The mean value of the kyphosis was 78.8° ± 7.59° (Cobb) before surgery and 47.5° ± 12.54° at late follow up, with mean correction of 33.9° ± 9.53° and lost correction of 2.2°. Conclusion: The surgical treatment of the thoracic kyphosis using multiples posterior osteotomies presented a good correction of the deformity and minimal lost of correction during follow up. PMID:27077062

  4. Case report of lumbar intradural capillary hemangioma

    PubMed Central

    Unnithan, Ajaya Kumar Ayyappan; Joseph, T. P.; Gautam, Amol; Shymole, V.

    2016-01-01

    Background: Capillary hemangioma is a rare tumor in spinal intradural location. Despite the rarity, early recognition is important because of the risk of hemorrhage. This is a case report of a woman who had capillary hemangioma of cauda equina. Case Description: A 54 -year-old woman presented with a low backache, radiating to the left leg for 2 months. She had left extensor hallucis weakness, sensory impairment in left L5 dermatome, and mild tenderness in lower lumbar spine. Magnetic resonance imaging (MRI) LS spine showed L4/5 intradural tumor, completely occluding canal in myelogram, enhancing with contrast, s/o benign nerve sheath tumor. L4 laminectomy was done. Reddish tumor was seen originating from a single root. It was removed preserving the root. Postoperatively, she was relieved of symptoms. MRI showed no residue. Histopathology showed lobular proliferation of capillary-sized blood vessels and elongated spindle cells. Immunohistochemistry showed CD34 positivity in endothelial cell lining of blood vessel and smooth muscle actin positivity in blood vessel muscle cells. HPR-capillary hemangioma. Conclusion: Although rare, capillary hemangioma should be in the differential diagnosis of intradural tumors. It closely mimics nerve sheath tumor. PMID:27069745

  5. Breast carcinoma metastasis to meningioma in the thoracic spine: A case report and review of the literature

    PubMed Central

    Okada, Eijiro; Nakamura, Masaya; Koshida, Yoshitomo; Mukai, Kiyoshi; Toyama, Yoshiaki; Matsumoto, Morio

    2015-01-01

    Context Systemic metastasis to a primary tumor of the central nervous system is uncommon. Breast carcinomas metastasizing to a possibly preexisting meningioma in the spine are reported very rarely. Study design Case report. Findings A 69-year-old female was referred to us with progressive gait disturbance. She had undergone a total mastectomy for carcinoma of the right breast 11 years previously. A magnetic resonance imaging of the thoracic spine showed an intra- and extradural spinal cord tumor. The patient underwent resection of the tumor via laminectomy from T2 to T4. After the operation, the patient's neurological status improved significantly, and she was able to walk without assistance. Histological examination showed the tumor to be a fibrous-type meningioma within a metastatic breast cancer tumor. The patient underwent 40 Gy radiation treatment for local control of the tumor. However, the tumor recurred locally 7 months after the surgery. The patient died of carcinomatous pleurisy 13 months after the surgery. Conclusion This case illustrates that a primary meningioma in the thoracic spine can be a recipient of breast cancer metastasis, which may alter the treatment strategy. PMID:24617535

  6. Syncope caused by congenital anomaly at the craniovertebral junction: a case report

    PubMed Central

    2014-01-01

    Introduction Anomalies in the craniovertebral junction may be a rare cause of syncope. The mechanisms of syncope related to craniovertebral junction anomaly remain unknown. We present an extremely rare case with anomaly in the craniovertebral junction and syncope, and discuss the mechanism of the syncope. Case presentation A 10-year-old Japanese boy with a congenital anomaly in the craniovertebral junction presented with recurrent syncope. A physical examination showed generalized hyperreflexia, but motor and sensory examinations were normal. Computed tomography and magnetic resonance imaging showed basilar invagination and spinal cord compression at his craniovertebral junction. Three-dimensional computed tomography angiography revealed an anomalous course of his bilateral vertebral arteries, both of which showed a persistent first intersegmental artery that entered the spinal canal at the caudal portion of the C1 posterior arch. In this case, the arteries were nearly pinched between the C1 posterior arch and the pars interarticularis of the C2. C1 laminectomy and occiput-cervical fusion (O-C2) was performed using an instrumentation system. After surgery, the syncope was not observed. Conclusions Syncope can be related to compression of extracranial arteries within the neck. In this case, transient brain ischemia caused by the anomalous course of vertebral arteries that were pinched between the C1 posterior arch and the pars interarticularis of C2 in cervical motion was the suspected cause of the syncope. PMID:25296768

  7. Surgery for posterior mediastinal dumbbell tumors: A case report

    PubMed Central

    Mo, Ansheng; Zhang, Jiali

    2015-01-01

    Introduction Mediastinal dumbbell tumors are rare, and special cases provide valuable knowledge to the existing literature. Presentation of case A 57-year-old woman was diagnosed with a recurrent dumbbell-shaped nerve sheath tumor with intrathoracic and intraspinal components. We attempted to resect the tumor via combined biport thoracoscopy and laminectomy with the patient in a prone position. However, copious bleeding prevented complete removal of the intraspinal component of the tumor. Pathological examination of the operative specimens showed a mixed hemangioma. Discussion The first report on the use of triportal thoracoscopy for treatment of a posterior mediastinal dumbbell tumor with the patient in the prone position was published in 1995. However, this technique is not widely used. The technique used in our case is unique only in that biportal rather than triportal thoracoscopy was used to resect the intrathoracic component of the tumor. The differential diagnoses of posterior mediastinal dumbbell-shaped tumors include neurogenic tumors, meningiomas, and hemangiomas. Very rarely, cavernous and capillary hemangiomas also present as dumbbell-shaped lesions. To our knowledge, a mixed hemangioma presenting as a dumbbell-shaped lesion has not been previously reported. Conclusion The intrathoracic component of a posterior mediastinal dumbbell tumor can be resected by biportal thoracoscopy with the patient in a prone position, reducing the operative time. If the diagnosis of a dumbbell tumor is inconclusive, an endoscopic biopsy should be performed before removing the tumor. PMID:26568825

  8. Minimally invasive resection of an extradural far lateral lumbar schwannoma with zygapophyseal joint sparing: surgical nuances and literature review.

    PubMed

    Gonçalves, Vítor M; Santiago, Bruno; Ferreira, Vítor C; Cunha E Sá, Manuel

    2014-01-01

    Introduction. Spinal schwannomas are benign nerve sheath tumors. Completely extradural schwannomas of the lumbar spine are extremely rare lesions, accounting for only 0,7-4,2% of all spinal NSTs. Standard open approaches have been used to treat these tumors, requiring extensive muscle dissection, laminectomy, radical foraminotomy, and facetectomy. In this paper the authors present the case of a minimally invasive resection of a completely extradural schwannoma. Operative technique literature review is presented. Material & Methods. A 50-year-old woman presented with progressive complains of chronic right leg pain and paresthesia. The magnetic resonance imaging revealed a giant well-encapsulated dumbbell-shaped extradural lesion at the L3-L4 level. The patient underwent a minimally invasive gross total resection of the tumor using a tubular expandable retractor system. Results. The patient had complete resolution of radiculopathy in the immediate postoperative period and she was discharged home, neurologically intact, on the second postoperative day. Postoperative MRI demonstrated no evidence of residual tumor. At latest follow-up (18 months) the patient remains asymptomatic. Conclusion. Although challenging, this minimally invasive procedure is safe and effective, being an appropriate alternative, with many potential advantages, to the open approach. PMID:25328530

  9. Management of traumatic c6-7 spondyloptosis with cord compression.

    PubMed

    Choi, Man-Kyu; Jo, Dae-Jean; Kim, Min-Ki; Kim, Tae-Sung

    2014-05-01

    A case of total spondyloptosis of the cervical spine at C6-7 level with cord compression is described in a 51-year-old male. Because the bodies of C6 and 7 were tightly locked together, cervical traction failed. Then the patient was operated on by a posterior approach. Posterior stabilization and fusion were performed by C4-5 lateral mass and C7-T1 pedicle screw fixation and rod instrumentation with bridging both C4-5's rods to the C7-T1's extended ones. After C6 total laminectomy and foraminotomy, the C6 body was returned to its proper position. Secondly, anterior stabilization and fusion were performed by C6-7 discectomy with a screw-plate system. A postoperative lateral plain radiograph showed good realignment. In this case, we report the clinical presentation and discuss the surgical modalities of C6-7 total spondyloptosis and the failed close reduction. PMID:25132938

  10. Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis

    PubMed Central

    Tanweer, Omar; Thomas, Cheddhi; Engler, John; Shapiro, Maksim; Becske, Tibor

    2016-01-01

    Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature. PMID:27114966

  11. Thoracic epidural spinal angiolipoma with coexisting lumbar spinal stenosis: Case report and review of the literature

    PubMed Central

    Benvenutti-Regato, Mario; De la Garza-Ramos, Rafael

    2015-01-01

    Background Spinal angiolipomas (SALs) are uncommon benign lesions that may present insidiously with back pain or acutely with weakness due to tumor bleeding/thrombosis. Given their rarity, these lesions are often overlooked in the differential diagnosis of epidural masses. The purpose of this article is to report the case of an epidural SAL and to conduct a literature review on the topic. Methods A case report and review of the literature using the PubMed/Medline databases. All case reports and case series were reviewed up to June 2015. Results A 65-year old female presented with neurogenic claudication and magnetic resonance imaging (MRI) revealed lumbar spinal stenosis. Following decompressive surgery, she experienced symptom resolution, but three months postoperatively she presented to the emergency department with acute paraparesis. A thoracic MRI revealed a lesion located between T8 and T10 causing severe spinal cord compression. Following emergent laminectomy and en bloc resection, the patient regained function and the lesion was diagnosed as SAL. Our literature review revealed 178 reported cases, with a female and thoracic predominance. The majority of patients underwent surgical treatment, achieving a gross total resection in most cases. Similarly, complete symptom resolution was the most common outcome. Conclusion Spinal angiolipomas are uncommon spinal tumors. However, they may be treated as any other space-occupying lesion, and surgical resection allows for complete symptom recovery in most patients. PMID:26767159

  12. Thoracic arachnoiditis, arachnoid cyst and syrinx formation secondary to myelography with Myodil, 30 years previously.

    PubMed

    Gnanalingham, Kanna K; Joshi, Shabin Man; Sabin, Ian

    2006-10-01

    Spinal arachnoiditis can rarely occur following irritation from foreign body substances, including certain oil based contrast agents used for myelography. We describe a patient with thoracic arachnoiditis, arachnoid cyst and syringomyelia, 30 years following a myelogram with Myodil. A 62-year-old female presented with chronic thoraco-lumbar back pain, a spastic paraparesis and sphincter disturbance. She had undergone a myelogram with Myodil, 30 years previously for investigation of back pain. A MRI scan revealed evidence of arachnoiditis, thoracic syringomyelia (T6-T8) and an anteriorly placed, extramedullary, arachnoid cyst at T10-T12, compressing the cord. At surgery, T7-T10 thoracic laminectomies were carried out and syringo- and cysto-subarachnoid shunts were inserted. At 12 months follow-up, the sphincter disturbance, lower limb weakness and mobility problems had almost resolved. Although, the use of oil based contrast agents such as Myodil has been discontinued, the present case illustrates some of the rare sequelae of its use, manifesting decades later. Aggressive surgical intervention produced symptomatic benefit. PMID:16944225

  13. Lameness caused by an extradural lumbosacral foraminal synovial cyst in three German Shepherd Dogs.

    PubMed

    Schmökel, Hugo; Rapp, Martin

    2016-01-13

    Three German Shepherd Dogs that were presented for investigation of chronic unilateral hindlimb lameness and pain in the lumbosacral region were diagnosed with an intraspinal, extradural synovial cyst and reactive fibrosis protruding into the foramen of the lumbosacral articulation using magnetic resonance imaging and histology. This extradural mass compressed the nerve root in the foramen and the cauda equina. During a dorsal laminectomy and unilateral partial foraminotomy, the cyst and the fibrotic tissue were removed with the aid of a 2.4 mm 30° arthroscope for visualization of the foramen. The fibrotic tissue surrounding the cysts was in all cases confluent with the annulus of the intervertebral disc. The histological examination confirmed the diagnosis of a synovial cyst in all three cases by finding inflamed synovial membrane in the samples from the wall of the cyst as well as reactive fibrosis and cartilaginous metaplasia in the surrounding tissue. The three patients improved after the surgery and were pain free during the follow-up evaluations. PMID:26511526

  14. Selective dorsal rhizotomy for spastic diplegia secondary to stroke in an adult patient

    PubMed Central

    Eppinger, Melissa Ann; Berman, Casey Melissa; Mazzola, Catherine Anne

    2015-01-01

    Background: Selective dorsal rhizotomy (SDR) is often recommended for children with spastic paraparesis and cerebral palsy. SDR reduces spasticity in the lower extremities for these children with spastic paraplegia. However, SDR is infrequently recommended for adults with spasticity. Spastic diplegia in adult patients can be due to stroke, brain or spinal cord injury from trauma, infection, toxic-metabolic disorders, and other causes. Although rarely considered, SDR is an option for adult patients with spastic diplegia as well. Case Description: The authors describe a patient who underwent a SDR with a successful postoperative outcome. This man suffered a hypertensive and hemorrhagic stroke secondary to intravenous drug abuse at age 46. A SDR was performed after two failed intrathecal baclofen pump placements due to recurrent infections, likely resulting from his immunocompromised status. The patient underwent lumbar laminectomies and dorsal rhizotomies at levels L1-S1 bilaterally. Postoperatively, the patient's spasticity was significantly reduced. His Ashworth spasticity score decreased from 4/5 to 1/5, and the reduction in tone has been durable over 3 years. Conclusion: SDR in older patients with spastic paraparesis may be considered as a treatment option. PMID:26167363

  15. A case of spinal epidural venous malformation with mediastinal extension: management with combined surgery and percutaneous sclerotherapy.

    PubMed

    Gandhoke, Gurpreet S; Yilmaz, Sabri; Grunwaldt, Lorelei; Hamilton, Ronald L; Salvetti, David J; Greene, Stephanie

    2016-05-01

    While spinal epidural arteriovenous malformations, fistulas, and shunts are well reported, the presence of a venous malformation in the spinal epidural space is a rare phenomenon. Herein, the authors report the clinical presentation, imaging findings, pathological features, and the outcome of surgical and percutaneous interventional management of a mediastinal and spinal epidural venous malformation in a young woman who presented clinically with neurogenic claudication from presumed venous hypertension precipitating the formation of a syrinx. The patient underwent a C6-T5 osteoplastic laminectomy for decompression of the spinal canal and subtotal resection of the epidural venous malformation, followed by percutaneous sclerotherapy of the mediastinal and residual anterior spinal venous malformation. She developed transient loss of dorsal column sensation, which returned to baseline within 3 weeks of the surgery. A 6-month postoperative MRI study revealed complete resolution of the syrinx and the mediastinal venous malformation. Twelve months after the surgery, the patient has had resolution of all neurological symptoms with the exception of her premorbid migraine headaches. A multidisciplinary approach with partial resection and the use of percutaneous sclerotherapy for the residual malformation can be used to successfully treat a complex venous malformation. PMID:26771680

  16. Skeletal sequelae of radiation therapy for malignant childhood tumors

    SciTech Connect

    Butler, M.S.; Robertson, W.W. Jr.; Rate, W.; D'Angio, G.J.; Drummond, D.S. )

    1990-02-01

    One hundred forty-three patients who received radiation therapy for childhood tumors, and survived to the age of skeletal maturity, were studied by retrospective review of oncology records and roentgenograms. Diagnoses for the patients were the following: Hodgkin's lymphoma (44), Wilms's tumor (30), acute lymphocytic leukemia (26), non-Hodgkin's lymphoma (18), Ewing's sarcoma (nine), rhabdomyosarcoma (six), neuroblastoma (six), and others (four). Age at the follow-up examination averaged 18 years (range, 14-28 years). Average length of follow-up study was 9.9 years (range, two to 18 years). Asymmetry of the chest and ribs was seen in 51 (36%) of these children. Fifty (35%) had scoliosis; 14 had kyphosis. In two children, the scoliosis was treated with a brace, while one developed significant kyphosing scoliosis after laminectomy and had spinal fusion. Twenty-three (16%) patients complained of significant pain at the radiation sites. Twelve of the patients developed leg-length inequality; eight of those were symptomatic. Three patients developed second primary tumors. Currently, the incidence of significant skeletal sequelae is lower and the manifestations are less severe than reported in the years from 1940 to 1970. The reduction in skeletal complications may be attributed to shielding of growth centers, symmetric field selection, decreased total radiation doses, and sequence changes in chemotherapy.

  17. Midline Lumbar Fusion with Cortical Bone Trajectory Screw

    PubMed Central

    MIZUNO, Masaki; KURAISHI, Keita; UMEDA, Yasuyuki; SANO, Takanori; TSUJI, Masanori; SUZUKI, Hidenori

    2014-01-01

    A novel cortical bone trajectory (CBT) screw technique provides an alternative fixation technique for lumbar spine. Trajectory of CBT screw creates a caudo-cephalad path in sagittal plane and a medio-lateral path in axial plane, and engages cortical bone in the pedicle. The theoretical advantage is that it provides enhanced screw grip and interface strength. Midline lumbar fusion (MIDLF) is composed of posterior mid-line approach, microsurgical laminectomy, and CBT screw fixation. We adopted the MIDLF technique for lumbar spondylolisthesis. Advantages of this technique include that decompression and fusion are available in the same field, and it minimizes approach-related damages. To determine whether MIDLF with CBT screw is as effective as traditional approach and it is minimum invasive technique, we studied the clinical and radiological outcomes of MIDLF. Our results indicate that MIDLF is effective and minimum invasive technique. Evidence of effectiveness of MIDLF is that patients had good recovery score, and that CBT screw technique was safety in clinical and stable in radiological. MIDLF with CBT screw provides the surgeon with additional options for fixation. This technique is most likely to be useful for treating lumbar spondylolisthesis in combination with midline decompression and insertion of an interbody graft, such as the transforaminal lumbar interbody fusion or posterior lumbar interbody fusion techniques. PMID:25169139

  18. Pelvic pain from a giant presacral Tarlov cyst successfully obliterated using aneurysm clips in a patient with Marfan syndrome.

    PubMed

    Wang, Bonnie; Moon, Seong-Jin; Olivero, William C; Wang, Huan

    2014-11-01

    Patients with Marfan syndrome used to succumb early in life from cardiovascular complications. With the current rapid advance in medical and surgical care, such patients may now have near-normal longevities. Consequently, rare late-life complications are emerging in these patients and represent challenges to clinicians for their diagnoses and treatments. The authors report a rare case of pelvic pain and genital prolapse from a giant presacral Tarlov cyst in a 67-year-old patient with Marfan syndrome. This 67-year-old Caucasian female presented with progressively severe pelvic pain, intermittent explosive diarrhea, and dysuria. Physical and bimanual examination demonstrated genital prolapse and a nontender, cyst-like mass fixed in the midline. She underwent ultrasound, CT, and eventually MRI evaluations that led to the diagnosis of a giant (6.7 × 6.4 × 6.6 cm) Tarlov cyst originating from the right S-2 nerve root sleeve/sacral foramen with intrapelvic extension. She underwent S1-S2 and S2-S3 laminectomy with obliteration of the Tarlov cyst using aneurysm clips. Postoperatively, her pelvic pain and bowel symptoms resolved and the bladder symptoms improved. The 3-month follow-up CT of abdomen/pelvis demonstrated resolution of the cyst. The present case illustrates that clinicians caring for elderly patients with Marfan syndrome need to increasingly recognize such unusual late-life complications. Also, these large Tarlov cysts can be simply and effectively obliterated with aneurysm clips. PMID:25216402

  19. Comparison between percutaneous fluoroscopic-guided and conventional open pedicle screw placement techniques for the thoracic spine: a safety evaluation in human cadavers.

    PubMed

    Kwan, M K; Chiu, C K; Lee, C K; Chan, C Y W

    2015-11-01

    Percutaneous placement of pedicle screws is a well-established technique, however, no studies have compared percutaneous and open placement of screws in the thoracic spine. The aim of this cadaveric study was to compare the accuracy and safety of these techniques at the thoracic spinal level. A total of 288 screws were inserted in 16 (eight cadavers, 144 screws in percutaneous and eight cadavers, 144 screws in open). Pedicle perforations and fractures were documented subsequent to wide laminectomy followed by skeletalisation of the vertebrae. The perforations were classified as grade 0: no perforation, grade 1: < 2 mm perforation, grade 2: 2 mm to 4 mm perforation and grade 3: > 4 mm perforation. In the percutaneous group, the perforation rate was 11.1% with 15 (10.4%) grade 1 and one (0.7%) grade 2 perforations. In the open group, the perforation rate was 8.3% (12 screws) and all were grade 1. This difference was not significant (p = 0.45). There were 19 (13.2%) pedicle fractures in the percutaneous group and 21 (14.6%) in the open group (p = 0.73). In summary, the safety of percutaneous fluoroscopy-guided pedicle screw placement in the thoracic spine between T4 and T12 is similar to that of the conventional open technique. PMID:26530660

  20. Catastrophic chest pain: blinded by cardiopulmonary disease.

    PubMed

    Barreiro, Timothy John; Asiimwe, Denis D; Gemmel, David; Brine, Patrick

    2015-01-01

    A 53-year-old man with a history of diabetic foot ulcer, osteomyelitis, coronary artery disease, hypertension and hyperlipidaemia, presented with chest pain of 3 weeks duration. Eleven days earlier, the patient had had a drug-eluting stent (DES) placed in a branch of the right coronary artery (RCA) after similar chest pain, leading to the findings of a positive nuclear stress test. Since discharge, he was not compliant with taking clopidegrel (Plavix), a concern for in-stent thrombosis with recurrent myocardial ischaemia; but work up was negative and medications were restarted. Within 24 h of admission, he developed bilateral flaccid leg weakness, urine retention and loss of sensation from the umbilicus level down. MRI revealed a T4-T6 epidural abscess. Emergent decompression laminectomy and abscess drainage was completed. Neurological symptoms improved hours after surgery with complete resolution of sensory deficits. Cultures grew Streptococcus sp., treated with intravenous nafcillin for 8 weeks. He regained leg strength with continued improvement seen in rehabilitation. PMID:26135489

  1. Surgical treatment of idiopathic syringomyelia: Silastic wedge syringosubarachnoid shunting technique

    PubMed Central

    Soo, Teck M.; Sandquist, Lee; Tong, Doris; Barrett, Ryan

    2014-01-01

    Background: The underlying pathophysiology leading to syringomyelia is elusive with multiple flow-related theories constituting our current limited understanding of the disease process. Syringomyelia is associated with pathologies related to the disturbance of cerebral spinal fluid flow found in conditions such as Chiari I malformations, spinal malignancy, spinal cord tethering, trauma, or arachnoid adhesions. Our aim is to describe a unique surgical shunting technique used to treat refractory cases of idiopathic syringomyelia. Methods: Five patients, aged 22-50, presented with progressive neurologic symptoms associated with an idiopathic syrinx. All underwent decompressive laminectomy surgery with syringosubarachnoid shunting using the silastic wedge technique. Results: In five cases of idiopathic syringomyelia, clinical and radiographic follow up ranges from 3 to 36 months. Three patients have radiographic and clinical follow up greater than 24 months. All patients improved clinically and their symptoms have been stable. Conclusions: Shunting procedures for the syringomyelia disease spectrum have been criticized due to the inconsistent long-term outcomes. This surgical technique used to treat symptomatic idiopathic syringomyelia has been devised based on our intraoperative experience, surgical outcomes, and evaluation of the literature. The purpose of the wedges is to preserve patency of the communication between the syrinx cavity and the expanded subarachnoid space by preventing healing of the myelotomy edges and by maintaining an artificial conduit between the syrinx cavity and the subarachnoid space. Although short-term results are promising, continued long-term follow up is needed to determine the ultimate success of the silastic wedge shunting procedure. PMID:25101209

  2. Severe thoracic spinal fracture-dislocation without neurological symptoms and costal fractures: a case report and review of the literature

    PubMed Central

    2014-01-01

    Introduction Only a high-energy force can cause thoracic spinal fracture-dislocation injuries, and such injuries should always be suspected in patients with polytrauma. The injury is usually accompanied by neurological symptoms. There are only a few cases of severe thoracic spinal fracture-dislocation without neurological symptoms in the literature, and until now, no case of severe thoracic spinal fracture-dislocation without neurological symptoms and without costal fractures has been reported. Case presentation A 30-year-old Han Chinese man had T6 to T7 vertebral fracture and anterolateral dislocation without neurological symptoms and costal fractures. The three-dimensional reconstruction by computed tomography and magnetic resonance imaging indicated the injuries in detail. A patient with thoracic spinal fracture-dislocation without neurological symptoms inclines to further dislocation of the spine and secondary neurological injury; therefore, laminectomy, reduction and internal fixations with rods and screws were done. The outcome was good. Severe spinal fracture-dislocation without neurological symptoms should be evaluated in detail, especially with three-dimensional reconstruction by computed tomography. Although treatment is individualized, reduction and internal fixation are advised for the patient if the condition is suitable for operation. Conclusions Severe thoracic spinal fracture-dislocation without neurological symptoms and costal fractures is frighteningly rare; an operation should be done if the patient's condition permits. PMID:25316002

  3. Spontaneous haematoma of ligamentum flavum. Case report and literature review.

    PubMed

    Albanese, A; Braconi, A; Anile, C; Mannino, S; Sabatino, G; Mangiola, A

    2006-06-01

    Spontaneous infarction of the ligamentum flavum is a very rare cause of mielo-radicular compression. In the literature only four cases are reported, all characterized by a clinical history of slowly progressive mielo-radiculopathy and good outcome after surgical treatment. A 70 year-old female patient presented with a four months clinical history of spontaneous, sub-continuous, progressive lumbar pain with bilateral irradiation to the L4-L5 dermatomers, right leg monoparesis and hypoaesthesia affecting tactile, thermal and pain sensivity, urinary incontinence and constipation. CT scan and MRI evidenced an extradural ovalar lesion in correspondence of the L1-L2 levels, that exerted compression over the dural sac, dislocating it anteriorly. The patient underwent a L1-L2 laminectomy and the lesion was totally resected. Rapid improvement of the patient's symptomatology has been noticed in the postoperative period, with complete recovery during the following month. Histologic examinations demonstrated that the mass was a haematoma of the ligamentum flavum. It's our opinion, that a picture of ligamentum flavum haematoma should be taken into account in differential diagnosis of posterior mielo-radicular compression. The progressive growth of the haematoma may explain the long clinical history of these patients and surgical treatment, even if delayed, permits an excel-lent clinical outcome. PMID:16841030

  4. Time-related effects of general functional training in spinal cord-injured rats

    PubMed Central

    Miranda, Taisa Amoroso Bortolato; Vicente, Juliana Mendes Yule; Marcon, Raphael Martus; Cristante, Alexandre Fogaça; Morya, Edgard; do Valle, Angela Cristina

    2012-01-01

    OBJECTIVES: This prospective, randomized, experimental study with rats aimed to investigate the influence of general treatment strategies on the motor recovery of Wistar rats with moderate contusive spinal cord injury. METHODS: A total of 51 Wistar rats were randomized into five groups: control, maze, ramp, runway, and sham (laminectomy only). The rats underwent spinal cord injury at the T9-T10 levels using the NYU-Impactor. Each group was trained for 12 minutes twice a week for two weeks before and five weeks after the spinal cord injury, except for the control group. Functional motor recovery was assessed with the Basso, Beattie, and Bresnahan Scale on the first postoperative day and then once a week for five weeks. The animals were euthanized, and the spinal cords were collected for histological analysis. RESULTS: Ramp and maze groups showed an earlier and greater functional improvement effect than the control and runway groups. However, over time, unexpectedly, all of the groups showed similar effects as the control group, with spontaneous recovery. There were no histological differences in the injured area between the trained and control groups. CONCLUSION: Short-term benefits can be associated with a specific training regime; however, the same training was ineffective at maintaining superior long-term recovery. These results might support new considerations before hospital discharge of patients with spinal cord injuries. PMID:22892926

  5. Posterior reversible encephalopathy syndrome in a patient with a Chiari I malformation

    PubMed Central

    Hansberry, David R.; Agarwal, Nitin; Tomei, Krystal L.; Goldstein, Ira M.

    2013-01-01

    Background: The authors describe a unique case of a patient who developed posterior reversible encephalopathy syndrome (PRES) following postoperative treatment of a Chiari I malformation. Case Decsription: A 25-year-old female presented with complaints of left upper and lower extremity paresthesias and gait disturbances. A magnetic resonance imaging (MRI) of the brain and cervical spine showed a Chiari I malformation with tonsillar descent beyond the level of the C1 lamina. She underwent a suboccipital craniectomy and C1 laminectomy with cerebellar tonsillar cauterization and duraplasty. Postoperatively, an MRI showed bilateral acute infarcts of the cerebellar vermis. She was initially treated for cerebellar ischemia with hypertensive therapy with a subsequent decline in her neurologic status and generalized tonicclonic seizure. Further workup showed evidence of PRES. After weaning pressors, the patient had a significant progressive improvement in her mental status. Conclusion: Although the mechanism of PRES remains controversial given its diverse clinical presentation, several theories implicate hypertension and steroid use as causative agents. PMID:24232171

  6. Remote Cerebellar Hemorrhage after Revision Lumbar Spine Surgery.

    PubMed

    Haller, Justin M; Calvert, Graham; Spiker, William R; Brodke, Darrel S; Lawrence, Brandon D

    2015-12-01

    Study Design Case report. Objective To report a case of remote cerebellar hemorrhage (RCH) without intraoperative dural tear after revision lumbar spine surgery. RCH is a rare postoperative complication following spine surgery. RCH has previously been reported only in cases with intraoperative dural tear or durotomy. Methods Case report and literature review. Results A 58-year-old woman underwent removal of L4-S1 posterior spinal instrumented fusion (PSIF) implants and L3-L4 decompressive laminectomy with PSIF. There was no intraoperative dural tear. After doing well initially, the patient developed new neurologic symptoms and was found to have RCH. Lumbar spine magnetic resonance imaging (MRI) demonstrated a large dural defect. After repair of the dura, the patient had dramatic improvement of her neurologic symptoms. At 1-year follow-up, the patient continued to have no neurologic sequelae. Conclusion This report demonstrates that RCH can occur without intraoperative dural tear. Although rare, any patient with new onset of declining neurologic symptoms following spine surgery should have a brain MRI and should have RCH on the differential diagnosis. PMID:26682108

  7. Spinal Autofluorescent Flavoprotein Imaging in a Rat Model of Nerve Injury-Induced Pain and the Effect of Spinal Cord Stimulation

    PubMed Central

    Jongen, Joost L. M.; Smits, Helwin; Pederzani, Tiziana; Bechakra, Malik; Hossaini, Mehdi; Koekkoek, Sebastiaan K.; Huygen, Frank J. P. M.; De Zeeuw, Chris I.; Holstege, Jan C.; Joosten, Elbert A. J.

    2014-01-01

    Nerve injury may cause neuropathic pain, which involves hyperexcitability of spinal dorsal horn neurons. The mechanisms of action of spinal cord stimulation (SCS), an established treatment for intractable neuropathic pain, are only partially understood. We used Autofluorescent Flavoprotein Imaging (AFI) to study changes in spinal dorsal horn metabolic activity. In the Seltzer model of nerve-injury induced pain, hypersensitivity was confirmed using the von Frey and hotplate test. 14 Days after nerve-injury, rats were anesthetized, a bipolar electrode was placed around the affected sciatic nerve and the spinal cord was exposed by a laminectomy at T13. AFI recordings were obtained in neuropathic rats and a control group of naïve rats following 10 seconds of electrical stimulation of the sciatic nerve at C-fiber strength, or following non-noxious palpation. Neuropathic rats were then treated with 30 minutes of SCS or sham stimulation and AFI recordings were obtained for up to 60 minutes after cessation of SCS/sham. Although AFI responses to noxious electrical stimulation were similar in neuropathic and naïve rats, only neuropathic rats demonstrated an AFI-response to palpation. Secondly, an immediate, short-lasting, but strong reduction in AFI intensity and area of excitation occurred following SCS, but not following sham stimulation. Our data confirm that AFI can be used to directly visualize changes in spinal metabolic activity following nerve injury and they imply that SCS acts through rapid modulation of nociceptive processing at the spinal level. PMID:25279562

  8. Cervical epidural hematoma in a healthy donor presenting stroke mimic symptoms: a rare adverse event following peripheral blood stem cell apheresis.

    PubMed

    Terabe, Satomi; Nishiwaki, Satoshi; Koyama, Daisuke; Okuno, Shingo; Harada, Yasuhiko; Tomita, Hiroyuki; Yoshihara, Hisatake; Iwasaki, Toshihiro; Sugiura, Isamu

    2015-06-01

    Peripheral blood stem cell apheresis from a healthy donor is indispensable for allogeneic peripheral blood stem cell transplantation. Here, we report a rare adverse event following peripheral blood stem cell apheresis. A female sibling donor, aged 61 years with an unremarkable medical history, complained of pain in the left neck and shoulder and numbness in the left upper limb 1 h after the end of peripheral blood stem cell apheresis. Paralysis of the left upper and lower limbs appeared consecutively. Computed tomography and magnetic resonance imaging of the head showed no abnormalities. Anticoagulant therapy was initiated according to the standard treatment of atherothrombotic brain infarction. Magnetic resonance imaging of the cervical cord on the following day revealed a cervical epidural hematoma. An emergency C4-C5 laminectomy was performed, and the paralysis was improved immediately after surgery. This report is the first case of cervical epidural hematoma in a healthy donor who underwent peripheral blood stem cell apheresis and presented symptoms confusingly similar to those of brain infarction. PMID:25759485

  9. Coma from wall suction-induced CSF leak complicating spinal surgery

    PubMed Central

    Fehnel, Corey R; Razmara, Ali; Feske, Steven K

    2014-01-01

    A 72-year-old woman was admitted for elective L4/L5 laminectomy. The operative procedure was extradural, and a Jackson-Pratt (JP) drain was placed in the tissue bed and set to wall suction during skin closure. During closure, the patient developed a 15 s period of asystole. The patient was haemodynamically stable, but was comatose for 3 days postoperatively. Cardiac enzymes and EEG were unrevealing. Head CT showed traces of subarachnoid haemorrhage and signs suggestive of cerebral anoxia. JP drain at the incision produced 170–210 mL/day of fluid, positive for β-2 transferrin, indicating cerebrospinal fluid (CSF). The patient fully returned to baseline on hospital day 10. MRI on hospital day 8 normalised. The reversible coma and radiographic findings were most consistent with acute intracranial hypotension relating to acute loss of CSF. Because radiographic findings can mimic hypoxic-ischaemic injury, acute intracranial hypotension should be considered in the differential diagnosis of postoperative coma after cranial or spinal surgery. PMID:24623547

  10. Nondural-based lumbar clear cell meningioma. Case report.

    PubMed

    Holtzman, R N; Jormark, S C

    1996-02-01

    This 32-year-old man had noticed right leg pain for 4 years and developed classic right sciatica after heavy lifting, followed by episodes of buckling of both legs 1 month prior to admission. His medical history included congenital left abducens palsy. Examination revealed a right Lasègue's sign and Fajersztajn's sign with mild weakness of the right extensor hallucis longus. Magnetic resonance imaging revealed a 1.5 x 2.0-cm enhancing intradural lesion at the L3-4 level. Following laminectomy of L-3 and L-4 and intradural exposure, the tumor was found to be draped loosely by the roots of the cauda equina and attached to a single root without any adherence to dura. Transection of the adherent fascicles and typical microdissection of arachnoidal filaments permitted its complete removal without violation of the capsule, allowing the preservation of a large fascicle. The patient's recovery was uneventful. Postoperatively, a mild right lateral foot hypalgesia and diminution of the right ankle jerk implicated the S-1 root. Histological and immunohistochemical analyses diagnosed the specimen as a clear cell meningioma. PMID:8592230

  11. Results of surgery for lumbar spinal stenosis in patients aged 80 years or more. A retrospective study of thirty-four cases.

    PubMed

    Ishac, R; Alhayek, G; Fournier, D; Mercier, P; Guy, G

    1996-03-01

    As life expectancy increases and spinal imaging techniques improve, surgery is being increasingly viewed as a therapeutic alternative for symptomatic lumbar spinal stenosis in patients older than 80 years. Thirty-four patients (21 men and 13 women) who had surgery for lumbar spinal stenosis in our department between 1979 and 1994 were studied retrospectively. The most common initial symptoms were walking-related disorders (n = 29) and sciatica or femoral neuralgia (n = 34). All 34 patients underwent laminectomy at one or more levels. Ten patients also had a herniated disk. There were no deaths and only two patients had serious complications (persistent foot drop in one and left-sided hemiplegia in the other). Results were evaluated immediately after surgery and after three and 12 months. The overall result on pain and walking-related disorders was good in 53% of cases, acceptable in 32%, and poor in 15%. Our data suggest that surgery is a reasonable alternative in symptomatic elderly patients who are in good general health. Satisfactory results can be obtained although disabling complications can occur. PMID:8731237

  12. The mechanisms of medial pedicle wall violation: insertion method is as important as correct cannulation of the pedicle.

    PubMed

    Isik, Cengiz; Kose, Kamil Cagri; Inanmaz, Mustafa Erkan; Tagil, Suleyman Murat; Sarman, Hakan

    2014-01-01

    A cadaver study aims to determine the mechanisms of medial pedicle wall violation after a correct cannulation of the pedicle. The study presents finding out the effect of insertion angle and insertion force on medial wall violation. We used 100 lumbar pedicles of cadavers. Special wooden blocks were produced to simulate a fixed angle fault after a correct pedicle cannulation. Pedicles were divided into 4 groups: 10-degree free drive (group 10), 15-degree free drive (group 15), 10-degree push drive (group 10P), and 15-degree push drive (group 15P). After insertion of pedicle screws, laminectomies were done and the pedicles were evaluated from the inside. Pedicle complications were more in group 10P than group 10 (P = 0.009). Medial wall fracture (P = 0.002) and canal penetration were more in group 15P than group 15 (P = 0.001). Groups 10P and 15P were similar regarding medial wall fractures but canal penetration was significantly higher in group 15P (P = 0.001). Medial wall breaches can happen after correct cannulation of pedicles. Change in insertion angle is one factor but the most important factor is the use of a pushing force while inserting a screw. The pedicle seems to be extremely tolerant to insertion angulation mistakes up to 10 degrees and tends to lead the screw into the correct path spontaneously. PMID:25400951

  13. Calibrated Forceps Model of Spinal Cord Compression Injury

    PubMed Central

    Ariza, Jeanelle; Martnez-Cerdeo, Vernica

    2015-01-01

    Compression injuries of the murine spinal cord are valuable animal models for the study of spinal cord injury (SCI) and spinal regenerative therapy. The calibrated forceps model of compression injury is a convenient, low cost, and very reproducible animal model for SCI. We used a pair of modified forceps in accordance with the method published by Plemel et al. (2008) to laterally compress the spinal cord to a distance of 0.35 mm. In this video, we will demonstrate a dorsal laminectomy to expose the spinal cord, followed by compression of the spinal cord with the modified forceps. In the video, we will also address issues related to the care of paraplegic laboratory animals. This injury model produces mice that exhibit impairment in sensation, as well as impaired hindlimb locomotor function. Furthermore, this method of injury produces consistent aberrations in the pathology of the SCI, as determined by immunohistochemical methods. After watching this video, viewers should be able to determine the necessary supplies and methods for producing SCI of various severities in the mouse for studies on SCI and/or treatments designed to mitigate impairment after injury. PMID:25938880

  14. Synchrotron FTIR Microspectroscopic Analysis of the Effects of Anti-inflammatory Therapeutics on Would Healing in Laminectomized Rats

    SciTech Connect

    Weins,R.; Rak, M.; Cox, N.; Abraham, S.; Juurlink, B.; Kulyk, W.; Gough, K.

    2007-01-01

    Peridural scarring, or the excessive formation of scar tissue following spinal surgery, is one of the important contributing factors that result in persistent pain and disability in many individuals who have undergone elective back surgery. Treatment with anti-inflammatory agents following surgery may reduce oxidative stress and scarring, leading to a reduction in post-operative pain. We are using a surgical rat model to test the hypothesis that post-surgical inflammation and oxidative stress following laminectomy can be reduced by systemic administration of L: -2-oxo-thiazolidine-4-carboxylate (OTC) and quercetin. OTC is a cysteine precursor required for the synthesis of glutathione, an important antioxidant. Quercetin is a flavenoid with anti-oxidant properties, found in fruits and vegetables. Synchrotron FTIR microspectroscopy data has been collected on OTC, quercetin and saline (control)-treated post-surgery animals, sacrificed at 3 and 21 days (n=6 per age and treatment group). This paper presents preliminary IR results, supported by immunocytochemistry, on the heterogenous distribution of biological components present in the healing tissue. The data collected on animals sacrificed at 3 and 21 days post-surgery will be combined in the future with data from animals sacrificed 63 days after surgery (representing a third time point) to evaluate the efficacy of the different treatments. Initial statistical analysis of ED1 immunohistochemistry results indicates a decrease in the number of activated macrophages 21 days post-surgery in the OTC-treated animals compared with the saline controls.

  15. Arachnoiditis ossificans after spinal surgery.

    PubMed

    Liu, Li-Di; Zhao, Song; Liu, Wan-Guo; Zhang, Shao-Kun

    2015-05-01

    This article presents an unusual case of arachnoiditis ossificans after spinal surgery. A case of arachnoiditis ossificans secondary to lumbar fixation and decompression surgery for the treatment of multilevel lumbar fractures is reported and the relevant literature is reviewed. A 29-year-old man who previously underwent posterior pedicle screw fixation and fusion for multiple lumbar spine fractures reported lower back stiffness and discomfort 23 months postoperatively. A laminectomy was performed at L2 and at L3-L4. At L2, bone fragments from the burst fracture had injured the dural sac and some nerve roots. A posterolateral fusion was performed using allogeneic bone. Postoperatively, there were no signs of fever, infection, or systemic inflammatory responses. Arachnoiditis ossificans of the thecal sac from L1-L5 was diagnosed by magnetic resonance imaging and computed tomography at the 2-year follow-up. His postoperative neurological status progressively improved and he regained motor and sensory functions. Because of neurological improvements, fixation hardware was removed without further decompression. The authors report a case of arachnoiditis ossificans secondary to lumbar fixation and decompression surgery, which involved a large region. Arachnoiditis ossificans is a relatively rare disorder with unclear etiologies and limited treatment options. Spinal surgical intervention of arachnoiditis ossificans should be carefully considered because it may lead to poor outcomes and multiple revision surgeries. PMID:25970374

  16. Intradural extramedullary primary hydatid cyst of the spine: a case report and review of literature.

    PubMed

    Lotfinia, Iraj; Sayyahmelli, Sima; Mahdkhah, Ata; Shoja, M M

    2013-05-01

    Primary intradural extramedullary hydatid cyst is a rare form of parasitic infection, causing focal neurological signs, commonly observed in sheep-raising areas of the world. We report a rare case of intradural, extramedullary spinal cyst, which we had misdiagnosis in the first surgery, because of rarity of the case. A 55-year-old man presented to our hospital in August 2008. He was admitted to our clinic because of lumbar pain of increasing severity and progressive difficulty with walking and stiffness of both lower limbs, which had lasted for 1 month. On the basis of imaging results, arachnoid cyst of the lumbar spine was diagnosed. Due to rapid progression of the patient's symptoms toward spastic paraplegia, he underwent an emergency surgical decompression procedure. The patient underwent exploratory surgery using a posterior approach. A L1-L2 laminectomy was performed. After opening the dura, an intradural extramedullary cystic mass was determined. The surgical specimen measured 6 × 2 cm and was described as a whitish, pearl-like, semitranslucent, cystic material, which was thought to be parasitic. Surgery has to be followed by albendazole therapy. PMID:22706667

  17. Cervical Myeloradiculopathy due to Ossification of the Posterior Longitudinal Ligament with versus without Diffuse Idiopathic Spinal Hyperostosis.

    PubMed

    Tauchi, Ryoji; Lee, Sang-Hun; Peters, Colleen; Imagama, Shiro; Ishiguro, Naoki; Riew, K Daniel

    2016-06-01

    Study Design Retrospective study. Objectives Assess demographics, ossification characteristics, surgical outcomes, and complications in patients with both diffuse idiopathic spinal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) compared with patients who only have OPLL. Methods Clinical charts and radiographs of all patients treated surgically from February 2004 to July 2012 for cervical myeloradiculopathy due to DISH with OPLL or OPLL alone were reviewed retrospectively. All patients were observed for a minimum of 1 year. Pre- and postoperative Nurick grades were assessed for all patients. Results Forty-nine patients underwent surgical treatment for cervical myeloradiculopathy due to OPLL, and 8 also had DISH (average 58.9 years, range 37 to 70). The DISH with OPLL group had a significantly higher proportion of subjects with diabetes mellitus (50 versus 9.8% in the OPLL-only group). Everyone in the DISH with OPLL group had continuous or mixed-type OPLL, whereas 78% of patients in the OPLL-only group had primarily segmental type. Operative treatments for patients in the DISH with OPLL group included laminoplasty, anterior decompression and fusion, and posterior laminectomy with fusion. By Nurick grade, 5 patients improved and 3 showed no change. Conclusion Patients with both DISH and OPLL had a higher prevalence of diabetes mellitus and either continuous or mixed-type OPLL classifications. Surgical outcomes were mostly satisfactory; there was no aggravation of symptoms after surgery during the follow up period. PMID:27190737

  18. Case report of an epidural cervical Onchocerca lupi infection in a 13-year-old boy.

    PubMed

    Chen, Tsinsue; Moon, Karam; deMello, Daphne E; Feiz-Erfan, Iman; Theodore, Nicholas; Bhardwaj, Ratan D

    2015-08-01

    A 13-year-old boy presented with fever and neck pain and stiffness, which was initially misdiagnosed as culture-negative meningitis. Magnetic resonance images of the brain and cervical spine demonstrated what appeared to be an intradural extramedullary mass at the C1-3 level, resulting in moderate cord compression, and a Chiari Type I malformation. The patient underwent a suboccipital craniectomy and a C1-3 laminectomy with intradural exploration for excisional biopsy and resection. The lesion containing the parasite was extradural, extending laterally through the C2-3 foramina. Inflammatory tissue secondary to Onchocerca lupi infection was identified, and treatment with steroids and doxycycline was initiated. At the 6-month follow-up, the patient remained asymptomatic, with MR images demonstrating a significant reduction in lesional size. However, 10 weeks postoperatively, the infection recurred, necessitating a second operation. The patient was treated with an additional course of doxycycline and is currently maintained on ivermectin therapy. This is the second reported case of cervical O. lupi infection in a human. In the authors' experience, oral doxycycline alone was insufficient in controlling the disease, and the addition of ivermectin therapy was necessary. PMID:25932778

  19. Hydrocephalus due to Membranous Obstruction of Magendie's Foramen

    PubMed Central

    Varthalitis, Dimitrios; Georgakoulias, Nikolaos; Orphanidis, Georgios

    2015-01-01

    We report a case of non communicating hydrocephalus due to membranous obstruction of Magendie's foramen. A 37-year-old woman presented with intracranial hypertension symptoms caused by the occlusion of Magendie's foramen by a membrane probably due to arachnoiditis. As far as the patient's past medical history is concerned, an Epstein-Barr virus infectious mononucleosis was described. Fundoscopic examination revealed bilateral papilledema. Brain magnetic resonance imaging demonstrated a significant ventricular dilatation of all ventricles and turbulent flow of cerebelospinal fluid (CSF) in the fourth ventricle as well as back flow of CSF through the Monro's foramen to the lateral ventricles. The patient underwent a suboccipital craniotomy with C1 laminectomy. An occlusion of Magendie's foramen by a thickened membrane was recognized and it was incised and removed. We confirm the existence of hydrocephalus caused by fourth ventricle outflow obstruction by a membrane. The nature of this rare entity is difficult to demonstrate because of the complex morphology of the fourth ventricle. Treatment with surgical exploration and incision of the thickened membrane proved to be a reliable method of treatment without the necessity of endoscopic third ventriculostomy or catheter placement. PMID:25674349

  20. Cauda equina syndrome caused by isolated spinal extramedullary-intradural cauda equina metastasis is the primary symptom of small cell lung cancer: a case report and review of the literatrure

    PubMed Central

    Xiong, Jian; Zhang, Peixun

    2015-01-01

    Objectives: To describe a case of extramedullary-intradural metastases causing cauda equina syndrome (CES) as the primary syndrome of lung cancer, and to review the pertinent medical literature. Summary of Background Data: Intradural spinal metastasis is rare, accounting for 6% of all spinal metastases. Of all primary lesion types, lung carcinoma is about 40-85%. Extramedullary-intradural metastases of lung cancer causing CES is unusual. Methods: A 55-year-old patient with symptoms of low back pain that radiated to bilateral lower legs with painful paresthesias and piecemeal sphincter disturbances and lead to urinary incontinence, and constipation at last for three months. The MRI showed that there was an isolated, well-demarcated, intradural extramedullary mass at the L3, 4 levels. Results: The patient was admitted to the hospital as the severe cauda equina syndrome (CES) and considering the possibility of nerve system neoplasms for surgery. After a series of examinations, the X-ray and computed tomography (CT) detected a tumor in the left upper lobe with hilar and mediastinal lymph node metastases. The concluded diagnosis through histopathologic examination with immunohistochemistry after the patient received an L3-L4 laminectomy and tumor excision and biopsy was extramedullary-intradural spinal metastasis of the small cell lung cancer (SCLC). The patient had a rapid improvement of the CES. Conclusion: Although the majority of cauda equina tumors are primary tumors, extramedullary-intradural metastasis should be considered before surgery in patients with rapid developed CES. PMID:26309698

  1. Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients.

    PubMed

    da Silva, José Alberto Gonçalves; Holanda, Maurus Marques de Almeida

    2003-06-01

    The present study shows the results of 53 patients who have been treated surgically for basilar impression (BI), Chiari malformation (CM), and syringomyelia (SM). The patients were divided into two groups. Group I (24 patients) underwent osteodural decompression with large inferior occipital craniectomy, laminectomy from C 1 to C 3, dural opening in Y format, dissection of arachnoid adhesion between the cerebellar tonsils, medulla oblongata and spinal cord, large opening of the fourth ventricle and dural grafting with the use of bovine pericardium. Group II patients (29 patients) underwent osteodural-neural decompression with the same procedures described above plus dissection of the arachnoid adherences of the vessels of the region of the cerebellar tonsils, and tonsillectomy (amputation) in 10 cases, and as for the remainning 19 cases, intrapial aspiration of the cerebellar tonsils was performed. The residual pial sac was sutured to the dura in craniolateral position. After completion of the suture of the dural grafting, a thread was run through the graft at the level of the created cisterna magna and fixed to the cervical aponeurosis so as to move the dural graft on a posterior- caudal direction, avoiding, in this way, its adherence to the cerebellum. PMID:12894269

  2. Secondary adrenal insufficiency after glucocorticosteroid administration in acute spinal cord injury: A case report

    PubMed Central

    Yang, Huiqing; Trbovich, Michelle; Harrow, Jeffrey

    2014-01-01

    Context/background A 61-year-old female with cervical stenosis underwent an elective cervical laminectomy with post-op worsening upper extremity weakness. Over the first 3 weeks post-op, she received two separate courses of intravenous steroids. Two days after cessation of steroids, she presented with non-specific symptoms of adrenal insufficiency (AI). Initial formal diagnostic tests of random cortisol level and 250 µg cosyntropin challenge were non-diagnostic; however, symptoms resolved with the initiation of empiric treatment with hydrocortisone. Ten days later, repeat cosyntropin (adrenocortocotropic hormone stimulation) test confirmed the diagnosis of AI. Findings AI is a potentially life-threatening complication of acute spinal cord injury (ASCI), especially in those receiving steroids acutely. Only three cases have been reported to date of AI occurring in ASCI after steroid treatment. The presenting symptoms can be non-specific (as in this patient) and easily confused with other common sequelae of ASCI such as orthostasis and diffuse weakness. The 250 µg cosyntropin simulation test may not the most sensitive test to diagnose AI in ASCI. Conclusion The non-specific presentations and variability of diagnosis criteria make diagnosis more difficult. One microgram cosyntropin simulation test may be more sensitive than higher dose. Clinicians should be aware that AI can be a potential life-threatening complication of ASCI post-steroid treatment. Prompt diagnosis and treatment can reverse symptoms and minimize mortality. PMID:24969098

  3. Chiropractic management of postoperative spine pain: a report of 3 cases

    PubMed Central

    Coulis, Christopher M.; Lisi, Anthony J.

    2013-01-01

    Objective The purpose of this case series is to describe chiropractic care including spinal manipulation for 3 patients with postsurgical spine pain. Clinical features Three patients with postsurgical spine pain (1 cervical fusion, 1 lumbar discectomy, and 1 lumbar laminectomy) presented for chiropractic treatment at a major US medical center. Treatment included spinal manipulation and/or flexion-distraction mobilization based on patient response to joint loading strategies. Intervention and outcomes Two patients were treated with high-velocity, low-amplitude spinal manipulation; and 1 patient was treated with flexion-distraction mobilization. Treatment frequency and duration were 4 treatments over 4 weeks for case 1, 17 treatments over 7 years for case 2, and 5 treatments over 5 weeks for case 3. Subjective improvement was noted using numeric pain scores and functional changes; and upon completion, the patients reported being “satisfied” with their overall outcome. One episode of transient benign soreness was noted by 1 patient. No additional adverse events or effects were noted. Conclusion In these 3 cases, patients with postsurgical spine pain responded positively to chiropractic care. Spinal manipulation/mobilization was tolerated without significant adverse effects. PMID:24396317

  4. Variety of the Wave Change in Compound Muscle Action Potential in an Animal Model

    PubMed Central

    Ito, Zenya; Ando, Kei; Muramoto, Akio; Kobayashi, Kazuyoshi; Hida, Tetsuro; Ito, Kenyu; Ishikawa, Yoshimoto; Tsushima, Mikito; Matsumoto, Akiyuki; Tanaka, Satoshi; Morozumi, Masayoshi; Matsuyama, Yukihiro; Ishiguro, Naoki

    2015-01-01

    Study Design Animal study. Purpose To review the present warning point criteria of the compound muscle action potential (CMAP) and investigate new criteria for spinal surgery safety using an animal model. Overview of Literature Little is known about correlation palesis and amplitude of spinal cord monitoring. Methods After laminectomy of the tenth thoracic spinal lamina, 2-140 g force was delivered to the spinal cord with a tension gage to create a bilateral contusion injury. The study morphology change of the CMAP wave and locomotor scale were evaluated for one month. Results Four different types of wave morphology changes were observed: no change, amplitude decrease only, morphology change only, and amplitude and morphology change. Amplitude and morphology changed simultaneously and significantly as the injury force increased (p<0.05) Locomotor scale in the amplitude and morphology group worsened more than the other groups. Conclusions Amplitude and morphology change of the CMAP wave exists and could be the key of the alarm point in CMAP. PMID:26713129

  5. Rapidly progressive quadriparesis heralding disseminated coccidioidomycosis in an immunocompetent patient.

    PubMed

    Tan, Lee A; Kasliwal, Manish K; Nag, Sukriti; O'Toole, John E; Traynelis, Vincent C

    2014-06-01

    Coccidioides species are dimorphic fungi endemic to southwestern USA and northern Mexico. Disseminated coccidioidomycosis is rare with an estimated incidence of 1% in affected individuals and usually presents as meningitis when the central nervous system is involved. Spinal involvement with coccidioidomycosis, though not uncommon, predominantly manifests as osseous involvement leading to osteomyelitis and epidural abscess formation. Progressive quadriparesis as a presenting symptom secondary to intramedullary spinal cord coccidioidomycosis is very unusual and to our knowledge has not been described. We report a patient with disseminated coccidioidomycosis who presented with rapidly progressive quadriparesis due to cervical intramedullary spinal cord involvement. The absence of known coccidioidomycosis with atypical clinical presentation made the diagnosis elusive, requiring emergent cervical laminectomies with dural biopsy for decompression of the spinal cord and confirmation of the diagnosis. The patient eventually succumbed to the progressive course of the disease. Although rare, disseminated coccidioidomycosis can present as new, rapidly progressing quadriparesis in patients who have traveled to endemic areas. A high index of suspicion in such patients with appropriately directed laboratory investigations and consideration of early biopsy might unravel the diagnosis facilitating early antifungal treatment with the potential to minimize morbidity and mortality associated with disseminated coccidioidomycosis. PMID:24321458

  6. Neuroprotective effect of epidural hypothermia after spinal cord lesion in rats

    PubMed Central

    Barbosa, Marcello Oliveira; Cristante, Alexandre Fogaça; dos Santos, Gustavo Bispo; Ferreira, Ricardo; Marcon, Raphael Martus; de Barros Filho, Tarcisio Eloy Pessoa

    2014-01-01

    OBJECTIVES : To evaluate the neuroprotective effect of epidural hypothermia in rats subjected to experimental spinal cord lesion. METHODS: Wistar rats (n = 30) weighing 320-360 g were randomized to two groups (hypothermia and control) of 15 rats per group. A spinal cord lesion was induced by the standardized drop of a 10-g weight from a height of 2.5 cm, using the New York University Impactor, after laminectomy at the T9-10 level. Rats in the hypothermia group underwent epidural hypothermia for 20 minutes immediately after spinal cord injury. Motor function was assessed for six weeks using the Basso, Beattie and Bresnahan motor scores and the inclined plane test. At the end of the final week, the rats' neurological status was monitored by the motor evoked potential test and the results for the two groups were compared. RESULTS: Analysis of the Basso, Beattie and Bresnahan scores obtained during the six-week period indicated that there were no significant differences between the two groups. There was no significant difference between the groups in the inclined plane test scores during the six-week period. Furthermore, at the end of the study, the latency and amplitude values of the motor evoked potential test were not significantly different between the two groups. CONCLUSION: Hypothermia did not produce a neuroprotective effect when applied at the injury level and in the epidural space immediately after induction of a spinal cord contusion in Wistar rats. PMID:25141116

  7. Economic impact of minimally invasive lumbar surgery

    PubMed Central

    Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

    2015-01-01

    Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures. PMID:25793159

  8. Attenuation of the pulmonary chemoreflex following acute cervical spinal cord injury.

    PubMed

    Tsai, I-Lun; Lee, Kun-Ze

    2014-04-01

    Bronchopulmonary C fibers are the primary chemosensitive afferents in the lung. The activation of bronchopulmonary C fibers evokes the pulmonary chemoreflex, which is characterized by apnea, hypotension, and bradycardia and is a critical reflex that modulates cardiorespiratory responses under physiological and pathological conditions. The present study was designed to investigate whether the pulmonary chemoreflex is altered following acute cervical spinal injury. A unilateral hemisection (Hx) or laminectomy (uninjured) in the second cervical spinal cord was performed in adult male Sprague-Dawley rats. The pulmonary chemoreflex induced by intrajugular capsaicin administration was evaluated by measuring respiratory airflow in spontaneously breathing rats and phrenic nerve activity in mechanically ventilated rats. Capsaicin treatment evoked a cessation of respiratory airflow and phrenic bursting in uninjured animals, but not in C2Hx animals. To clarify whether the attenuation of the pulmonary chemoreflex in C2Hx animals is restricted to capsaicin-induced stimuli, or generally applied to other stimuli that excite bronchopulmonary C fibers, another bronchopulmonary C-fiber stimulant (phenylbiguanide) was used to evoke the pulmonary chemoreflex in spontaneously breathing rats. We observed that phenylbiguanide-induced apnea was also blunted in C2Hx animals, suggesting that the respiratory response induced by bronchopulmonary C-fiber activation was attenuated following acute cervical spinal Hx. The blunted inhibitory respiratory response may represent a compensatory respiratory plasticity to preserve the breathing capacity and may also reduce the capability of preventing inhaled irritants in this injured condition. PMID:24557796

  9. [Surgery of lumbar disk hernia: historical perspective].

    PubMed

    Brunori, A; De Caro, G M; Giuffrè, R

    1998-01-01

    Although the clinical picture of discogenic sciatica is well known already in the ancient world, it is not until 1933 that WJ Mixter and JS Barr provide the correct pathogenetic interpretation and suggest surgery as the treatment of choice. The work of the American Authors was however based on the knowledge acquired during the previous centuries starting with Domenico Cotugno, who first suggested the neurogenic nature of sciatica (1764) and later with the neurologists of the french school Valleix, Lasègue, Dejerine, Sicard who elucidated the semeiology and debated in detail the etiopathogenesis of the condition. The german pathologists Schmorl and Andrae (1927-29) are to be credited for their contribution to the pathology of intervertebral disc, recognizing the frequency and degenerative (not neoplastic) nature of nucleus pulposus herniation. Surgery of disc herniation starts with Oppenheim and Krause (1909). Mixter and Barr used laminectomy and a transdural route although a more limited approach to the spinal canal had already been proposed by the italian Bonomo (1902), unknown to many. Love, of the Mayo Clinic (1937-39) introduced the extradural/interlaminar approach while Caspar and Yasargil (1977) applied the concepts of microsurgery to the procedure. The latest advances are represented by percutaneous and endoscopic techniques. PMID:9835099

  10. Extraspinal Type I Dural Arteriovenous Fistula with a Lumbosacral Lipomyelomeningocele: A Case Report and Review of the Literature

    PubMed Central

    Karsy, Michael; Ray, Wilson Z.; Dailey, Andrew T.

    2015-01-01

    Seven cases of adult spinal vascular malformations presenting in conjunction with spinal dysraphism have been reported in the literature. Two of these involved male patients with a combined dural arteriovenous fistula (DAVF) and lipomyelomeningocele. The authors present the third case of a patient with an extraspinal DAVF and associated lipomyelomeningocele in a lumbosacral location. A 58-year-old woman with rapid decline in bilateral motor function 10 years after a prior L4-5 laminectomy and cord detethering for diagnosed tethered cord underwent magnetic resonance imaging showing evidence of persistent cord tethering and a lipomyelomeningocele. Diagnostic spinal angiogram showed a DAVF with arterial feeders from bilateral sacral and the right internal iliac arteries. The patient underwent Onyx embolization of both feeding right and left lateral sacral arteries. At 6-month follow-up, MRI revealed decreased flow voids and new collateralized supply to the DAVF. The patient underwent successful lipomyelomeningocele exploration, resection, AV fistula ligation, and cord detethering. This report discusses management of this patient as well as the importance of endovascular embolization followed by microsurgery for the treatment of cases with combined vascular and dysraphic anomalies. PMID:25949837

  11. Minimally Invasive Resection of an Extradural Far Lateral Lumbar Schwannoma with Zygapophyseal Joint Sparing: Surgical Nuances and Literature Review

    PubMed Central

    Gonçalves, Vítor M.; Santiago, Bruno; Ferreira, Vítor C.; Cunha e Sá, Manuel

    2014-01-01

    Introduction. Spinal schwannomas are benign nerve sheath tumors. Completely extradural schwannomas of the lumbar spine are extremely rare lesions, accounting for only 0,7–4,2% of all spinal NSTs. Standard open approaches have been used to treat these tumors, requiring extensive muscle dissection, laminectomy, radical foraminotomy, and facetectomy. In this paper the authors present the case of a minimally invasive resection of a completely extradural schwannoma. Operative technique literature review is presented. Material & Methods. A 50-year-old woman presented with progressive complains of chronic right leg pain and paresthesia. The magnetic resonance imaging revealed a giant well-encapsulated dumbbell-shaped extradural lesion at the L3-L4 level. The patient underwent a minimally invasive gross total resection of the tumor using a tubular expandable retractor system. Results. The patient had complete resolution of radiculopathy in the immediate postoperative period and she was discharged home, neurologically intact, on the second postoperative day. Postoperative MRI demonstrated no evidence of residual tumor. At latest follow-up (18 months) the patient remains asymptomatic. Conclusion. Although challenging, this minimally invasive procedure is safe and effective, being an appropriate alternative, with many potential advantages, to the open approach. PMID:25328530

  12. Juxtafacet Spinal Synovial Cysts

    PubMed Central

    2016-01-01

    Study Design This was a retrospective study. Purpose To study the surgical outcome of synovial cysts of the lumbar spine through posterior laminectomy in combination with transpedicular screw fixation. Overview of Literature Synovial cysts of the lumbar spine contribute significantly to narrowing of the spinal canal and lateral thecal sac and nerve root compression. Cysts form as a result of arthrotic disruption of the facet joint, leading to degenerative spondylolisthesis in up to 40% of patients. Methods Retrospective data from 6 patients, treated during the period of March 2007 to February 2011, were analyzed. All preoperative and postoperative manifestations, extension/flexion radiographs, magnetic resonance imaging, and computed tomography records were reviewed. All underwent surgery for synovial cysts with excision and decompression combined with posterior fixation. The result of surgery was evaluated with Macnab's classification. An excellent or good outcome was considered as satisfactory. Japanese Orthopedic Association Scale was used for evaluation of back pain. Results All patients included in this study had excellent outcomes as regarding to improvement of all preoperative manifestations and returning to normal daily activities. Only 2 cases developed postoperative transient cerebro-spinal fluid leak and were treated conservatively and improved during the follow up period. Conclusions Although this study included a small number of cases and we could not have statistically significant results, the good outcome of decompression of synovial cysts combined with posterior fixation and fusion encouraged us to recommend this approach for patients with juxtafacet synovial cysts. PMID:26949457

  13. Spontaneous Resolution of Non-traumatic Cervical Spinal Subdural Hematoma Presenting Acute Hemiparesis: A Case Report.

    PubMed

    Park, Yong Jin; Kim, Seok Won; Ju, Chang Il; Wang, Hui Sun

    2012-09-01

    Spontaneous cervical SDH with no underlying pathology is a very unusual condition. To the best of the authors' knowledge, only two cases have been previously reported. A 48-year-old female patient was admitted to our emergency room due to severe neck pain following standing up position with rapid onset of hemiparesis. MRI revealed a dorsolateral subdural hematoma from C3-C5 with cord compression. An emergency laminectomy was planned, but motor weakness gradually improved during surgical preparation. The patient showed substantial clinical improvement and complete recovery was confirmed after 7 days of conservative management without surgical treatment. To determine a differential diagnosis distinct from other conditions such as cervical epidural hematoma, a lumbar spinal puncture was performed. Follow-up MRI performed 10 days after admission revealed complete resolution of the hematoma. We report an extremely rare case of spontaneous cervical spinal subdural hematoma (SDH), present a review of relevant literature, and discuss the etiology, pathogenesis, and prognosis of this case. PMID:25983826

  14. Post-surgical thoracic pseudomeningocele causing spinal cord compression.

    PubMed

    Macki, Mohamed; Lo, Sheng-fu L; Bydon, Mohamad; Kaloostian, Paul; Bydon, Ali

    2014-03-01

    Pseudomeningoceles are extradural cerebrospinal fluid collections categorized into three groups: traumatic, congenital, and iatrogenic. Iatrogenic pseudomeningoceles occur after durotomy, usually after cervical or lumbar spine surgery. Although many remain asymptomatic, pseudomeningoceles can compress or herniate the spinal cord and nerve roots. We present a 57-year-old woman who had a thoracic laminectomy and discectomy. Two weeks after surgery, she presented with lower extremity weakness and gait difficulty. Physical examination revealed hyperreflexia and a T11 sensory level. MRI revealed a pseudomeningocele compressing the thoracic spinal cord. The patient underwent surgical drainage of the cyst. On follow-up, she had complete resolution of her symptoms, and MRI did not show a residual lesion. To our knowledge, this is the second documented post-operative pseudomeningocele causing symptomatic spinal cord compression of the thoracic spine. In this article, a review of the literature is presented, including four reported patients with post-traumatic pseudomeningocele causing myelopathic symptoms and 20 patients with iatrogenic pseudomeningocele that resulted in neurological decline due to herniation or compression of neural tissue. Treatment options for these lesions include conservative management, epidural blood patch, lumbar subarachnoid drainage, and lumbo-peritoneal shunt placement. Surgical repair, usually by primary dural closure, remains the definitive treatment modality for iatrogenic symptomatic pseudomeningoceles. PMID:24210805

  15. Paraplegia as the presenting manifestation of extramedullary megakaryoblastic transformation of previously undiagnosed chronic myelogenous leukemia.

    PubMed

    Bryant, Barbara J; Alperin, Jack B; Elghetany, M Tarek

    2007-02-01

    Extramedullary tumors, also known as granulocytic sarcomas (GS), occur most frequently in acute myelogenous leukemia (AML). They may signal the onset of the accelerated phase of chronic myelogenous leukemia (CML) or the blastic transformation of a myeloproliferative disorder. Occasionally, a GS may be the presenting sign of undiagnosed AML, and rarely the presenting sign of undiagnosed CML or aleukemic leukemia. Paraplegia due to a spinal cord GS is an extremely rare presentation of undiagnosed leukemia. This is the first case report of paraplegia as the presenting manifestation of extramedullary megakaryoblastic transformation of previously undiagnosed CML. A 53-year-old woman reported back pain for 6 days, rapidly progressing to paraplegia. Physical examination noted a large abdominal mass and flaccid paralysis in both lower extremities. Spinal MRI revealed a T4-T6 vertebral mass causing spinal stenosis and cord compression. Tumor debulking and laminectomy were performed emergently. The tumor consisted of noncohesive blast cells. The CBC revealed a leukocyte count of 238,300/microl and a differential consistent with CML. Reexamination of the patient found that the abdominal mass was a giant spleen. Further immunohistochemical studies of the tumor were consistent with extramedullary acute megakaryoblastic blast transformation of CML. Although extramedullary blast crises herald the accelerated phases in approximately 10% of CML cases, megakaryoblastic blast transformation of CML accounts for less than 3% of these cases. The combination of acute paraplegia and megakaryoblastic transformation in a previously undiagnosed patient with CML is extremely rare and may pose a diagnostic dilemma. PMID:17019692

  16. Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization

    PubMed Central

    Yaldiz, Can; Yaldiz, Mahizer; Ceylan, Nehir; Kacira, Ozlem Kitiki; Ceylan, Davut; Kacira, Tibet; Kizilcay, Gokhan; Tanriverdi, Taner

    2015-01-01

    Abstract Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs. PMID:26200620

  17. Cerebrospinal fluid reconstitution via a perfusion-based cadaveric model: feasibility study demonstrating surgical simulation of neuroendoscopic procedures.

    PubMed

    Winer, Jesse L; Kramer, Daniel R; Robison, Richard A; Ohiorhenuan, Ifije; Minneti, Michael; Giannotta, Steven; Zada, Gabriel

    2015-11-01

    Cadaveric surgical simulation carries the advantage of realistic anatomy and haptic feedback but has been historically difficult to model for intraventricular approaches given the need for active flow of CSF. This feasibility study was designed to simulate intraventricular neuroendoscopic approaches and techniques by reconstituting natural CSF flow in a cadaveric model. In 10 fresh human cadavers, a simple cervical laminectomy and dural opening were made, and a 12-gauge arterial catheter was introduced. Saline was continuously perfused at physiological CSF pressures to reconstitute the subarachnoid space and ventricles. A neuroendoscope was subsequently inserted via a standard right frontal bur hole. In 8 of the 10 cadavers, adequate reconstitution and endoscopic access of the lateral and third ventricles were achieved. In 2 cadavers, ventricular access was not feasible, perhaps because of a small ventricle size and/or deteriorated tissue quality. In all 8 cadavers with successful CSF flow reconstitution and endoscopic access, identifying the foramen of Monro was possible, as was performing septum pellucidotomy and endoscopic third ventriculostomy. Furthermore, navigation of the cerebral aqueduct, fourth ventricle, prepontine cistern, and suprasellar cistern via the lamina terminalis was possible, providing a complementary educational paradigm for resident education that cannot typically be performed in live surgery. Surgical simulation plays a critical and increasingly prominent role in surgical education, particularly for techniques with steep learning curves including intraventricular neuroendoscopic procedures. This novel model provides feasible and realistic surgical simulation of neuroendoscopic intraventricular procedures and approaches. PMID:25859805

  18. Effects of serotonergic agents on respiratory recovery after cervical spinal injury.

    PubMed

    Hsu, Shih-Hui; Lee, Kun-Ze

    2015-11-15

    Unilateral cervical spinal cord hemisection (i.e., C2Hx) usually interrupts the bulbospinal respiratory pathways and results in respiratory impairment. It has been demonstrated that activation of the serotonin system can promote locomotor recovery after spinal cord injury. The present study was designed to investigate whether serotonergic activation can improve respiratory function during the chronic injury state. Bilateral diaphragm electromyogram and tidal volume were measured in anesthetized and spontaneously breathing adult rats at 8 wk post-C2Hx or C2 laminectomy. A bolus intravenous injection of a serotonin precursor [5-hydroxytryptophan (5-HTP), 10 mg/kg], a serotonin reuptake inhibitor (fluoxetine, 10 mg/kg), or a potent agonist for serotonin 2A receptors (TCB-2, 0.05 mg/kg) was used to activate the serotonergic system. Present results demonstrated that 5-HTP and TCB-2, but not fluoxetine, significantly increased the inspiratory activity of the diaphragm electromyogram ipsilateral to the lesion for at least 30 min in C2Hx animals, but not in animals that received sham surgery. However, the tidal volume was not increased after administration of 5-HTP or TCB-2, indicating that the enhancement of ipsilateral diaphragm activity is not associated with improvement of the tidal volume. These results suggest that exogenous activation of the serotonergic system can specifically enhance the ipsilateral diaphragmatic motor outputs, but this approach may not be sufficient to improve respiratory functional recovery following chronic cervical spinal injury. PMID:26359482

  19. Surgical complications associated with spinal decompression surgery in a Japanese cohort.

    PubMed

    Takai, Keisuke; Matsumoto, Takahiro; Yabusaki, Hajime; Yokosuka, Junichi; Hatanaka, Ryo; Taniguchi, Makoto

    2016-04-01

    The aim of the present study was to identify risk factors for perioperative complications associated with spinal surgery for cervical, thoracic, and lumber spinal stenosis in a Japanese cohort. Patients with spinal stenosis who underwent spinal surgery between 2008 and 2012 were included. Neurological and/or surgical site complications within 30days of index surgery were retrospectively collected, and the rates of complications were calculated. Using univariate and multivariate logistic regression analyses, risk factors for complications were identified. A total of 364 patients underwent 407 spinal surgeries. Of the 407 surgeries performed, 236 were cervical, 28 were thoracic, and 143 were lumbar surgeries. Ossification of the ligamentum flavum was the most common diagnosis in patients with thoracic stenosis (85%), whereas spinal degenerative stenosis and disc herniation were the two most common diagnoses in patients with cervical and lumbar stenosis. Laminoplasty and laminectomy alone were the two most frequently performed procedures. The rate of complications was greater in patients with thoracic stenosis (36%) than in those with cervical (16%) or lumbar stenosis (13%, p=0.013). After a multivariate analysis, only thoracic stenosis (odds ratio 2.87) remained an independent risk factor for surgical complications. The novel result of the present study was that the level of stenosis in the spine had a significant impact on complications after spinal surgery in a Japanese cohort. The result can be explained by the fact that challenging ossified lesions are a common cause of thoracic stenosis in eastern Asia. PMID:26791473

  20. Spinal Myeloid Sarcoma “Chloroma” Presenting as Cervical Radiculopathy: Case Report

    PubMed Central

    Hu, Xiaobang; Shahab, Imran; Lieberman, Isador H.

    2015-01-01

    Study Design Case report. Objective Myeloid sarcoma (also known as chloroma) is a rare, extramedullary tumor composed of immature granulocytic cells. It may occur early in the course of acute or chronic leukemia or myeloproliferative disorders. Spinal cord invasion by myeloid sarcoma is rare. The authors report a rare case of spinal myeloid sarcoma presenting as cervical radiculopathy. Methods A previously healthy 43-year-old man presented with progressive neck, right shoulder, and arm pain. Cervical magnetic resonance imaging (MRI) revealed a very large enhancing extradural soft tissue mass extending from C7 through T1, with severe narrowing of the thecal sac at the T1 level. The patient underwent posterior cervical open biopsy, laminectomy, and decompression. Histologic examination of the surgical specimen confirmed the diagnosis of myeloid sarcoma. Postoperatively, a bone marrow biopsy was done, which showed myeloproliferative neoplasm with eosinophilia. The patient then received systemic chemotherapy and radiotherapy. Results At the 10-month follow-up, the patient reported complete relief of arm pain and neck pain. X-rays showed that the overall cervical alignment was intact and there was no evidence of a recurrent lesion. MRI showed no evidence of compressive or remnant lesion. Conclusions Spinal myeloid sarcoma presenting as cervical radiculopathy is rare, and it may be easily misdiagnosed. Knowledge of its clinical presentation, imaging, and histologic characterization can lead to early diagnosis and appropriate treatment. PMID:26131394

  1. Recurrent Craniocervical Pseudogout: Indications for Surgical Resection, Surveillance Imaging, and Craniocervical Fixation

    PubMed Central

    Kelkar, Prashant; Keen, Joseph; Rostad, Steven; Delashaw, Johnny B

    2016-01-01

    Background: Calcium pyrophosphate dihydrate (CPPD) crystallization is known to occur in the spine, leading to the development of visible calcification as seen by imaging. Occasionally, the deposition of this material can lead to larger accumulations that are seen as masses in the articular processes, intervertebral discs, and posterior longitudinal ligaments. A particularly significant manifestation of this process is at the craniocervical junction, where symptomatic presentations can arise. Clinical presentation: A 74-year-old woman presented after several falls from standing, complaining of leg and arm weakness. Imaging revealed a mass arising from the C1-C2 articulation dorsal to the dens, extending to the clivus. The mass compressed the medulla and cervicomedullary junction. Intervention: The patient underwent a left, far lateral craniotomy with C1 laminectomy to approach the cervicomedullary junction. The mass was cyst-like and contained scattered crystals and amorphous material consistent with pseudogout. There were no cells with an elevated Ki-67 index. The patient’s symptoms and exam improved at follow-up two months later. However, seven months after surgery, she declined once again and was found to have a recurrence. Conclusion: A subtotal resection of pseudogout may lead to recurrence. The recurrence can occur in a rapid fashion. Serial MRIs are indicated following resection. Occipitocervical fusion could reduce the likelihood of recurrence in such cases.

  2. Upper Cervical Epidural Abscess in a Patient With Parkinson Disease: A Case Report and Review.

    PubMed

    Al-Hourani, Khalid; Frost, Chelsea; Mesfin, Addisu

    2015-12-01

    To our knowledge, there are no reports in the literature of patients with Parkinson disease (PD) developing upper cervical spine infections. Our objective is to present a case of upper cervical epidural abscess in a patient with PD and to review upper cervical spine infection. We present the patient's presentation, physical examination, imaging findings, and management as well a review of the literature. A 66-year-old male with PD presented to the emergency department (ED) following referral by a neurologist for a presumed C2 fracture. The preceding history was 1 week of severe neck pain requiring a magnetic resonance imaging (MRI), which was initially interpreted as a C2 fracture. On admission from the ED, further review of the MRI appeared to show anterior prevertebral abscess and an epidural abscess. The patient's neurological examination was at baseline. In the span of 2 days, the patient developed significant motor weakness. A repeat MRI demonstrated expansion of the epidural collection and spinal cord compression. Surgical management consisting of C1 and C2 laminectomy, irrigation, and debridement from anterior and posterior approaches was performed. Postoperatively, the patient did not recover any motor strength and elected to withdraw care and died. Spinal epidural abscess requires a high index of suspicion and needs prompt recognition to prevent neurological impairment. Upper cervical spine infections are rare but can lead to lethal consequences. PMID:26623170

  3. How does interleukin 15 contribute to the pathogenesis of HTLV type 1-associated myelopathy/tropical spastic paraparesis?

    PubMed

    Azimi, N; Mariner, J; Jacobson, S; Waldmann, T A

    2000-11-01

    HTLV-1 is the etiological agent of a neurological disease named HAM/TSP that has clinical characteristics similar to those of multiple sclerosis (MS). The PBMC obtained from HAM/TSP patients undergo spontaneous proliferation in the absence of addition of any exogenous cytokines in an ex vivo culture. This spontaneous proliferation has been thought to be due to the proliferation of T cells. It was demonstrated that this proliferation is, in part, due to the production of IL-2 and its receptor (IL-2Ralpha) by HTLV-1-infected T cells. In this review, we demonstrate that IL-15 production also contributes to the spontaneous proliferation of T cells obtained from HAM/TSP PBMC. We provide data indicating that IL-15 expression is elevated in HAM/TSP PBMC when compared to that of the normal donors. Furthermore, we demonstrate that IL-15 overexpression by HTLV-1 is due to Tax trans-activation of its promoter and induction of NF-kappaB transcription factors. On the basis of these studies, we propose a model in which HTLV-1 infection of T cells results in the production of both IL-2 and IL-15 cytokines, growth factors that support the proliferation of T cells. PMID:11080816

  4. Prediction of Neurological Impairment in Cervical Spondylotic Myelopathy using a Combination of Diffusion MRI and Proton MR Spectroscopy

    PubMed Central

    Ellingson, Benjamin M.; Salamon, Noriko; Hardy, Anthony J.; Holly, Langston T.

    2015-01-01

    Purpose In the present study we investigated a combination of diffusion tensor imaging (DTI) and magnetic resonance spectroscopic (MRS) biomarkers in order to predict neurological impairment in patients with cervical spondylosis. Methods Twenty-seven patients with cervical spondylosis were evaluated. DTI and single voxel MRS were performed in the cervical cord. N-acetylaspartate (NAA) and choline (Cho) metabolite concentration ratios with respect to creatine were quantified, as well as the ratio of choline to NAA. The modified mJOA scale was used as a measure of neurologic deficit. Linear regression was performed between DTI and MRS parameters and mJOA scores. Significant predictors from linear regression were used in a multiple linear regression model in order to improve prediction of mJOA. Parameters that did not add value to model performance were removed, then an optimized multiparametric model was established to predict mJOA. Results Significant correlations were observed between the Torg-Pavlov ratio and FA (R2 = 0.2021, P = 0.019); DTI fiber tract density and FA, MD, Cho/NAA (R2 = 0.3412, P = 0.0014; R2 = 0.2112, P = 0.016; and R2 = 0.2352, P = 0.010 respectively); along with FA and Cho/NAA (R2 = 0.1695, P = 0.033). DTI fiber tract density, MD and FA at the site of compression, along with Cho/NAA at C2, were significantly correlated with mJOA score (R2 = 0.05939, P < 0.0001; R2 = 0.4739, P < 0.0001; R2 = 0.7034, P < 0.0001; R2 = 0.4649, P < 0.0001). A combination biomarker consisting of DTI fiber tract density, MD, and Cho/NAA showed the best prediction of mJOA (R2 = 0.8274, P<0.0001), with post-hoc tests suggesting fiber tract density, MD, and Cho/NAA were all significant contributors to predicting mJOA (P = 0.00053, P = 0.00085, and P = 0.0019, respectively). Conclusion A linear combination of DTI and MRS measurements within the cervical spinal cord may be useful for accurately predicting neurological deficits in patients with cervical spondylosis. Additional studies may be necessary to validate these observations. PMID:26431174

  5. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities.

    PubMed

    Bakaloudis, Georgios; Lolli, Francesco; Di Silvestre, Mario; Greggi, Tiziana; Astolfi, Stefano; Martikos, Konstantinos; Vommaro, Francesco; Barbanti-Brodano, Giovanni; Cioni, Alfredo; Giacomini, Stefano

    2011-05-01

    The traditional surgical treatment of severe spinal deformities, both in adult and pediatric patients, consisted of a 360° approach. Posterior-based spinal osteotomy has recently been reported as a useful and safe technique in maximizing kyphosis and/or kyphoscoliosis correction. It obviates the deleterious effects of an anterior approach and can increase the magnitude of correction both in the coronal and sagittal plane. There are few reports in the literature focusing on the surgical treatment of severe spinal deformities in large pediatric-only series (age <16 years old) by means of a posterior-based spinal osteotomy, with no consistent results on the use of a single posterior-based thoracic pedicle subtraction osteotomy in the treatment of such challenging group of patients. The purpose of the present study was to review our operative experience with pediatric patients undergoing a single level PSO for the correction of thoracic kyphosis/kyphoscoliosis in the region of the spinal cord (T12 and cephalad), and determine the safety and efficacy of posterior thoracic pedicle subtraction osteotomy (PSO) in the treatment of severe pediatric deformities. A retrospective review was performed on 12 consecutive pediatric patients (6 F, 6 M) treated by means of a posterior thoracic PSO between 2002 and 2006 in a single Institution. Average age at surgery was 12.6 years (range, 9-16), whereas the deformity was due to a severe juvenile idiopathic scoliosis in seven cases (average preoperative main thoracic 113°; 90-135); an infantile idiopathic scoliosis in two cases (preoperative main thoracic of 95° and 105°, respectively); a post-laminectomy kypho-scoliosis of 95° (for a intra-medullar ependimoma); an angular kypho-scoliosis due to a spondylo-epiphisary dysplasia (already operated on four times); and a sharp congenital kypho-scoliosis (already operated on by means of a anterior-posterior in situ fusion). In all patients a pedicle screws instrumentation was used, under continuous intra-operative neuromonitoring (SSEP, NMEP, EMG). At an average follow-up of 2.4 years (range, 2-6) the main thoracic curve showed a mean correction of 61°, or a 62.3% (range, 55-70%), with an average thoracic kyphosis of 38.5° (range, 30°-45°), for an overall correction of 65% (range, 60-72%). Mean estimated intra-operative blood loss accounted 19.3 cc/kg (range, 7.7-27.27). In a single case (a post-laminectomy kypho-scoliosis) a complete loss of NMEP occurred, promptly assessed by loosening of the initial correction, with a final negative wake-up test. No permanent neurologic damage, or instrumentation related complications, were observed. According to our experience, posterior-based thoracic pedicle subtraction osteotomies represent a valuable tool in the surgical treatment of severe pediatric spinal deformities, even in revision cases. A dramatic correction of both the coronal and sagittal profile may be achieved. Mandatory the use of a pedicle screws-only instrumentation and a continuous intra-operative neuromonitoring to obviate catastrophic neurologic complications. PMID:21468647

  6. Comparison of anterior decompression and fusion versus laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis

    PubMed Central

    Liu, Weijun; Hu, Ling; Chou, Po-Hsin; Liu, Ming; Kan, Wusheng; Wang, Junwen

    2016-01-01

    Purpose A meta-analysis was conducted to evaluate the clinical outcomes, complications, reoperation rates, and late neurological deterioration between anterior decompression and fusion (ADF) and laminoplasty (LAMP) in the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL). Methods All related studies published up to August 2015 were acquired by searching PubMed and EMBASE. Exclusion criteria were case reports, revision surgeries, combined anterior and posterior surgeries, the other posterior approaches including laminectomy or laminectomy and instrumented fusion, non-English studies, and studies with quality assessment scores of <7. The main end points including Japanese Orthopedic Association (JOA) score, recovery rate of JOA, cervical lordosis, complication rate, reoperation rate, and late neurological deterioration were analyzed. All available data was analyzed using RevMan 5.2.0 and Stata 12.0. Results A total of seven studies were included in the meta-analysis. The mean surgical level of ADF was 3.1, and the mean preoperative occupation ratios of ADF and LAMP group were 55.9% and 51.9%, respectively. No statistical difference was observed with regard to preoperative occupation ratio and preoperative JOA score. Although LAMP group had a higher preoperative cervical lordosis than ADF group (P<0.05, weighted mean difference [WMD] =−5.73, 95% confidence interval [CI] =−9.67–−1.80), significantly decreased cervical lordosis was observed in LAMP group after operation. ADF group had higher postoperative JOA score (P<0.05, WMD =2.18, 95% CI =0.98–3.38) and neurological recovery rate (P<0.05, WMD =27.22, 95% CI =15.20–39.23). Furthermore, ADF group had a lower late neurological deterioration rate than the LAMP group (P<0.05, risk difference =0.16, 95% CI =0.04–0.73). The complication rates of both groups had no statistical difference. However, LAMP group had a significantly lower reoperation rate than ADF group. The reoperation rate of ADF group (20.5%) was almost six times that of LAMP group (3.5%). Conclusion Our meta-analysis suggested that ADF was associated with better postoperative neurological function, neurological recovery rate, and less late neurological deterioration than LAMP in the treatment of multilevel cervical OPLL with a high mean occupation ratio. LAMP was associated with a decreased postoperative cervical lordosis, which might be a cause of late neurological deterioration. The complication rates of both groups showed no statistical difference. However, the reoperation rate was significantly higher in ADF group compared with LAMP group. Benefits and risks should be balanced when ADF or LAMP is selected. PMID:27217760

  7. Unusual cervical spine epidural abscess.

    PubMed

    Liou, Jr-Han; Su, Yu-Jang

    2015-10-01

    A 48-year-old man presented to the emergency department with complain of severe neck pain and anterior chest pain. Intermittent fever in the recent 2 days was also noted. There is a track maker over his left side of neck. The laboratory examination showed leukocytosis and high C-reactive protein level. Urine drug screen was positive for opiate. Empirical antibiotic administration was given. Blood culture grew gram-positive cocci in chain, and there was no vegetation found by heart echocardiogram. However, progressive weakness of four limbs was noted, and patient even cannot stand up and walk. The patient also complained of numbness sensation over bilateral hands and legs, and lower abdomen. Acute urine retention occurred. We arranged magnetic resonance imaging survey, which showed evidence of inflammatory process involving the retropharyngeal spaces and epidural spaces from the skull base to the bony level of T5. Epidural inflammatory process resulted in compression of the spinal cord and bilateral neural foramen narrowing. Neurosurgeon was consulted. Operation with laminectomy and posterior fusion with bone graft and internal fixation was done. Culture of epidural abscess and 2 sets of blood culture all yielded methicillin-sensitive Staphylococcus aureus. For epidural abscess, the most common involved spine is lumbar followed by thoracic and cervical spine. Diagnosis and treatment in the drug abusers are still challenging because they lack typical presentation, drug compliance, and adequate follow-up and because it is hard to stop drug abuser habit. Significant improvement of neurological deficit can be expected in most spinal abscess in drug abusers after treatment. PMID:26298050

  8. An efficient device to experimentally model compression injury of mammalian spinal cord.

    PubMed

    Ropper, Alexander E; Zeng, Xiang; Anderson, Jamie E; Yu, Dou; Han, InBo; Haragopal, Hariprakash; Teng, Yang D

    2015-09-01

    We report an efficient and effective device to reproducibly model clinically relevant spinal cord injury (SCI) via controlled mechanical compression. In the present study, following skin incision, dorsal laminectomy was performed to expose T10 spinal cord of adult female Sprague-Dawley rats (230-250 g). The vertebral column was suspended and stabilized by Allis clamps at T8 and 12 spinous processes. A metal impounder was then gently loaded onto T10 dura (20, 35 or 50 g × 5 min; n=7/group), resulting in acute mild, moderate, or severe standing weight compression, respectively. Neurobehavioral outcomes were evaluated using the BBB locomotor scale and inclined plane test for coordinated hindlimb function, and a battery of spinal reflex tests for sensorimotor functions, at 1 day following SCI and weekly thereafter for 7 weeks. Quantitative histopathology was used to assess injury-triggered loss of white matter, gray matter and ventral horn motor neurons. Immunocytochemical levels of glial fibrillary acidic protein (GFAP) and β-amyloid precursor protein (APP) at the cervical and lumbar regions were measured to determine the distal segment impact of T10 compression. The data demonstrates that the standardized protocol generates weight-dependent hindlimb motosensory deficits and neurodegeneration primarily at and near the lesion epicenter. Importantly, there are significantly increased GFAP and APP expressions in spinal cord segments involved in eliciting post-SCI allodynia. Therefore, the described system reliably produces compression trauma in manners partially emulating clinical quasi-static insults to the spinal cord, providing a pragmatic model to investigate pathophysiological events and potential therapeutics for compression SCI. PMID:26210871

  9. Cervical facet dislocation adjacent to the fused motion segment

    PubMed Central

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kuroiwa, Toshihiko

    2016-01-01

    This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER) of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI) performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B). Cervical computed tomography (CT) indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D). In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation. PMID:26933361

  10. A Novel Vertebral Stabilization Method for Producing Contusive Spinal Cord Injury

    PubMed Central

    Zhang, Y. Ping; Shields, Lisa B. E.; Shields, Christopher B.; Xu, Xiao-Ming

    2015-01-01

    Clinically-relevant animal cervical spinal cord injury (SCI) models are essential for developing and testing potential therapies; however, producing reliable cervical SCI is difficult due to lack of satisfactory methods of vertebral stabilization. The conventional method to stabilize the spine is to suspend the rostral and caudal cervical spine via clamps attached to cervical spinous processes.  However, this method of stabilization fails to prevent tissue yielding during the contusion as the cervical spinal processes are too short to be effectively secured by the clamps (Figure 1).  Here we introduce a new method to completely stabilize the cervical vertebra at the same level of the impact injury.  This method effectively minimizes movement of the spinal column at the site of impact, which greatly improves the production of consistent SCIs.  We provide visual description of the equipment (Figure 2-4), methods, and a step-by-step protocol for the stabilization of the cervical 5 vertebra (C5) of adult rats, to perform laminectomy (Figure 5) and produce a contusive SCI thereafter.  Although we only demonstrate a cervical hemi-contusion using the NYU/MASCIS impactor device, this vertebral stabilization technique can be applied to other regions of the spinal cord, or be adapted to other SCI devices.  Improving spinal cord exposure and fixation through vertebral stabilization may be valuable for producing consistent and reliable injuries to the spinal cord.  This vertebral stabilization method can also be used for stereotactic injections of cells and tracers, and for imaging using two-photon microscopy in various neurobiological studies. PMID:25590284

  11. Bone marrow stem cells delivered into the subarachnoid space via cisterna magna improve repair of injured rat spinal cord white matter

    PubMed Central

    Marcol, Wiesław; Slusarczyk, Wojciech; Sieroń, Aleksander L; Koryciak-Komarska, Halina; Lewin-Kowalik, Joanna

    2015-01-01

    The influence of bone marrow stem cells on regeneration of spinal cord in rats was investigated. Young adult male Wistar rats were used (n=22). Focal injury of spinal cord white matter at Th10 level was produced using our original non-laminectomy method by means of high-pressured air stream. Cells from tibial and femoral bone marrow of 1-month old rats (n=3) were cultured, labeled with BrdU/Hoechst and injected into cisterna magna (experimental group) three times: immediately after spinal cord injury and 3 as well as 7 days later. Neurons in brain stem and motor cortex were labeled with FluoroGold (FG) delivered caudally from the injury site a week before the end of experiment. Functional outcome and morphological features of regeneration were analyzed during 12-week follow-up. The lesions were characterized by means of MRI. Maximal distance of expansion of implanted cells in the spinal cord was measured and the number of FG-positive neurons in the brain was counted. Rats treated with stem cells presented significant improvement of locomotor performance and spinal cord morphology when compared to the control group. Distance covered by stem cells was 7 mm from the epicenter of the injury. Number of brain stem and motor cortex FG-positive neurons in experimental group was significantly higher than in control. Obtained data showed that bone marrow stem cells are able to induce the repair of injured spinal cord white matter. The route of cells application via cisterna magna appeared to be useful for their delivery in spinal cord injury therapy. PMID:26628950

  12. Does intraoperative neurophysiologic monitoring matter in noncomplex spine surgeries?

    PubMed Central

    van der Goes, David N.; Nuwer, Marc R.

    2015-01-01

    Objectives: To determine associations between intraoperative neurophysiologic monitoring (IOM) for spinal decompressions and simple fusions with neurologic complications, length of stay, and hospitalization charges. Methods: Adult discharges in the Nationwide/National Inpatient Sample (NIS) (2007–2012) with spinal decompressions and simple spinal fusions were included. Revision surgeries, instrumentations, complicated approaches, and tumor- and trauma-related surgeries were excluded. Extracted data included patient demographics, medical comorbidities, primary spinal surgery type, and hospital characteristics. Bivariate and multiple regression analyses using NIS survey design variables correlated IOM use with neurologic complications, hospital charges, and length of stay. Results: IOM was reported in 4.9% of an estimated 1.1 million discharges in the weighted sample. Discharges reporting IOM were more often privately insured (61% vs 57%, p < 0.001) and had slightly more comorbidities (25% vs 24% with 3+ comorbidities, p = 0.01). Spinal fusions more often reported IOM than decompressions. The IOM group had fewer neurologic complications (0.8% vs 1.4% of controls) with no difference in length of stay (3.0 days for each group), but increased hospital charges (39% greater). Multiple regression adjustment showed significant associations of IOM with fewer neurologic complications (odds ratio 0.60, 95% confidence interval [CI] 0.47, 0.76, p < 0.001), while the estimated percentage of hospital charges was sizably diminished from the unadjusted analysis (IOM effect +9%, 95% CI +4%, +13%, p < 0.001), and length of stay was reduced (IOM effect −0.26 days, 95% CI −0.42, −0.11, p < 0.001). Conclusions: IOM was associated with better clinical outcomes and some increased hospital charges among discharges of simple spinal fusions and laminectomies in a large, multiyear, nationally representative dataset. PMID:26446062

  13. Firearm bullet settling into the lumbar spinal canal without causing neurological deficit: A report of two cases

    PubMed Central

    Hakan, Tayfun; Çerçi, Ajlan; Gürcan, Serkan; Akçay, Serkan

    2016-01-01

    Background: Uncertainty still exists regarding the treatment of the patients presenting with gunshot wounds to the spine. Neurological insults, cerebrospinal fluid fistula, infection, lead or copper toxicity, migration of bullets, and spinal instability are included among the common challenging issues. Case Description: An 18-year-old woman was admitted with low back pain following a gunshot injury five days ago. She was neurologically intact. Radiological examinations showed that a bullet was settled in L4-5 disc space. The bullet was removed with a unilateral L4-5 partial hemilaminectomy and discectomy from the left side. The second case was of a 29-year-old man admitted with radiating leg pain on the right side following a gunshot injury from his left side of lower back four months ago. He had only positive straight leg raising test. Radiological studies showed two bullets, one was in the psoas muscle on the left side and the other was in spinal canal that had caused a burst fracture of the L5 vertebra. Following L5 laminectomy and bilateral L5-S1 facetectomy, the bullet was removed from the spinal canal and L5-S1 transpedicular posterior stabilization was performed. The postoperative period of both patients was unremarkable. Conclusion: Bullet settling into the lumbar spinal canal without causing neurological deficit may require surgical intervention. Removal of bullets provided not only pain relief in both the cases but also prevented future complications such as migration of the bullets, plumbism, and neuropathic pain and instability. PMID:27213110

  14. Dental Apical Papilla as Therapy for Spinal Cord Injury.

    PubMed

    De Berdt, P; Vanacker, J; Ucakar, B; Elens, L; Diogenes, A; Leprince, J G; Deumens, R; des Rieux, A

    2015-11-01

    Stem cells of the apical papilla (SCAP) represent great promise regarding treatment of neural tissue damage, such as spinal cord injury (SCI). They derive from the neural crest, express numerous neurogenic markers, and mediate neurite outgrowth and axonal targeting. The goal of the present work was to investigate for the first time their potential to promote motor recovery after SCI in a rat hemisection model when delivered in their original stem cell niche-that is, by transplantation of the human apical papilla tissue itself into the lesion. Control groups consisted of animals subjected to laminectomy only (shams) and to lesion either untreated or injected with a fibrin hydrogel with or without human SCAP. Basso-Beattie-Bresnahan locomotor scores at 1 and 3 d postsurgery confirmed early functional decline in all SCI groups. This significant impairment was reversed, as seen in CatWalk analyses, after transplantation of apical papilla into the injured spinal cord wound, whereas the other groups demonstrated persistent functional impairment. Moreover, tactile allodynia did not develop as an unwanted side effect in any of the groups, even though the SCAP hydrogel group showed higher expression of the microglial marker Iba-1, which has been frequently associated with allodynia. Notably, the apical papilla transplant group presented with reduced Iba-1 expression level. Masson trichrome and human mitochondria staining showed the preservation of the apical papilla integrity and the presence of numerous human cells, while human cells could no longer be detected in the SCAP hydrogel group at the 6-wk postsurgery time point. Altogether, our data suggest that the transplantation of a human apical papilla at the lesion site improves gait in spinally injured rats and reduces glial reactivity. It also underlines the potential interest for the application of delivering SCAP in their original niche, as compared with use of a fibrin hydrogel. PMID:26341974

  15. Implanting Glass Spinal Cord Windows in Adult Mice with Experimental Autoimmune Encephalomyelitis

    PubMed Central

    Fenrich, Keith K.; Weber, Pascal; Rougon, Genevieve; Debarbieux, Franck

    2013-01-01

    Experimental autoimmune encephalomyelitis (EAE) in adult rodents is the standard experimental model for studying autonomic demyelinating diseases such as multiple sclerosis. Here we present a low-cost and reproducible glass window implantation protocol that is suitable for intravital microscopy and studying the dynamics of spinal cord cytoarchitecture with subcellular resolution in live adult mice with EAE. Briefly, we surgically expose the vertebrae T12-L2 and construct a chamber around the exposed vertebrae using a combination of cyanoacrylate and dental cement. A laminectomy is performed from T13 to L1, and a thin layer of transparent silicone elastomer is applied to the dorsal surface of the exposed spinal cord. A modified glass cover slip is implanted over the exposed spinal cord taking care that the glass does not directly contact the spinal cord. To reduce the infiltration of inflammatory cells between the window and spinal cord, anti-inflammatory treatment is administered every 2 days (as recommended by ethics committee) for the first 10 days after implantation. EAE is induced only 2-3 weeks after the cessation of anti-inflammatory treatment. Using this approach we successfully induced EAE in 87% of animals with implanted windows and, using Thy1-CFP-23 mice (blue axons in dorsal spinal cord), quantified axonal loss throughout EAE progression. Taken together, this protocol may be useful for studying the recruitment of various cell populations as well as their interaction dynamics, with subcellular resolution and for extended periods of time. This intravital imaging modality represents a valuable tool for developing therapeutic strategies to treat autoimmune demyelinating diseases such as EAE. PMID:24378439

  16. Comparison between Bilateral C2 Pedicle Screwing and Unilateral C2 Pedicle Screwing, Combined with Contralateral C2 Laminar Screwing, for Atlantoaxial Posterior Fixation

    PubMed Central

    Hongo, Michio; Kobayashi, Takashi; Suzuki, Tetsuya; Abe, Eiji; Shimada, Yoichi

    2014-01-01

    Study Design A retrospective study. Purpose To compare clinical and radiological outcomes between bilateral C2 pedicle screwing (C2PS) and unilateral C2PS, combined with contralateral C2 laminar screwing (LS), for posterior atlantoaxial fixation. Overview of Literature Posterior fixation with C1 lateral mass screwing (C1LMS) and C2PS (C1LMS-C2PS method) is an accepted procedure for rigid atlantoaxial stabilization. However, conventional bilateral C2PS is not always allowed in this method due to anatomical variations of C2 pedicles and/or asymmetry of the vertebral artery. Although unilateral C2PS plus contralateral LS (C2PS+LS) is an alternative in such cases, the efficacy of this procedure has not been evaluated in controlled studies (i.e., with bilateral C2PS as a control). Methods Clinical and radiological records of patients who underwent the C1LMS-C2PS method, using unilateral C2PS+LS (n=9), and those treated using conventional bilateral C2PS (n=10) were compared, with a minimum two years follow-up. Results Postoperative complications related to the unilateral C2PS+LS technique included one case of spontaneous spinous process fracture of C2. A C1 anterior arch fracture occurred after a fall in one patient, who underwent bilateral C2PS and C1 laminectomy. No significant differences were seen between the groups in reduction of neck pain after surgery or improvement of neurological status, as evaluated using the Japanese Orthopaedic Association score. A delayed union occurred in one patient each of the groups, with the final fusion rate being 100% in both groups. Conclusions Clinical and radiological outcomes of unilateral C2PS+LS were comparable with those of the bilateral C2PS fixation technique for the C1LMS-C2PS method. PMID:25558320

  17. A Neonatal Mouse Spinal Cord Compression Injury Model

    PubMed Central

    Züchner, Mark; Glover, Joel C.; Boulland, Jean-Luc

    2016-01-01

    Spinal cord injury (SCI) typically causes devastating neurological deficits, particularly through damage to fibers descending from the brain to the spinal cord. A major current area of research is focused on the mechanisms of adaptive plasticity that underlie spontaneous or induced functional recovery following SCI. Spontaneous functional recovery is reported to be greater early in life, raising interesting questions about how adaptive plasticity changes as the spinal cord develops. To facilitate investigation of this dynamic, we have developed a SCI model in the neonatal mouse. The model has relevance for pediatric SCI, which is too little studied. Because neural plasticity in the adult involves some of the same mechanisms as neural plasticity in early life1, this model may potentially have some relevance also for adult SCI. Here we describe the entire procedure for generating a reproducible spinal cord compression (SCC) injury in the neonatal mouse as early as postnatal (P) day 1. SCC is achieved by performing a laminectomy at a given spinal level (here described at thoracic levels 9-11) and then using a modified Yasargil aneurysm mini-clip to rapidly compress and decompress the spinal cord. As previously described, the injured neonatal mice can be tested for behavioral deficits or sacrificed for ex vivo physiological analysis of synaptic connectivity using electrophysiological and high-throughput optical recording techniques1. Earlier and ongoing studies using behavioral and physiological assessment have demonstrated a dramatic, acute impairment of hindlimb motility followed by a complete functional recovery within 2 weeks, and the first evidence of changes in functional circuitry at the level of identified descending synaptic connections1. PMID:27078037

  18. The role and mechanisms of action of SIRT6 in the suppression of postoperative epidural scar formation.

    PubMed

    Fan, Xiaochen; Chen, Junjie; Shi, Da; Jia, Jing; He, Jia; Li, Liang; Lei, Tao; Chen, Xuesong

    2016-05-01

    In order to investigate the role which sirtuin-6 (SIRT6) plays in lumbar spinal epidural fibrosis (EF) and scar formation in vitro and in vivo, SIRT6 and transforming growth factor β (TGF‑β) protein levels in the lumbar disc of patients were detected using western blotting in patients who had undergone a laminectomy. The results demonstrated that SIRT6 expression was significantly reduced in the lumbar discs of patients in whom an epidural scar had formed, but the expression pattern of TGF-β2 was much higher. Subsequently, a pcDNA‑SIRT6 expression vector was constructed and transfected into the primary fibroblasts isolated from the epidural scars. Flow cytometric and MTT analyses indicated that overexpression of SIRT6 suppressed the proliferation of the fibroblasts, and TGF‑β2 and interleukin-1α expression, as well as collagen type I (Col I) production. The results of bioinformatics and molecular biological analyses demonstarted that TGF‑β2 was a target of microRNA-21 (miR-21) and SIRT6 overexpression suppressed the levels of TGF-β2 through promoting the expression of miR-21. Finally, by injecting the pcDNA-SIRT6 vector, it was possible to observe that SIRT6 suppressed EF and epidural scar formation in vivo. In conclusion, we noted that SIRT6 suppressed EF and epidural scar formation in vitro and in vivo. It was also noted that SIRT6 overexpression suppressed TGF-β2 levels by promoting the expression of miR-21. PMID:26987016

  19. A Neonatal Mouse Spinal Cord Compression Injury Model.

    PubMed

    Züchner, Mark; Glover, Joel C; Boulland, Jean-Luc

    2016-01-01

    Spinal cord injury (SCI) typically causes devastating neurological deficits, particularly through damage to fibers descending from the brain to the spinal cord. A major current area of research is focused on the mechanisms of adaptive plasticity that underlie spontaneous or induced functional recovery following SCI. Spontaneous functional recovery is reported to be greater early in life, raising interesting questions about how adaptive plasticity changes as the spinal cord develops. To facilitate investigation of this dynamic, we have developed a SCI model in the neonatal mouse. The model has relevance for pediatric SCI, which is too little studied. Because neural plasticity in the adult involves some of the same mechanisms as neural plasticity in early life(1), this model may potentially have some relevance also for adult SCI. Here we describe the entire procedure for generating a reproducible spinal cord compression (SCC) injury in the neonatal mouse as early as postnatal (P) day 1. SCC is achieved by performing a laminectomy at a given spinal level (here described at thoracic levels 9-11) and then using a modified Yasargil aneurysm mini-clip to rapidly compress and decompress the spinal cord. As previously described, the injured neonatal mice can be tested for behavioral deficits or sacrificed for ex vivo physiological analysis of synaptic connectivity using electrophysiological and high-throughput optical recording techniques(1). Earlier and ongoing studies using behavioral and physiological assessment have demonstrated a dramatic, acute impairment of hindlimb motility followed by a complete functional recovery within 2 weeks, and the first evidence of changes in functional circuitry at the level of identified descending synaptic connections(1). PMID:27078037

  20. What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    What are the risks, benefits, alternatives, and pitfalls for operating on cervical ossification of the posterior longitudinal ligament (OPLL)? To successfully diagnose OPLL, it is important to obtain Magnetic Resonance Images (MR). These studies, particularly the T2 weighted images, provide the best soft-tissue documentation of cord/root compression and intrinsic cord abnormalities (e.g. edema vs. myelomalacia) on sagittal, axial, and coronal views. Obtaining Computed Tomographic (CT) scans is also critical as they best demonstrate early OPLL, or hypertrophied posterior longitudinal ligament (HPLL: hypo-isodense with punctate ossification) or classic (frankly ossified) OPLL (hyperdense). Furthermore, CT scans reveal the “single layer” and “double layer” signs indicative of OPLL penetrating the dura. Documenting the full extent of OPLL with both MR and CT dictates whether anterior, posterior, or circumferential surgery is warranted. An adequate cervical lordosis allows for posterior cervical approaches (e.g. lamionplasty, laminectomy/fusion), which may facilitate addressing multiple levels while avoiding the risks of anterior procedures. However, without lordosis and with significant kyphosis, anterior surgery may be indicated. Rarely, this requires single/multilevel anterior cervical diskectomy/fusion (ACDF), as this approach typically fails to address retrovertebral OPLL; single or multilevel corpectomies are usually warranted. In short, successful OPLL surgery relies on careful patient selection (e.g. assess comorbidities), accurate MR/CT documentation of OPLL, and limiting the pros, cons, and complications of these complex procedures by choosing the optimal surgical approach. Performing OPLL surgery requires stringent anesthetic (awake intubation/positioning) and also the following intraoperative monitoring protocols: Somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and electromyography (EMG). PMID:24843819

  1. A controlled spinal cord contusion for the rhesus macaque monkey.

    PubMed

    Ma, Zhengwen; Zhang, Yi Ping; Liu, Wei; Yan, Guofeng; Li, Yao; Shields, Lisa B E; Walker, Melissa; Chen, Kemin; Huang, Wei; Kong, Maiying; Lu, Yi; Brommer, Benedikt; Chen, Xuejin; Xu, Xiao-Ming; Shields, Christopher B

    2016-05-01

    Most in vivo spinal cord injury (SCI) experimental models use rodents. Due to the anatomical and functional differences between rodents and humans, reliable large animal models, such as non-human primates, of SCI are critically needed to facilitate translation of laboratory discoveries to clinical applications. Here we report the establishment of a controlled spinal contusion model that produces severity-dependent functional and histological deficits in non-human primates. Six adult male rhesus macaque monkeys underwent mild to moderate contusive SCI using 1.0 and 1.5mm tissue displacement injuries at T9 or sham laminectomy (n=2/group). Multiple assessments including motor-evoked potential (MEP), somatosensory-evoked potential (SSEP), MR imaging, and monkey hindlimb score (MHS) were performed. Monkeys were sacrificed at 6months post-injury, and the lesion area was examined for cavitation, axons, myelin, and astrocytic responses. The MHS demonstrated that both the 1.0 and 1.5mm displacement injuries created discriminative neurological deficits which were severity-dependent. The MEP response rate was depressed after a 1.0mm injury and was abolished after a 1.5mm injury. The SSEP response rate was slightly decreased following both the 1.0 and 1.5mm SCI. MRI imaging demonstrated an increase in T2 signal at the lesion site at 3 and 6months, and diffusion tensor imaging (DTI) tractography showed interrupted fiber tracts at the lesion site at 4h and at 6months post-SCI. Histologically, severity-dependent spinal cord atrophy, axonal degeneration, and myelin loss were found after both injury severities. Notably, strong astrocytic gliosis was not observed at the lesion penumbra in the monkey. In summary, we describe the development of a clinically-relevant contusive SCI model that produces severity-dependent anatomical and functional deficits in non-human primates. Such a model may advance the translation of novel SCI repair strategies to the clinic. PMID:26875994

  2. Effects of combining methylprednisolone with magnesium sulfate on neuropathic pain and functional recovery following spinal cord injury in male rats.

    PubMed

    Farsi, Leila; Naghib Zadeh, Maryam; Afshari, Khashayar; Norouzi-Javidan, Abbas; Ghajarzadeh, Mahsa; Naghshband, Zeinab; Keshavarz, Mansoor

    2015-01-01

    Methylprednisolone (MP) has been widely used as a standard therapeutic agent for the treatment of spinal cord injury (SCI). Because of its controversial useful effects, the combination of MP and other pharmacological agents to enhance neuroprotective effects is desirable. Magnesium sulfate (MgSO4) has been shown to have neuroprotective and antihyperalgesic effects. In the present study, we sought to determine the effect of combining MP and MgSO4, on neuropathic pain and functional recovery following spinal cord injury (SCI) in male rats. A total of 48 adult male rats (weight 300-350 g) were used. After laminectomy, complete SCI was achieved by compression of the spinal cord for one minute with aneurysm clips. Single doses of Magnesium sulfate (MgSO4), (600 mg/kg), Methylprednisolone (MP), (30 mg/kg) or combining MgSO4 and MP were injected intraperitoneally. Prior to surgery and during four weeks of study Tail flick latency (TFL) and BBB (Basso-Beattie-Bresnahan) score and the acetone drop test were evaluated. In mean values of BBB score, a significant difference was observed in SCI+veh compared with other groups (P<0.05). Mean TFL also was significantly higher in SCI+veh compared with other groups (P<0.05). Mean acetone drop test score and weight were significantly different in MgSO4, MP and combining MgSO4 and MP  treated groups compared with SCI+veh group (P<0.05). These findings revealed that MP, MgSO4 and combining MgSO4 and MP treatment can attenuate neuropathic pains following SCI in rats include: thermal hyperalgesia and cold allodynia. They also can yield better improvement in motor function and decrease weight loss after SCI in rats compared with the control group. PMID:25796020

  3. Characterization of Graded MASCIS Contusion Spinal Cord Injury using Somatosensory Evoked Potentials

    PubMed Central

    Agrawal, Gracee; Kerr, Candace; Thakor, Nitish V.; All, Angelo H.

    2009-01-01

    Study Design Electrophysiological analysis using somatosensory evoked potentials (SEPs) and behavioral assessment using Basso-Beattie-Bresnahan (BBB) scale were compared over time for graded MASCIS contusion spinal cord injury (SCI). Objective To study SEP responses across different contusion injury severities and to compare them with BBB scores. Summary of Background Data For any SCI therapy evaluation, it is important to accurately and objectively standardize the injury model. The graded MASCIS contusion injuries on dorsal spine have been standardized using BBB, which is subjective and prone to human errors. Furthermore, dorsal pathway disruption does not always produce locomotor deficits. SEP monitoring provides an advantage of providing a reliable and objective assessment of the functional integrity of dorsal sensory pathways. Methods Four groups of Fischer rats received contusion at T8 using NYU-MASCIS impactor from impact heights of 6.25 (mild), 12.5 (moderate), 25 (severe), or 50 mm (very severe). The control group underwent laminectomy only. SEP and BBB recordings were performed once prior to injury, and then weekly for up to 7 weeks. Results Graded levels of injury produced concomitant attenuations in hindlimb SEP amplitudes. Following injury, 25 and 50 mm groups together differed significantly from 12.5 and 6.25 mm groups (p<0.01). From week 5, differences between 12.5 and 6.25 mm groups also became apparent (p<0.01), which showed significant electrophysiological improvement. However, no significant differences were observed between 25 and 50 mm groups, which showed negligible electrophysiological recovery. While comparable differences between different groups were also detected by BBB after injury (p<0.001), BBB was less sensitive in detecting any improvement in 6.25 and 12.5 mm groups. Conclusion SEP amplitudes and BBB scores decrease corresponding to increase in injury severity, however these show different temporal patterns of recovery. These results demonstrate the utility of SEPs, in conjunction with BBB, to monitor therapeutic interventions in SCI research. PMID:20354478

  4. The effects of local and general hypothermia on temperature profiles of the central nervous system following spinal cord injury in rats.

    PubMed

    Bazley, Faith A; Pashai, Nikta; Kerr, Candace L; All, Angelo H

    2014-09-01

    Local and general hypothermia are used to treat spinal cord injury (SCI), as well as other neurological traumas. While hypothermia is known to provide significant therapeutic benefits due to its neuroprotective nature, it is unclear how the treatment may affect healthy tissues or whether it may cause undesired temperature changes in areas of the body that are not the targets of treatment. We performed 2-hour moderate general hypothermia (32°C core) or local hypothermia (30°C spinal cord) on rats that had received either a moderate contusive SCI or laminectomy (control) while monitoring temperatures at three sites: the core, spinal cord, and cortex. First, we identified that injured rats that received general hypothermia exhibited larger temperature drops at the spinal cord (-3.65°C, 95% confidence intervals [CIs] -3.72, -3.58) and cortex (-3.64°C, CIs -3.73, -3.55) than uninjured rats (spinal cord: -3.17°C, CIs -3.24, -3.10; cortex: -3.26°C, CIs -3.34, -3.17). This was found due to elevated baseline temperatures in the injured group, which could be due to inflammation. Second, both general hypothermia and local hypothermia caused a significant reduction in the cortical temperature (-3.64°C and -1.18°C, respectively), although local hypothermia caused a significantly lower drop in cortical temperature than general hypothermia (p<0.001). Lastly, the rates of rewarming of the cord were not significantly different among the methods or injury groups that were tested; the mean rate of rewarming was 0.13±0.1°C/min. In conclusion, local hypothermia may be more suitable for longer durations of hypothermia treatment for SCI to reduce temperature changes in healthy tissues, including the cortex. PMID:25019643

  5. Is atlantoaxial instability the cause of “high” cervical ossified posterior longitudinal ligament? Analysis on the basis of surgical treatment of seven patients

    PubMed Central

    Goel, Atul

    2016-01-01

    Background: Multilevel ossified posterior longitudinal ligaments (OPLLs), particularly those that extend into the high cervical region, are formidable and challenging surgical problems. The aim of the presentation is to analyze the results of surgical treatment of seven consecutive patients having high cervical OPLL with atlantoaxial and subaxial facetal fixations. Objectives: We analyze the role of atlantoaxial instability in the management of OPLL that extended into the high cervical region, above the lower border of C3 vertebra. Materials and Methods: All patients in the series were males. The age of the patients ranged 48-65 years. Clinical evaluation was done by a 5-point clinical grading scale described by us, Japanese Orthopedic Association (JOA) score, and visual analog scale (VAS). All patients were identified to have relatively “subtle” but definite atlantoaxial facetal instability on sagittal imaging and the instability was confirmed by direct handling of the facets during surgery. All patients were treated by multilevel facetal fixation that included fixation of atlantoaxial facets. The aim of surgery was stabilization and arthrodesis of the involved spinal segments, as instability was considered to be the prime pathogenetic factor of OPLL. Spinal canal decompression, either by anterior corpectomy or discoidectomy or by posterior laminectomy or laminoplasty was not done and no attempts were made to remove the OPLL. At an average follow-up of 8 months, all patients showed progressive symptomatic recovery. Conclusion: Atlantoaxial facetal instability can be a cause or an association of high cervical OPLL. Stabilization of the atlantoaxial joint forms a remarkably effective method of treatment. PMID:27041881

  6. Surgical management of recurrent disc herniations with microdiscectomy and long-term results on life quality: Detailed analysis of 70 cases

    PubMed Central

    Albayrak, Serdal; Ozturk, Sait; Durdag, Emre; Ayden, Ömer

    2016-01-01

    Background: Aim of this paper is to recall the surgical technique used in the recurrent lumbar disc herniations (LDHs) and to share our experiences. Materials and Methods: Out of series of 1115 patients who underwent operations for LDH between 2006 and 2013, 70 patients underwent re-operations, which were included in this study. During surgery, lateral decompression performed over the medial facet joint to the superior facet joint border was seen after widening the laminectomy defect, and microdiscectomy was performed. The demographic findings of the patients, their complaints in admission to hospital, the level of operation, the condition of dural injury, the first admission in the prospective analysis, and their quality of life were evaluated through the Oswestry scoring during their postoperative 1st, 3rd, 6th-month and 1st, 3rd, 5th and 7th-year follow-up. In the statical analysis, Friedman test was performed for the comparison of the Oswestry scores and Siegel Castellan test was used for the paired nonparametrical data. A P < 0.05 was considered statistically significant. Results: Considering the Oswestry Index during the follow-ups, the values in the postoperative early period and follow-ups were seen to be significantly lower than those at the time of admission to hospital (P < 0.05). None of the patients, who re-operated by microdiscectomy, presented with iatrogenic instability in 7 years follow-up period. Conclusion: Microdiscectomy performed through a proper technique in the re-operation of recurrent disc herniations eases complaints and improves the quality of life. Long-term follow-ups are required for more accurate results. PMID:26933352

  7. Long-term survival and functional status of patients with low-grade astrocytoma of spinal cord

    SciTech Connect

    Robinson, Clifford G.; Prayson, Richard A.; Hahn, Joseph F.; Kalfas, Iain H.; Whitfield, Melvin D.; Lee, S.-Y.; Suh, John H. . E-mail: suhj@ccf.org

    2005-09-01

    Purpose: To determine survival and changes in neurologic function and Karnofsky performance status (KPS) in a series of patients treated for low-grade astrocytoma of the spinal cord during the past two decades. Methods: This study consisted of 14 patients with pathologically confirmed low-grade astrocytoma of the spinal cord who were treated between 1980 and 2003. All patients underwent decompressive laminectomy followed by biopsy (n = 7), subtotal resection (n = 6), or gross total resection (n = 1). Ten patients underwent postoperative radiotherapy (median total dose 50 Gy in 28 fractions). The overall survival, progression-free survival, and changes in neurologic function and KPS were measured. Results: The overall survival rate at 5, 10, and 20 years was 100%, 75%, and 60%, respectively. The progression-free survival rate at 5, 10, and 20 years was 93%, 80%, and 60%, respectively. Neither overall survival nor progression-free survival was clearly correlated with any patient, tumor, or treatment factors. Neurologic function and KPS worsened after surgery in 8 (57%) of 14 and 9 (69%) of 13 patients, respectively. At a mean follow-up of 10.2 years, neurologic function had stabilized or improved in 8 (73%) of 11 remaining patients, but the KPS had worsened in 5 (50%) of 10. Most patients who were employed before surgery were working at last follow-up. Conclusion: Patients who undergo gross total resection of their tumor may be followed closely. Patients who undergo limited resection should continue to receive postoperative RT (50.4 Gy in 1.8-Gy fractions). The functional measures should be routinely evaluated to appreciate the treatment outcomes.

  8. Unnecessary multiple epidural steroid injections delay surgery for massive lumbar disc: Case discussion and review

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: Epidural steroid injections (ESI) in the lumbar spine are not effective over the long-term for resolving “surgical” lesions. Here, we present a patient with a massive L2–L3 lumbar disk herniation whose surgery was delayed for 4 months by multiple unnecessary ESI, resulting in a cauda equina syndrome. Methods: A 54-year-old male acutely developed increased low back and radiating left leg pain in October of 2014. In December of 2014, a magnetic resonance imaging (MRI) scan showed a massive central/left sided disk herniation at the L2–L3 level resulting in marked thecal sac and left L2 foraminal and L3 lateral recess root compression. Despite the marked degree of neural compression, pain management treated him with 3 ESI over the next 3 months. Results: At the end of April of 2015, he presented to spine surgeon with a cauda equina syndrome. When the new MRI scan confirmed the previously documented massive central-left sided L2–L3 disk herniation, the patient emergently underwent an L1–L3 laminectomy with central-left sided L2–L3 lateral/foraminal diskectomy. Postoperatively, the patient was neurologically intact. Conclusions: Pain specialists performed multiple unnecessary lumbar ESI critically delaying spinal surgery for 4 months in this patient with a massive lumbar disk herniation who ultimately developed a cauda equina syndrome. Unfortunately, pain specialists (e.g., radiologists, anesthesiologists, and physiatrists), not specifically trained to perform neurological examinations or spinal surgery, are increasingly mismanaging spinal disease with ESI/variants. It is time for spine surgeons to speak out against this, and “take back” the care of patients with spinal surgical disease. PMID:26425398

  9. Characterization of Upper Thoracic Spinal Neurons Receiving Noxious Cardiac and/or Somatic Inputs in Diabetic Rats

    PubMed Central

    Ghorbani, Marie Louise M.; Qin, Chao; Wu, Mingyuan; Farber, Jay P.; Sheykhzade, Majid; Fjalland, Bjarne; Nyborg, Niels C.B.; Foreman, Robert D.

    2011-01-01

    The aim of the present study was to examine spinal processing of cardiac and somatic nociceptive input in rats with STZ-induced diabetes. Type 1 diabetes was induced with streptozotocin (50 mg/kg) in 14 male Sprague-Dawley rats and citrate buffer was injected in 14 control rats. After 4–11 weeks, the rats were anesthetized with pentobarbital, ventilated and paralyzed. A laminectomy enabled extracellular recording of T3 spinal cord neuronal activity. Intrapericardial administration of a mixture of algogenic chemicals (bradykinin, serotonin, prostaglandin E2 (all at 10−5 M), and adenosine (10−3 M)) was applied to activate nociceptors of cardiac afferent nerve endings. Furthermore, somatic receptive properties were examined by applying innocuous (brush and light pressure) and noxious (pinch) cutaneous mechanical stimuli. Diabetes-induced increases in spontaneous activity were observed in subsets of neurons exhibiting long-lasting excitatory responses to administration of the algogenic mixture. Algogenic chemicals altered activity of a larger proportion of neurons from diabetic animals (73/111) than control animals (55/115, P < 0.05). Some subtypes of neurons exhibiting long-lasting excitatory responses, elicited prolonged duration and others, had a shortened latency. Some neurons exhibiting short-lasting excitatory responses in diabetic animals elicited a shorter latency and some a decreased excitatory change. The size of the somatic receptive field was increased for cardiosomatic neurons from diabetic animals. Cutaneous somatic mechanical stimulation caused spinal neurons to respond with a mixture of hyper- and hypoexcitability. In conclusion, diabetes induced changes in the spinal processing of cardiac input and these might contribute to cardiovascular autonomic neuropathy in patients with diabetes. PMID:21862419

  10. Tamoxifen reduces infiltration of inflammatory cells, apoptosis and inhibits IKK/NF-kB pathway after spinal cord injury in rats.

    PubMed

    Wei, Hong-Yu; Ma, Xiao

    2014-11-01

    In this study, neuroprotective effect of tamoxifen has been explored in spinal cord injury (SCI) in rats by examining factors influencing IKK/NF-kB pathway in SCI in rats. It has been shown in several studies that IKK/NF-kB signaling pathway plays a key role in pathophysiology of SCI. In this study, three groups of rats (n = 17 each) were selected that included, tamoxifen group (here tamoxifen was injected after SCI in rats), SCI group (here only dimethylsulfoxide was administered after inducing SCI in rats) and sham group (here only laminectomy was performed). The effect of tamoxifen (5 mg/kg) on various factors responsible for activation of IKK/NF-kB signaling pathway including NF-kB p65, phosphorylated I-kBα was studied through Western blotting as well as densitometry. The examination of expression of active caspase-3 and myeloperoxidase activity was also carried out through Western blot analysis and densitometry. A comparison of three groups of rats showed that administration of tamoxifen significantly reduced the expression of NF-kB p65 and phosphorylated I-kBα (P < 0.05) compared to control. It also attenuated the expression of active caspase-3 resulting in the reduction of apoptosis, and infiltration of leukocytes to the injury site was also greatly reduced in the group where tamoxifen was administered. Statistical analysis through SPSS 13.0 software showed a significant decrease in the expression of inflammatory factors in groups where tamoxifen was administered. We conclude that tamoxifen possesses the potential neuroprotective effects that can be explored further for future therapeutic techniques in treating spinal cord injuries. PMID:24873902

  11. Cervical facet dislocation adjacent to the fused motion segment.

    PubMed

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kuroiwa, Toshihiko

    2016-01-01

    This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER) of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI) performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B). Cervical computed tomography (CT) indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D). In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation. PMID:269