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1

Laminectomy for cervical myelopathy  

Microsoft Academic Search

Study design: Cervical laminectomy with or without fusion, or laminoplasty, successfully address congenital or acquired stenosis, multilevel spondylosis, ossification of the posterior longitudinal ligament (OPLL), and ossification of the yellow ligament (OYL). To optimize surgical results, however, these procedures should be applied to carefully selected patients.Objectives: To determine the clinical, neurodiagnostic, appropriate posterior cervical approaches to be employed in patients

N E Epstein

2003-01-01

2

Laminectomy  

MedlinePLUS

Lumbar decompression; Decompressive laminectomy; Spine surgery - laminectomy ... JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine . 2010;35(14): ...

3

Alternative Procedures for the Treatment of Cervical Spondylotic Myelopathy: Arthroplasty, Oblique Corpectomy, Skip Laminectomy: Evaluation of Comparative Effectiveness and Safety.  

PubMed

Study Design. Systematic Review.Objective. To perform an evidence synthesis of the literature assessing the efficacy of arthroplasty, oblique corpectomy without fusion, and skip laminectomy to treat symptomatic cervical spondylotic myelopathy (CSM).Summary of Background Data. Traditionally, patients with symptomatic cervical spinal cord compression due to degenerative disease have been treated with anterior or posterior approaches or both. Recent reports suggest that there are several non-traditional management strategies which merit attention. The anterior procedures include decompression and anterior reconstruction with an artificial disc, and oblique corpectomy without fusion. A posterior option is decompression, utilizing the skip laminectomy technique.Methods. We conducted a systematic search in Medline and the Cochrane Collaboration Library for literature published through October 15, 2012 on human studies published in the English language containing abstracts to answer the following key questions: (1) Is there evidence that artificial disc replacement (ADR) following neural decompression results in equal or improved outcomes compared to anterior cervical decompression and fusion (ACDF) for CSM? (2) Describe the outcomes of oblique corpectomy without fusion for CSM. (3) Is there evidence that skip laminectomy results in equal or improved outcomes compared to laminoplasty for CSM?Results. The initial literature search yielded 141 unique, potentially relevant citations, which were evaluated against the inclusion/exclusion criteria set a priori. A total of 10 studies were selected for inclusion. For question one, two studies suggested that neurologic outcomes favored ADR compared to ACDF, while functional and pain outcomes were inconsistently reported. For question two, five reported case series suggested favorable neurologic, functional and pain outcomes associated with oblique corpectomy in subjects with CSM, compared to the pretreatment condition. For question three, three studies comparing laminoplasty to skip laminectomy suggested similar neurologic outcomes between treatment groups, although functional and pain outcomes were inconsistently reported.Conclusion. A paucity of high-quality literature exists regarding treatment outcomes associated with arthroplasty, oblique corpectomy without fusion, and skip laminectomy for symptomatic CSM. Comparative prospective studies with long-term follow-up and standardized outcome measures are needed to appropriately assess treatment outcomes associated with these alternative techniques.Recommendation #1. No recommendation can be made from comparative literature regarding treatment outcomes comparing ADR to ACDF for CSM.Overall Strength of Evidence. InsufficientStrength of Recommendation. StrongRecommendation #2. No recommendation can be made from comparative literature regarding treatment outcomes comparing laminoplasty to skip laminectomy for CSM.Overall Strength of Evidence. LowStrength of Recommendation. StrongSummary Statement. Oblique corpectomy is an option in selected cases of CSM. It should not be considered a first line treatment strategy due to the relatively high morbidity associated with this procedure. PMID:24026161

Traynelis, Vincent C; Arnold, Paul M; Fourney, Daryl R; Bransford, Richard J; Fischer, Dena J; Skelly, Andrea C

2013-09-10

4

The biomechanics of decompressive laminectomy.  

PubMed

The biomechanical effect of laminectomy as a means of relieving compression of the spinal cord-meningeal complex by an anterior mass was studied in ten grossly normal human cadaver spines. The basic experimental set-up involved drilling a sagittal plane hole transversely across a vertebral body to provide direct access to the anterior aspect of the neural canal. After securing a probe and linearly variable differential transformer (LVDT) assembly at each site to be tested, the probe was gently pushed into the neural canal; contact force against the tip of the probe as well as the depth of probe penetration was measured and recorded. Laminectomy did not alter the resulting contact force/anterior penetration plots at the fifth cervical, seventh thoracic, 12th thoracic, or third lumbar vertebra. Using the probe/LVDT assembly to measure anterior dural displacement and a cantilever displacement device to measure posterior dural displacement after laminectomy at the 12th thoracic vertebra, the authors found that although the anterior dura underwent gross displacement as the probe was pushed into the neural canal, the posterior dura displaced to a minimal degree. The extent of the laminectomy was not a factor. The study did not demonstrate any possible mechanism by which laminectomy could reduce the pressure exerted on the dura and neural elements by an anterior mass in a spine with otherwise normal neural canal dimensions. PMID:3686236

Allen, B L; Tencer, A F; Ferguson, R L

1987-10-01

5

Lumbar laminectomy with segmental continuous epidural anesthesia  

PubMed Central

Lumbar laminectomies are usually performed under general anesthesia in the prone position. We report a case of lumbar laminectomy done under segmental continuous epidural anesthesia, so that direct visual intra-operative monitoring of the motor and sensory component of the lower extremities was possible.

Kiran, Lakkam Vamsee; Radhika, Kusuma Srividhya; Parthasarathy, S.

2014-01-01

6

Piezoelectric Surgery -A Novel Technique for Laminectomy.  

PubMed

ABSTRACT Objective: Piezoelectric surgery is a novel technology that allows for the osteotomy of mineralized tissue with less risk of damaging underlying soft tissue structures. This selective cutting increases the safety of osteotomies performed in close vicinity to delicate structures such as dura mater, blood vessels, and neural tissue. This study aimed to develop and describe the technique of piezoelectric surgery for dorsal laminectomy and to assess its clinical safety in normal sheep. Methods: A piezoelectric, dorsal laminectomy technique was developed using ovine cadavers. Following technique development, six live sheep underwent a piezoelectric (n = 6) two-level dorsal laminectomy at L2-L3 and L4-L5 (PiezoL2-3,4-5), and another 30 live sheep underwent a three-level laminectomy at L1, L3, and L5 (PiezoL1,3,5) for a total of 102 laminectomy sites. Surgery time and postoperative complications were recorded. Results: Dorsal laminectomy was safely and accurately performed in 35/36 study sheep using a Piezoelectric surgical instrument. No dural tears were noted in any animal. Non-ambulatory paraparesis in one study sheep (PiezoL1,3,5) led to euthanasia at 48 hr and only mild epidural hematoma was noted on necropsy. No other major postoperative complications were observed in any of the animals. Subjectively, PiezoL was easy to perform and with a rapid learning curve. Mean surgery time was 105 min (range: 75-165 min; median: 97.5) for PiezoL2-3,4-5 and 93 minutes (range 55-100 min; median: 67.5) for PiezoL1,3,5. Conclusions: Based on our study, PiezoL is considered a safe and viable technique for performing ovine dorsal laminectomy in the preclinical research setting. PMID:25438097

Duerr, Felix M; Seim, Howard B; Bascuñán, Ana L; Palmer, Ross H; Easley, Jeremiah

2014-12-01

7

Multilevel decompressive laminectomy and transpedicular instrumented fusion for cervical spondylotic radiculopathy and myelopathy: A minimum follow-up of 3 years  

PubMed Central

Objective: Cervical laminectomies with transpedicular insertion technique is known to be a biomechanically stronger method in cervical pathologies. However, its frequency of use is low in the routine practice, as the pedicle is thin and risk of neurovascular damage is high. In this study, we emphasize the results of cervical laminectomies with transpedicular fixation using fluoroscopy in degenerative cervical spine disorder. Materials and Methods: Postoperative malposition of the transpedicular screws of the 70 pedicles of the 10 patients we operated due to degenerative stenosis in the cervical region, were investigated. Fixation was performed between C3 and C7, and we used resected lamina bone chips for fusion. Clinical indicators included age, gender, neurologic status, surgical indication, and number of levels stabilized. Dominant vertebral artery of all the patients was evaluated with Doppler ultrasonography. Preoperative and postoperative Nurick grade of each patient was documented. Results: No patients experienced neurovascular injury as a result of pedicle screw placement. Two patients had screw malposition, which did not require reoperation due to minor breaking. Most patients had 32-mm screws placed. Postoperative computed tomography scanning showed no compromise of the foramen transversarium. A total of 70 pedicle screws were placed. Good bony fusion was observed in all patients. At follow-up, 9/10 (90%) patients had improved in their Nurick grades. The cases were followed-up for an average of 35.7 months (30–37 months). Conclusions: Use of the cervical pedicular fixation (CPF) provides a very strong three-column stabilization but also carries vascular injury without nerve damage. Laminectomies technique may reduce the risk of malposition due to visualization of the spinal canal. CPF can be performed in a one-stage posterior procedure. This technique yielded good fusion rate without complications and can be considered as a good alternative compared other techniques. PMID:22013372

Kotil, Kadir; Ozyuvaci, Emine

2011-01-01

8

Comparison of Spinous Process-Splitting Laminectomy versus Conventional Laminectomy for Lumbar Spinal Stenosis  

PubMed Central

Study Design Seventy-five patients who had been treated for lumbar spinal stenosis (LSS) were reviewed retrospectively. Purpose Invasion into the paravertebral muscle can cause major problems after laminectomy for LSS. To address these problems, we performed spinous process-splitting laminectomy. We present a comparative study of decompression of LSS using 2 approaches. Overview of Literature There are no other study has investigated the lumbar spinal instability after spinous process-splitting laminectomy. Methods This study included 75 patients who underwent laminectomy for the treatment of LSS and who were observed through follow-ups for more than 2 years. Fifty-five patients underwent spinous process-splitting laminectomy (splitting group) and 20 patients underwent conventional laminectomy (conventional group). We evaluated the clinical and radiographic results of each surgical procedure. Results Japanese Orthopaedic Association score improved significantly in both groups two years postoperatively. The following values were all significantly lower, as shown with p-values, in the splitting group compared to the conventional group: average operating time (p=0.002), postoperative C-reactive protein level (p=0.006), the mean postoperative number of days until returning to normal body temperature (p=0.047), and the mean change in angulation 2 years postoperatively (p=0.007). The adjacent segment degeneration occurred in 6 patients (10.9%) in the splitting group and 11 patients (55.0%) in the conventional group. Conclusions In this study, the spinous process-splitting laminectomy was shown to be less invasive and more stable for patients with LSS, compared to the conventional laminectomy. PMID:25558319

Uehara, Masashi; Hashidate, Hiroyuki; Mukaiyama, Keijiro; Kuraishi, Shugo; Shimizu, Masayuki; Ikegami, Shota; Futatsugi, Toshimasa; Ogihara, Nobuhide; Hirabayashi, Hiroki; Kato, Hiroyuki

2014-01-01

9

[Osteoplastic laminectomy using hydroxyapatite ceramic implants].  

PubMed

Cervical osteoplastic laminectomy using ceramic or apatite beads as implants was performed in 31 patients with symptomatic cervical bony canal stenosis. Patients with degenerative changes such as osteochondrosis or disc herniation are included in this study but those with spinal cord tumor, arachnoid cyst or ossification of the posterior longitudinal ligament are not. Initially foraminotomies were performed at the C5-8 levels in an attempt at preventing worsening of radicular signs caused by posterior displacement of the cord and resultant tethering effect on the nerve root. Connecting the medial borders of the foraminotomies, laminae were removed in a single piece. A small suboccipital craniectomy and C1-2 laminectomy were added when necessary. Laminae were replaced maintaining an increased anteroposterior diameter of the bony canal, by means of interposition of apatite or ceramic beads of appropriate size between the cut surfaces of the laminae. Results were excellent in 13 (42%), good in 10 (32%), fair in 4 (13%), no change in 2 (6.5%) and worse in 2 (6.5%). Literature on the osteoplastic laminectomy (laminoplasty) for cervical canal stenosis was reviewed and the advantage of the present method was briefly discussed. PMID:3010151

Koyama, T; Iwasaki, K; Watanabe, K; Handa, J

1986-02-01

10

A preclinical post laminectomy rat model mimics the human post laminectomy syndrome  

Microsoft Academic Search

Chronic low back pain with sciatica complicating post laminectomy surgery is poorly understood. It is likely that some aspects of persistent pain of the syndrome results from spinal facilitation in which there is lowering of pain excitation levels. A small animal preclinical model is needed that mimics the clinical condition to permit detailed studies of the underlying altered neurochemistry of

Jennifer B Massie; Bill Huang; Shelley Malkmus; Tony L Yaksh; Choll W Kim; Steven R Garfin; Wayne H Akeson

2004-01-01

11

Acute Sciatic Neuritis following Lumbar Laminectomy  

PubMed Central

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

Hitchon, Patrick; Reddy, Chandan G.

2014-01-01

12

Limited Laminectomy and Restorative Spinoplasty in Spinal Canal Stenosis  

PubMed Central

Study Design Prospective cohort study. Purpose Evaluation of the clinico-radiological outcome and complications of limited laminectomy and restorative spinoplasty in spinal canal stenosis. Overview of Literature It is critical to achieve adequate spinal decompression, while maintaining spinal stability. Methods Forty-four patients with degenerative lumbar canal stenosis underwent limited laminectomy and restorative spinoplasty at our centre from July 2008 to December 2010. Four patients were lost to follow-up leaving a total of 40 patients at an average final follow-up of 32 months (range, 24-41 months). There were 26 females and 14 males. The mean±standard deviation (SD) of the age was 64.7±7.6 years (range, 55-88 years). The final outcome was assessed using the Japanese Orthopaedic Association (JOA) score. Results At the time of the final follow-up, all patients recorded marked improvement in their symptoms, with only 2 patients complaining of occasional mild back pain and 1 patient complaining of occasional mild leg pain. The mean±SD for the preoperative claudication distance was 95.2±62.5 m, which improved to 582±147.7 m after the operation, and the preoperative anterio-posterior canal diameter as measured on the computed tomography scan was 8.3±2.1 mm, which improved to 13.2±1.8 mm postoperatively. The JOA score improved from a mean±SD of 13.3±4.1 to 22.9±4.1 at the time of the final follow-up. As for complications, dural tears occurred in 2 patients, for which repair was performed with no additional treatment needed. Conclusions Limited laminectomy and restorative spinoplasty is an efficient surgical procedure which relieves neurogenic claudication by achieving sufficient decompression of the cord with maintenance of spinal stability. PMID:25187863

Sangwan, Sukhbir Singh; Garg, Rakesh; Kundu, Zile Singh; Gupta, Vinay; Kamboj, Pradeep

2014-01-01

13

Finite element modeling of cervical laminectomy with graded facetectomy.  

PubMed

In this study, an anatomically accurate three-dimensional finite element model of the human lower cervical spine (C4-C6) was used to study the biomechanical effects of cervical laminectomy with and without graded facetectomy. The intact finite element model was validated under flexion, extension, lateral bending, and axial torsion load vectors of 1.8 Nm magnitude. The moment rotation response of the finite element model matched well with experimental data. The gross external (angular motion) and the internal (superior and inferior intervertebral disc stress) responses were delineated under the four physiological loading modes for these iatrogenic changes. Results indicated that laminectomy markedly altered the cervical angular motion and the disc stress under flexion compared with all other loading modes. Facetectomy increased the angular motion and the inferior disc stress notably under flexion but did not affect the adjacent superior disc stress. Facet resection of > 50% caused pronounced increases in angular rotation and intervertebral disc stresses. These findings suggest that the resection of more than one-half of this structure may require additional procedures to restore the strength of the cervical column. Although gross external motion response can be obtained by experimental studies, the internal stress response can only be determined using mathematical models such as the finite element model used in the present study. The accentuated changes in the disc stress compared with the changes in the external rotation may be clinically relevant because increased internal load/stress can result in disc degeneration. The present three-dimensional finite element model offers additional information to better understand the extrinsic and intrinsic responses of the iatrogenically altered cervical spine. PMID:9041495

Kumaresan, S; Yoganandan, N; Pintar, F A; Voo, L M; Cusick, J F; Larson, S J

1997-02-01

14

Lamina replacement with titanium plate fixation improves spinal stability after total lumbar laminectomy.  

PubMed

Biomechanical experiments and strain analyses were performed to investigate the effects of lamina replacement surgery for intraspinal lesions on postoperative spinal stability. Eight specimens of thoracic and lumbar vertebrae (T12-L4) were collected from adult cadavers. Stepwise lumbar total laminectomy, and laminoplasty with lamina reduction and replacement was undertaken in combination with titanium-plate fixation to simulate the surgical setting. The effects of thoracic and lumbar vertebral strain, displacement, and rigidity on spinal stability were measured following both single and multiple segment laminectomy. Significant differences in mechanical indices of stability were seen between stepwise laminectomy of lumbar vertebrae and normal specimens (p < 0.05), between lamina replacement in combination with titanium-plate fixation and laminectomy (p < 0.05), and between single- and multiple-segment laminectomy (p < 0.05). Differences between laminoplasty with lamina replacement in combination with titanium-plate fixation and normal specimens need to be examined for further study. Lumbar laminectomy followed by reduction and replacement, in combination with titanium-plate fixation, was shown to be beneficial in terms of preserving spinal stability and maintaining biomechanical function and spinal loading capability. PMID:25169703

Nong, Luming; Zhou, Dong; Xu, Nanwei; Du, Rui; Jiang, Xijia

2015-12-01

15

Smoking as an independent predictor of reoperation after lumbar laminectomy: a study of 500 cases.  

PubMed

OBJECT This study aimed to identify the factors predicting an increased risk for reoperation in patients who had undergone a lumbar laminectomy. METHODS The authors retrospectively reviewed the electronic medical records of all patients who had undergone firsttime, bilateral laminectomy at 1, 2, or 3 levels for lumbar spondylosis at the authors' institution. Patients who underwent fusion, laminotomy, discectomy, or complete facetectomy were excluded. The patients' preoperative symptoms and comorbidities were also obtained from their medical records. RESULTS Over an average follow-up period of 46.8 months, of 500 patients who had undergone laminectomy at 1, 2, or 3 levels, 81 patients (16.2%) developed subsequent spinal disorders that required a reoperation. A multiple logistic regression analysis identified smoking as an independent predictor of reoperation (OR 2.15, p = 0.01). Smoking was also an independent predictor of reoperation after a single-level laminectomy (OR 11.3, p = 0.02) and after a multilevel (that is, involving 2 or 3 levels) laminectomy (OR 1.98, p = 0.05). For 72 patients undergoing reoperation only for spinal degeneration, smoking remained an independent, statistically significant predictor of reoperation (OR 2.06, p = 0.04). Nine patients underwent reoperation for nondegenerative conditions (hematoma, wound infection, or wound dehiscence), and in these patients, chronic obstructive pulmonary disease was the only statistically significant predictor of reoperation (OR 8.92, p = 0.03). CONCLUSIONS Smoking was the strongest predictor of reoperation in patients who had undergone single-level laminectomy, multilevel laminectomy, or reoperation for progression of spinal degeneration. These findings suggest that smokers have worse outcomes of lumbar decompression than nonsmokers. PMID:25555058

Bydon, Mohamad; Macki, Mohamed; De la Garza-Ramos, Rafael; Sciubba, Daniel M; Wolinsky, Jean-Paul; Gokaslan, Ziya L; Witham, Timothy F; Bydon, Ali

2015-03-01

16

The Effect of Resveratrol on Surgery-Induced Epidural Fibrosis in Laminectomy Rats  

PubMed Central

Epidural fibrosis (EF) is a common complication for the patients who underwent laminectomy. Recently, EF is thought to cause recurrent postoperative pain after laminectomy. Resveratrol has been shown to exert its anti-inflammatory, antifibrotic, and antiproliferative multifaceted properties. The object of this study was to investigate the effects of resveratrol on the prevention of postlaminectomy EF formation in laminectomy rats. A controlled double-blinded study was performed on 60 healthy adult Sprague-Dawley rats that underwent lumbar laminectomy at the L1-L2 levels. They were divided randomly into 3 groups (1, 2, and 3) of 20 rats each—group 1: resveratrol treatment group; group 2: resveratrol dilution saline treatment group; group 3: sham group (rats underwent laminectomy without treatment). All rats were killed 4 weeks after operation. The Rydell score, hydroxyproline content, vimentin cells density, fibroblasts density, and inflammatory factors expressional levels all suggested better results in resveratrol group than the other two groups. Resveratrol is able to inhibit fibroblasts proliferation, and TGF-?1 and IL-6 expressions and prevent epidural fibrosis in postlaminectomy rat. PMID:24782910

Sun, Peifeng; Miao, Bo; Xin, Hongmei; Zhao, Jinzhu; Xia, Guofeng; Xu, Peng; Hu, Jian; Li, Zhenfeng; Li, Jianmin

2014-01-01

17

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

Microsoft Academic Search

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

Asgeir S Jakola; Andreas Sørlie; Sasha Gulati; Øystein P Nygaard; Stian Lydersen; Tore Solberg

2010-01-01

18

The Effects of Single-Level Instrumented Lumbar Laminectomy on Adjacent Spinal Biomechanics  

PubMed Central

Study Design?Biomechanical study. Objective?Posterior instrumentation is used to stabilize the spine after a lumbar laminectomy. However, the effects on the adjacent segmental stability are unknown. Therefore, we studied the range of motion (ROM) and stiffness of treated lumbar spinal segments and cranial segments after a laminectomy and after posterior instrumentation in flexion and extension (FE), lateral bending (LB), and axial rotation (AR). These outcomes might help to better understand adjacent segment disease (ASD), which is reported cranial to the level on which posterior instrumentation is applied. Methods?We obtained 12 cadaveric human lumbar spines. Spines were axially loaded with 250?N for 1 hour. Thereafter, 10 consecutive load cycles (4 Nm) were applied in FE, LB, and AR. Subsequently, a laminectomy was performed either at L2 or at L4. Thereafter, load-deformation tests were repeated, after similar preloading. Finally, posterior instrumentation was added to the level treated with a laminectomy before testing was repeated. The ROM and stiffness of the treated, the cranial adjacent, and the control segments were calculated from the load-displacement data. Repeated-measures analyses of variance used the spinal level as the between-subject factor and a laminectomy or instrumentation as the within-subject factors. Results?After the laminectomy, the ROM increased (+19.4%) and the stiffness decreased (?18.0%) in AR. The ROM in AR of the adjacent segments also increased (+11.0%). The ROM of treated segments after instrumentation decreased in FE (?74.3%), LB (?71.6%), and AR (?59.8%). In the adjacent segments after instrumentation, only the ROM in LB was changed (?12.9%). Conclusions?The present findings do not substantiate a biomechanical pathway toward or explanation for ASD. PMID:25649753

Bisschop, Arno; Holewijn, Roderick M.; Kingma, Idsart; Stadhouder, Agnita; Vergroesen, Pieter-Paul A.; van der Veen, Albert J.; van Dieën, Jaap H.; van Royen, Barend J.

2014-01-01

19

Extensive spinal epidural abscess treated with "apical laminectomies" and irrigation of the epidural space: report of 2 cases.  

PubMed

Spinal epidural abscess (SEA) is a rare but often devastating infection of the epidural space around the spinal cord. When an SEA is widespread, extensive decompression with laminectomy is often impossible, as it may subject the patient to very long operative times, extensive blood loss, and mechanical instability. A technique called "skip laminectomy" has been described in the literature, in which laminectomies are performed at the rostral and caudal ends of an abscess that spans 3-5 levels and a Fogarty catheter is used to mechanically drain the abscess, much like in an embolectomy. In this report of 2 patients, the authors present a modification of this technique, which they call "apical laminectomies" to allow for irrigation and drainage of an extensive SEA spanning the entire length of the vertebral column (C1-2 to L5-S1). Two patients presented with cervico-thoraco-lumbar SEA. Laminectomies were performed at the natural apices of the spine, namely, at the midcervical, midthoracic, and midlumbar spine levels. Next, a pediatric feeding tube was inserted in the epidural space from the thoracic laminectomies up toward the cervical laminectomy site and down toward the lumbar laminectomy site, and saline antibiotics were used to irrigate the SEA. Both patients underwent this procedure with no adverse effects. Their SEAs resolved both clinically and radiologically. Neither patient suffered from mechanical instability at 1 year after treatment. For patients who present with extensive SEAs, apical laminectomies seem to allow for surgical cure of the infectious burden and do not subject the patient to extended operating room time, an increased risk of blood loss, and the risk of mechanical instability. PMID:25555055

Abd-El-Barr, Muhammad M; Bi, Wenya Linda; Bahluyen, Biji; Rodriguez, Samuel T; Groff, Michael W; Chi, John H

2015-03-01

20

Surgical outcomes of modified lumbar spinous process-splitting laminectomy for lumbar spinal stenosis.  

PubMed

The lumbar spinous process-splitting laminectomy (LSPSL) procedure was developed as an alternative to lumbar laminectomy. In the LSPSL procedure, the spinous process is evenly split longitudinally and then divided at its base from the posterior arch, leaving the bilateral paravertebral muscle attached to the lateral aspects. This procedure allows for better exposure of intraspinal nerve tissues, comparable to that achieved by conventional laminectomy while minimizing damage to posterior supporting structures. In this study, the authors make some modifications to the original LSPSL procedure (modified LSPSL), in which laminoplasty is performed instead of laminectomy. The purpose of this study was to compare postoperative outcomes in modified LSPSL with those in conventional laminectomy (CL) and to evaluate bone unions between the split spinous process and residual laminae following modified LSPSL. Forty-seven patients with lumbar spinal stenosis were enrolled in this study. Twenty-six patients underwent modified LSPSL and 21 patients underwent CL. Intraoperative blood loss and surgical duration were evaluated. The Japanese Orthopaedic Association (JOA) scale scores were used to assess parameters before surgery and 12 months after surgery. The recovery rates were also evaluated. Postoperative paravertebral muscle atrophy was assessed using MRI. Bone union rates between the split spinous process and residual laminae were also examined. The mean surgical time and intraoperative blood loss were 25.7 minutes and 42.4 ml per 1 level in modified LSPSL, respectively, and 22.7 minutes and 29.5 ml in CL, respectively. The recovery rate of the JOA score was 64.2% in modified LSPSL and 68.7% in CL. The degree of paravertebral muscle atrophy was 7.8% in modified LSPSL and 22.2% in CL at 12 months after surgery (p < 0.05). The fusion rates of the spinous process with the arcus vertebrae at 6 and 12 months in modified LSPSL were 56.3% and 81.3%, respectively. The modified LSPSL procedure was less invasive to the paravertebral muscles and could be a laminoplasty; therefore, the modified LSPSL procedure presents an effective alternative to lumbar laminectomy. PMID:25594729

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

2015-04-01

21

Symptomatic Extensive Thoracolumbar Epidural Hematoma Following Lumbar Disc Surgery Treated by Single Level Laminectomy  

PubMed Central

Spinal epidural hematomas (SEHs) are rare complications following spine surgery, especially for single level lumbar discectomies. The appropriate surgical management for such cases remains to be investigated. We report a case of an extensive spinal epidural hematoma from T11-L5 following a L3-L4 discectomy. The patient underwent a single level L4. A complete evacuation of the SEH resulted in the patient's full recovery. When presenting symptoms limited to the initial surgical site reveal an extensive postoperative SEH, we propose: to tailor the surgical exposure individually based on preoperative findings of the SEH; and to begin the surgical exposure with a limited laminectomy focused on the symptomatic levels that may allow an efficient evacuation of the SEH instead of a systematic extensive laminectomy based on imaging. PMID:22708022

Ali, Youssef; Roux, François-Xavier; Meder, Jean-François

2012-01-01

22

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

NASA Astrophysics Data System (ADS)

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.

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

23

[Prevention of peridural fibrosis and adhesion after laminectomy: an experimental study in rats].  

PubMed

An experimental study on the effectiveness of various materials including poly carboxymethylcellulose (PCMC), gelatin foam (GF), ligment (L), free fat (FF) in prevention of peridural fibrosis and adhension (PDA) was done in 144 SD rats using a total laminectomy model (L1-2). PDA was measured with a double-blind protocol at 2, 4, 8, 12 weeks postoperatively by gross anatomical appearance (blunt-dissection), microscopical evaluation, computed imaging analysis and MRI enhanced with gadolinium. The results demonstrated that the peak of PDA is within 8 weeks after operation. PCMC, as a three dimensional protective material, could effectively inhibit PDFA after laminectomy, but GF and L could not. SHA had some effect in the early stage, but not in the late period. For FF though it could effectively prevent PDA, the incision infection rate was higher, the atrophy and necrosis of FF were serious. What is more, almost all transplanted fat remained in situ extended into the spinal cord in some measure after 8 weeks postoperatively. PMID:9594173

Sun, K; Jiang, C; Lu, D

1996-06-01

24

Cervical Laminoplasty for Multilevel Cervical Myelopathy  

PubMed Central

Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes. Hirabayashi popularised the expansive open door laminoplasty which was later modified several surgeons. Laminoplasty has changed the way surgeons approach multilevel cervical spondylotic myelopathy. PMID:21991408

Sayana, Murali Krishna; Jamil, Hassan; Poynton, Ashley

2011-01-01

25

An Experimental Novel Study: Angelica sinensis Prevents Epidural Fibrosis in Laminectomy Rats via Downregulation of Hydroxyproline, IL-6, and TGF-?1  

PubMed Central

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-?1 and IL-6 expressions and prevent epidural scar adhesion in postlaminectomy rat model. PMID:24069047

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

2013-01-01

26

Outcomes after cervical laminectomy with instrumented fusion versus expansile laminoplasty: A propensity matched study of 3185 patients.  

PubMed

The aim of this study was to compare reoperation, complication rates, and healthcare resource utilization of expansile laminectomies with instrumented fusion versus laminoplasty. Using the MarketScan database (Truven Health Analytics, Ann Arbor, MI, USA), we selected patients aged >18years who underwent either cervical laminoplasty or laminectomy with fusion between 2000-2009. Propensity score modeling produced a matched cohort balanced for age, sex, comorbidities, and other relevant factors. A total of 3185 patients meeting our inclusion criteria also had 2year follow-up available. Of these, 2927 (91.90%) and 258 (8.10%) had laminectomy with fusion and laminoplasty, respectively. Laminoplasty patients had significantly lower complication rates during index hospitalization (5.81 versus 9.62%, adjusted odds ratio [aOR]: 0.556, 95% confidence interval [CI]: 0.418-0.740, p<0.0002), during 30day (6.87 versus 11.12%, aOR: 0.568, 95% CI: 0.436-0.740, p<0.0002) and 90day (7.61 versus 11.78%, aOR: 0.593, 95% CI: 0.460-0.764, p<0.0002) postoperative periods. They also had lower costs (United States dollars) during index hospitalization ($26,129 versus $35,483, p<0.0004), and overall during the 2year postoperative period ($77,960 versus $106,453, p<0.0001). Two year reoperation rates were similar between both groups (9.77% versus 7.36%, p=0.20). Our study suggests that cervical laminoplasty has significantly lower complication rates, similar long-term reoperation rates and lower healthcare resource utilization after 2years than laminectomy with fusion. PMID:25515781

Adogwa, Owoicho; Huang, Kevin; Hazzard, Matthew; Chagoya, Gustavo; Owens, Ryan; Cheng, Joseph; Ugiliweneza, Beatrice; Boakye, Maxwell; Lad, Shivanand P

2015-03-01

27

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

PubMed Central

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

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

28

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

PubMed Central

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

2010-01-01

29

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

PubMed Central

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

Kim, Deog-ryeong

2015-01-01

30

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

PubMed Central

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

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

31

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

PubMed

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

Son, Byung-Chul; Kim, Deog-Ryeong

2015-01-01

32

Four lateral mass screw fixation techniques in lower cervical spine following laminectomy: a finite element analysis study of stress distribution  

PubMed Central

Background Lateral mass screw fixation (LSF) techniques have been widely used for reconstructing and stabilizing the cervical spine; however, complications may result depending on the choice of surgeon. There are only a few reports related to LSF applications, even though fracture fixation has become a severe complication. This study establishes the three-dimensional finite element model of the lower cervical spine, and compares the stress distribution of the four LSF techniques (Magerl, Roy-Camille, Anderson, and An), following laminectomy -- to explore the risks of rupture after fixation. Method CT scans were performed on a healthy adult female volunteer, and Digital imaging and communication in medicine (Dicom) data was obtained. Mimics 10.01, Geomagic Studio 12.0, Solidworks 2012, HyperMesh 10.1 and Abaqus 6.12 software programs were used to establish the intact model of the lower cervical spines (C3-C7), a postoperative model after laminectomy, and a reconstructive model after applying the LSF techniques. A compressive preload of 74 N combined with a pure moment of 1.8 Nm was applied to the intact and reconstructive model, simulating normal flexion, extension, lateral bending, and axial rotation. The stress distribution of the four LSF techniques was compared by analyzing the maximum von Mises stress. Result The three-dimensional finite element model of the intact C3-C7 vertebrae was successfully established. This model consists of 503,911 elements and 93,390 nodes. During flexion, extension, lateral bending, and axial rotation modes, the intact model’s angular intersegmental range of motion was in good agreement with the results reported from the literature. The postoperative model after the three-segment laminectomy and the reconstructive model after applying the four LSF techniques were established based on the validated intact model. The stress distribution for the Magerl and Roy-Camille groups were more dispersive, and the maximum von Mises stress levels were lower than the other two groups in various conditions. Conclusion The LSF techniques of Magerl and Roy-Camille are safer methods for stabilizing the lower cervical spine. Therefore, these methods potentially have a lower risk of fixation fracture. PMID:25106498

2014-01-01

33

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

PubMed

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

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

2014-02-01

34

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

PubMed Central

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

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

2014-01-01

35

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

PubMed Central

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

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

2015-01-01

36

Atlantoaxial subluxation-induced myelopathy in cleidocranial dysplasia. Case report.  

PubMed

The authors describe the clinical course and treatment of a patient with cleidocranial dysplasia in whom spastic myelopathy developed due to atlantoaxial subluxation. This 27-year-old woman with cleidocranial dysplasia and a history of atlantoaxial subluxation presented with spastic myelopathy. Surgery was performed twice for cervical myelopathy and atlantoaxial subluxation, including laminectomy at the atlas and cervicooccipital fusion in which the Luque rod system was used, as well as C1-2 fusion via the transpharyngeal route. Solid bone fusion was achieved by 7 months postsurgery. Postoperative magnetic resonance imaging studies demonstrated that spinal cord compression was relieved, but atrophy persisted. At 2 years postsurgery there was no neurological disease progression, but spasticity persisted. The patient could walk with a cane. Cleidocranial dysplasia is an extremely rare cause of myelopathy in patients with atlantoaxial subluxation; the authors know of only two reports of this condition. When managing cleidocranial dysplasia, the practitioner should always be aware that atlantoaxial subluxation may be the cause of cervical myelopathy. PMID:17688067

Kobayashi, Shigeru; Uchida, Kenzo; Baba, Hisatoshi; Takeno, Kenichi; Yayama, Takasi; Nakajima, Hideaki; Nomura, Eiki; Yoshizawa, Hidezo

2007-08-01

37

Cross-clamping of the thoracic aorta. Influence of aortic shunts, laminectomy, papaverine, calcium channel blocker, allopurinol, and superoxide dismutase on spinal cord blood flow and paraplegia in baboons.  

PubMed Central

There is a high incidence of paraplegia associated with thoracic aortic cross-clamping, even when cardiopulmonary bypass or shunts are used. In 56 adult baboons, spinal cord blood flow (SCBF), vascular anatomy, and paraplegia rates were evaluated. Tissue blood flow was measured by radioactive microspheres. Various procedures were used to increase SCBF and to prevent ischemia-reperfusion injury. It was found that the rate of paraplegia was inversely correlated with neural tissue ischemia (SCBF) and directly correlated with reperfusion hyperemia. Two methods completely prevented paraplegia. These two methods were a thoracic shunt with occlusion of the infrarenal aorta or cerebrospinal fluid drainage plus intrathecal papaverine injection, both of which were associated with an increased SCBF. Furthermore, papaverine dilated the anterior spinal artery (ASA) (p = 0.007) and increased the blood flow through the lower ASA. Whereas procedures utilizing a calcium channel blocker (flunarizine), allopurinol, superoxide dismutase (SOD), laminectomy alone, and a thoracoabdominal shunt not perfusing the arteria radicularis magna (ARM) all failed to prevent paraplegia, allopurinol (p = 0.026) and SOD (p = 0.004) did prevent gastric stress lesions, indicating that their failure to prevent paraplegia was not due to a lack of activity. Of great clinical interest is that, if a shunt is used and the ARM is perfused, infrarenal aortic cross-clamping increases SCBF, thus preventing paraplegia. Intrathecal application of papaverine proved to be even more effective in increasing SCBF and also completely prevented paraplegia. As this is a safer procedure than the insertion of shunts, this is the method of choice for the prevention of paraplegia associated with thoracic aortic cross-clamping. The preliminary trial using intrathecal papaverine in human beings has thus far shown no adverse side effects from the drug, and no paraplegia has occurred. PMID:3729582

Svensson, L G; Von Ritter, C M; Groeneveld, H T; Rickards, E S; Hunter, S J; Robinson, M F; Hinder, R A

1986-01-01

38

Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

MedlinePLUS Videos and Cool Tools

... sponge and bone marrow, or sometimes bone morphogenic protein, which is not really approved for use in ... we’re using a material called bone morphogenic protein. Now, I should spend a moment speaking about ...

39

HEREDITARY MYELOPATHIES  

PubMed Central

Hereditary myelopathies are a diverse group of disorders in which major aspects of the clinical syndrome involve spinal cord structures. Hereditary myelopathic syndromes can be recognized as four clinical paradigms: (1) spinocerebellar ataxia, (2) motor neuron disorder, (3) leukodystrophy, and (4) distal motor-sensory axonopathy. This review illustrates these hereditary myelopathy paradigms with clinical examples with an emphasis on clinical recognition and differential diagnosis. PMID:20148180

Fink, John K.

2009-01-01

40

Tropical myelopathies.  

PubMed

A large number of causal agents produce spinal cord lesions in the tropics. Most etiologies found in temperate regions also occur in the tropics including trauma, herniated discs, tumors, epidural abscess, and congenital malformations. However, infectious and nutritional disorders occur with higher prevalence in tropical regions. Among the most common infectious etiologies are tuberculous Pott's disease, brucellosis, and neuroborreliosis. Parasitic diseases such as schistosomiasis, neurocysticercosis, and eosinophilic meningitis are frequent causes of nontraumatic paraplegia. The retrovirus HTLV-1 is a cause of tropical spastic paraparesis. Nutritional causes of paraparesis include deficiencies of vitamin B12 and folate; endemic clusters of konzo and tropical ataxic myeloneuropathy are associated in Africa with malnutrition and excessive consumption of cyanide-containing bitter cassava. Other toxic etiologies of tropical paraplegia include lathyrism and fluorosis. Nutritional forms of myelopathy are associated often with optic and sensory neuropathy, hence the name tropical myeloneuropathies. Acute transverse myelopathy is seen in association with vaccination, infections, and fibrocartilaginous embolism of the nucleus pulposus. Multiple sclerosis and optic myelopathy occur in the tropics but with lesser prevalence than in temperate regions. The advent of modern imaging in the tropics, including computed tomography and magnetic resonance imaging, has allowed better diagnosis and treatment of these conditions that are a frequent cause of death and disability. PMID:24365434

Román, Gustavo C

2014-01-01

41

A novel approach to improving the safety of patients undergoing lumbar laminectomy.  

PubMed

The anesthesiology field has recently embraced the use of checklists to obviate the need for long-term memory, improve safety, and achieve goals and tasks. These checklists serve to increase safety, improve consumer satisfaction, and reduce mortality and morbidity. Spinal surgery with the patient lying prone is associated with complex morbidities when there is inattention to proper positioning technique. Problems arising from malpositioning of the patient undergoing spinal surgery are attributed to body habitus and the body's contact with specialized and complex operating room table frames. Common problems associated with the prone position are brachial plexus injury, cervical spine nerve injuries, and postoperative visual loss. The purpose of this research project was to examine the use of a checklist for nurse anesthetists who provide care for patients undergoing spinal surgery. The checklist addressed specific positioning needs as a means of decreasing mortality and morbidity. It is theorized that the use of a checklist will serve as a systematic aid to memory and enable the anesthetist to adhere to proper positioning techniques in this patient population and thereby improve outcomes. PMID:24354076

Salkind, Edward M

2013-10-01

42

Spine surgery - discharge  

MedlinePLUS

... Intervertebral foramina - discharge; Spine surgery - foraminotomy - discharge; Lumbar decompression - discharge; Decompressive laminectomy - discharge; Spine surgery - laminectomy - discharge; ...

43

Over-shunting associated myelopathy.  

PubMed

Intracranial hypotension typically presents following cerebrospinal fluid (CSF) leak, but can be induced by CSF diversion. Classically, patients present with positional headache, but less common symptoms include neck pain and cranial nerve palsies. To our knowledge, the neurosurgical literature contains six reports of patients with symptomatic cervical, epidural venous plexus engorgement as the result of CSF shunting. The patient presented herein is a 26-year-old woman with shunt-dependent, congenital hydrocephalus. She presented with rapidly progressive cervical myelopathy following ventriculoperitoneal shunt revision. Imaging revealed engorgement of the cervical epidural venous plexus and mass effect on the cervical spinal cord. "Over-shunting associated myelopathy" is a rare complication of CSF diversion that should be familiar to physicians who routinely evaluate patients with intracranial shunts. PMID:25070631

Howard, Brian M; Sribnick, Eric A; Dhall, Sanjay S

2014-12-01

44

Longitudinally extensive myelopathy in children.  

PubMed

When children present with acute myelopathy manifested by sensory, motor, or bowel and bladder symptoms, MRI of the neuraxis with contrast agent is the most important imaging study to obtain. Although occasionally normal, MRI often demonstrates signal abnormality within the spinal cord. Classically, longitudinally extensive transverse myelitis (?3 vertebral bodies in length) has been described with neuromyelitis optica (NMO), but alternative diagnoses should be considered. This pictorial essay reviews the differential diagnoses that may present with longitudinally extensive spinal cord signal abnormalities. Multiple inflammatory, infectious, vascular, metabolic and neurodegenerative etiologies can present with a myelopathy. Thus, radiologists can assist in the diagnosis by familiarizing themselves with the spectrum of diseases in childhood that result in longitudinally extensive signal abnormalities in the absence of trauma. PMID:25636706

Sorte, Danielle Eckart; Poretti, Andrea; Newsome, Scott D; Boltshauser, Eugen; Huisman, Thierry A G M; Izbudak, Izlem

2015-02-01

45

Acute myelopathy with normal imaging  

PubMed Central

A 17-year old girl presented with rapidly progressive quadriparesis and ventilatorary failure. The clinical findings indicated a spinal level, but the diagnosis of myelopathy was not supported by her initial spinal imaging and cerebrospinal fluid studies. She had completed treatment for Guillain-Barre syndrome before a follow-up spinal imaging study showed interval expansion and enhancement of the cervical cord. PMID:22752484

Holland, Neil R.

2013-01-01

46

Pathobiology of cervical spondylotic myelopathy.  

PubMed

In this narrative review, we aim to outline what is currently known about the pathophysiology of cervical spondylotic myelopathy (CSM), the most common cause of spinal cord dysfunction. In particular, we note the unique factors that distinguish it from acute spinal cord injury. Despite its common occurrence, the reasons why some patients develop severe symptomatology while others have few or no symptoms despite radiographic evidence confirming similar degrees of compression is poorly understood. Neither is there a clear understanding of why certain patients have a stable clinical myelopathy and others present with only mild myelopathy. Moreover, the precise molecular mechanisms which contribute to the pathogenesis of the disease are incompletely understood. The current treatment method is decompression of the spinal cord but a lack of clinically relevant models of CSM have hindered the understanding of the full pathophysiology which would aid the development of new therapeutic avenues of investigation. Further elucidation of the role of ischemia, currently a source of debate, as well as the complex cascade of biomolecular events as a result of the unique pathophysiology in this disease will pave the way for further neuroprotective strategies to be developed to attenuate the physiological consequences of surgical decompression and augment its benefits. PMID:24626958

Karadimas, Spyridon K; Gatzounis, Georgios; Fehlings, Michael G

2015-04-01

47

Reversible hepatic myelopathy: a case report.  

PubMed

We report a case of reversible hepatic myelopathy. A 42-year-old female patient with 3-year history of alcoholic liver cirrhosis developed spastic gait, hyperreflexia and mild somatosensory disturbance in her lower extremities. The increased level of serum ammonia and the deficits of N30 and P38 in the tibial somatosensory evoked potentials (SEP) in conjunction with exclusion of the other known causes of myelopathy supported the diagnosis of her hepatic myelopathy. The ammonia lowering therapy by the oral administration of lactulose successfully improved the spastic gait accompanied with the emergence of N30 and P38 in the tibial SEP. Although liver transplantation was known to be the only therapy for hepatic myelopathy in the literatures, our case showed that the ammonia lowering therapy can be effective for the early stage of hepatic myelopathy. PMID:24705837

Hirozawa, Daisuke; Fukada, Kei; Yaegaki, Takahide; Hoshi, Taku; Sawada, Jinichi; Hazama, Takanori

2014-01-01

48

A Novel Endoscopic Technique to Suboccipital Decompression and Atlas Laminectomy for Chiari Malformation Type I: Technical Note  

Microsoft Academic Search

Objective: In order to make Chiari decompression simple and less invasive while using direct visualization, a noval solely endoscopic procedure has been employed for the decompression of Chiari malformation type 1. Methods: Zero degree and 30°-angled lens endoscope have been used for the resections of occiput and C1 lamina, and to maximally widen the rim of craniovertebral junction (CVJ) bilaterally

Xiao Di; Mark Luciano

49

Latent period in clinical radiation myelopathy  

SciTech Connect

Seventy-seven papers containing data on more than 300 cases of radiation myelopathy have been analyzed. The data suggest that the latent periods are similar in the cervical and thoracic levels of the spinal cord and are bimodally distributed. Myelopathy of lumbar cord apparently has a shorter latent period. As in controlled animal experiments, the latent period decreases with increasing dose. Furthermore, the variation in latent periods also decreases with dose. It is also seen that retreated patients and pediatric or adolescent patients have greatly reduced latent periods. The implications of these findings as they compare with the animal data are discussed.

Schultheiss, T.E.; Higgins, E.M.; El-Mahdi, A.M.

1984-07-01

50

Pure Spinal Epidural Cavernous Hemangioma with Intralesional Hemorrhage: A Rare Cause of Thoracic Myelopathy  

PubMed Central

Although cavernous hemangiomas occur frequently in the intracranial structures, they are rare in the spine. Most of spinal hemangiomas are vertebral origin and "pure" epidural hemangiomas not originating from the vertebral bone are very rare. Our spinal hemangioma case is extremely rare because of its "pure" epidural involvement and intralesional hemorrhage. A 64-year-old man presented with progressive paraparesis from two months ago. His motor weakness was rated as grade 4/5 in bilateral lower extremities. He also complained of decreased sensation below the T4 sensory dermatome, which continuously progressed to the higher dermatome level. Magnetic resonance imaging demonstrated thoracic spinal tumor at T3-T4 level. The tumor was located epidural space compressing thoracic spinal cord ventrally. The tumor was not involved with the thoracic vertebral bone. We performed T3-5 laminectomy and removed the tumor completely. The tumor was not infiltrating into intradural space or vertebral bone. The histopathologic study confirmed the epidural tumor as cavernous hemangioma. Postoperatively, his weakness improved gradually. Four months later, his paraparesis recovered completely. Here, we present a case of pure spinal epidural cavernous hemangioma, which has intralesional hemorrhage. We believe cavernous hemangioma should be included in the differential diagnosis of the spinal epidural tumors. PMID:25110490

Jang, Donghwan; Kim, Choonghyo; Lee, Seung Jin; Ryu, Young-Joon

2014-01-01

51

Pure spinal epidural cavernous hemangioma with intralesional hemorrhage: a rare cause of thoracic myelopathy.  

PubMed

Although cavernous hemangiomas occur frequently in the intracranial structures, they are rare in the spine. Most of spinal hemangiomas are vertebral origin and "pure" epidural hemangiomas not originating from the vertebral bone are very rare. Our spinal hemangioma case is extremely rare because of its "pure" epidural involvement and intralesional hemorrhage. A 64-year-old man presented with progressive paraparesis from two months ago. His motor weakness was rated as grade 4/5 in bilateral lower extremities. He also complained of decreased sensation below the T4 sensory dermatome, which continuously progressed to the higher dermatome level. Magnetic resonance imaging demonstrated thoracic spinal tumor at T3-T4 level. The tumor was located epidural space compressing thoracic spinal cord ventrally. The tumor was not involved with the thoracic vertebral bone. We performed T3-5 laminectomy and removed the tumor completely. The tumor was not infiltrating into intradural space or vertebral bone. The histopathologic study confirmed the epidural tumor as cavernous hemangioma. Postoperatively, his weakness improved gradually. Four months later, his paraparesis recovered completely. Here, we present a case of pure spinal epidural cavernous hemangioma, which has intralesional hemorrhage. We believe cavernous hemangioma should be included in the differential diagnosis of the spinal epidural tumors. PMID:25110490

Jang, Donghwan; Kim, Choonghyo; Lee, Seung Jin; Ryu, Young-Joon; Kim, Jiha

2014-06-01

52

Motor conduction measurement in myelopathy hand  

PubMed Central

Summary We studied the relationship between intramedullary high signal intensity (IMHSI) on T2-weighted magnetic resonance images and motor conduction in the spinal cords of cervical spondylotic myelopathy (CSM) patients. There was no significant difference between the biceps or triceps central motor conduction times (CMCTs) of the patients who did and did not exhibit IMHSI, whereas the abductor pollicis brevis CMCT was significantly longer in the patients who exhibited IMHSI (p<0.05) than in those who did not. The CMCT of the abductor pollicis brevis is sensitive to the degree of damage in the cervical spinal cord. Hand dysfunction is a characteristic of CSM regardless of the cervical level affected by the condition. The motor fibers innervating the intrinsic muscles of the hand in the long tract of the cervical spinal cord are more sensitive than other motor fibers. For this reason, we consider that myelopathy hand is a characteristic impairment of CSM. Transcranial magnetic stimulation of the hand motor cortex is useful for the evaluation of cervical myelopathy. PMID:25473737

Shibuya, Ryoichi; Wada, Eiji; Iwasaki, Motoki; Yonenobu, Kazuo; Yoshikawa, Hideki

2014-01-01

53

Development of a self-administered questionnaire to screen patients for cervical myelopathy  

Microsoft Academic Search

BACKGROUND: In primary care, it is often difficult to diagnose cervical myelopathy. However, a delay in treatment could cause irreversible aftereffects. With a brief and effective self-administered questionnaire for cervical myelopathy, cervical myelopathy may be screened more easily and oversight may be avoided. As there is presently no screening tool for cervical myelopathy, the aim of this study was to

Hiroshi Kobayashi; Shin-ichi Kikuchi; Koji Otani; Miho Sekiguchi; Yasufumi Sekiguchi; Shin-ichi Konno

2010-01-01

54

Acute compressive myelopathy due to vertebral haemangioma.  

PubMed

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

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

2014-01-01

55

Symptomatic vertebral hemangioma in pregnancy treated antepartum. A case report with review of literature  

Microsoft Academic Search

Pregnancy related compressive myelopathy secondary to vertebral hemangioma is a rare occurrence and its treatment antepartum\\u000a is rare. We report a 22-year-old lady in her 26th-week of pregnancy who was treated in two stages––antepartum with a laminectomy\\u000a and posterior stabilization. This resulted in complete recovery of the neurological deficits. She delivered a normal baby\\u000a after 3 months, following which a corpectomy

Kamath Vijay; Ajoy P. Shetty; S. Rajasekaran

2008-01-01

56

Conus medulla-cauda compression from nerve root hypertrophy in a child with Dejerine-Sottas syndrome: improvement with laminectomy and duraplasty. Case report.  

PubMed

This 7-year-old boy with Dejerine-Sottas syndrome caused by a mutation in the myelin protein zero gene began to suffer rapid deterioration with increasing leg weakness, loss of the ability to ambulate, and bowel and bladder incontinence. Magnetic resonance imaging of the spine revealed nerve root hypertrophy resulting in compression of the conus medullaris and cauda equina. Decompressive surgery was successful in reversing some of his deficits. PMID:12296688

Kleopa, Kleopas A; Sutton, Leslie N; Ong, Joseph; Tennekoon, Gihan; Telfeian, Albert E

2002-09-01

57

Aggressive vertebral hemangioma as a rare cause of myelopathy.  

PubMed

Vertebral hemangiomas (VHs) are common lesions in the adult population. They are usually asymptomatic and found incidentally on radiological imaging. New-onset back pain followed by subacute progression of thoracal myelopathy is the most common presentation in patients with neurological deficit. Differential diagnoses would include metastasis, multiple myeloma, lymphoma, Paget disease, osseous tumors such as Ewing sarcoma or hemangioblastoma and blood dyscrasia. We present a 41 year-old-male patient with thoracal VH causing myelopathy that completely improved after rehabilitation program with embolization and vertebroplasty procedures. PMID:23948851

Sari, Hidayet; Uludag, Murat; Akarirmak, Ulku; Ornek, Nurettin Irem; Gun, Kerem; Gulsen, Fatih

2014-01-01

58

Radiculopathy and Myelopathy in Patients with Primary Cervical Dystonia  

Microsoft Academic Search

In a prospective series of 34 incident patients with primary cervical dystonia (CD), 6 showed clinical or radiological signs of cervical radiculopathy (RP) or myelopathy (MP) during the course of their movement disorder. Age at onset in these patients was in the range reported for pure spondylotic cervical RP without an accompanying movement disorder. Radiologically, spondylosis was mild in 1

Johann M. Hagenah; Alexandra Vieregge; Peter Vieregge

2001-01-01

59

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

SciTech Connect

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.

Jain, Deepak, E-mail: deepakjain02@yahoo.com; Arora, Ankur, E-mail: aroradrankur@yahoo.com [Institute of Liver and Biliary Sciences, Department of Radiology (India); Deka, Pranjal, E-mail: drpranjaldeka@gmail.com [Institute of Liver and Biliary Sciences, Department of Hepatopancreatobiliary Surgery (India); Mukund, Amar, E-mail: dramarmukund@gmail.com; Bhatnagar, Shorav, E-mail: drshorav@yahoo.com [Institute of Liver and Biliary Sciences, Department of Radiology (India); Jindal, Deepti, E-mail: deepijindal@rediffmail.com; Kumar, Niteen, E-mail: drniteenkumar@gmail.com; Pamecha, Viniyendra, E-mail: viniyendra@yahoo.co.uk [Institute of Liver and Biliary Sciences, Department of Hepatopancreatobiliary Surgery (India)

2013-08-01

60

Portosystemic Myelopathy: A Rare Neurological Presentation of Portosystemic Shunts  

PubMed Central

Portosystemic myelopathy is an unusual complication in patients with chronic liver disease with hepatic encephalopathy and portosystemic shunts. Here we present a case of 35-year-old male patient who presented to us with difficulty in walking and progressive stiffness in both lower limbs for two months. He had undergone splenectomy with distal splenorenal shunt 20 years back. On physical examination, he had spasticity in both lower limbs of grade 3, with minimal pyramidal weakness in lower limbs, brisk knee and ankle jerks. The plantar response was extensor. Upper limb examination was normal. On investigations, he had hypoalbuminemia, hyperbilirubinemia, increased plasma ammonia levels. Contrast enhanced CT scan abdomen revealed dilated splenorenal shunt and MRI spine showed no spinal cord compression. Electromyoneurogram was also normal. Spastic paraparesis due to portosystemic shunts was diagnosed. Liver transplantation can reverse the myelopathy only in earlier stages, hence early and accurate diagnosis is important.

Rao, Prasanna K.S.; Sheth, Keyur A.; Nadig, Raghunandan; Patil, Mallikarjun; Channagiri, Adarsh K.

2012-01-01

61

Portosystemic myelopathy: a rare neurological presentation of portosystemic shunts.  

PubMed

Portosystemic myelopathy is an unusual complication in patients with chronic liver disease with hepatic encephalopathy and portosystemic shunts. Here we present a case of 35-year-old male patient who presented to us with difficulty in walking and progressive stiffness in both lower limbs for two months. He had undergone splenectomy with distal splenorenal shunt 20 years back. On physical examination, he had spasticity in both lower limbs of grade 3, with minimal pyramidal weakness in lower limbs, brisk knee and ankle jerks. The plantar response was extensor. Upper limb examination was normal. On investigations, he had hypoalbuminemia, hyperbilirubinemia, increased plasma ammonia levels. Contrast enhanced CT scan abdomen revealed dilated splenorenal shunt and MRI spine showed no spinal cord compression. Electromyoneurogram was also normal. Spastic paraparesis due to portosystemic shunts was diagnosed. Liver transplantation can reverse the myelopathy only in earlier stages, hence early and accurate diagnosis is important. PMID:25755460

Rao, Prasanna K S; Sheth, Keyur A; Nadig, Raghunandan; Patil, Mallikarjun; Channagiri, Adarsh K

2012-12-01

62

Subacute Cervical Myelopathy in a Child with Cerebral Palsy  

Microsoft Academic Search

A 12-year-old girl with a spastic dystonic tetraparesis due to cerebral palsy showed a subacute cervical myelopathy. X-ray films of the cervical spine demonstrated a subluxation of C4 on C5. Myelography and computerized tomography of the cervical spine performed under general anesthesia demonstrated only a minimal rotation of C3 with respect to C4 and a rather narrow cervical canal. In

L. Angelini; G. Broggi; N. Nardocci; M. Savoiardo

1982-01-01

63

Development of a self-administered questionnaire to screen patients for cervical myelopathy  

PubMed Central

Background In primary care, it is often difficult to diagnose cervical myelopathy. However, a delay in treatment could cause irreversible aftereffects. With a brief and effective self-administered questionnaire for cervical myelopathy, cervical myelopathy may be screened more easily and oversight may be avoided. As there is presently no screening tool for cervical myelopathy, the aim of this study was to develop a self-administered questionnaire for the screening of cervical myelopathy. Methods A case-control study was performed with the following two groups at our university hospital from February 2006 to September 2008. Sixty-two patients (48 men, 14 women) with cervical myelopathy who underwent operative treatment were included in the myelopathy group. In the control group, 49 patients (20 men, 29 women) with symptoms that could be distinguished from those of cervical myelopathy, such as numbness, pain in the upper extremities, and manual clumsiness, were included. The underlying conditions were diagnosed as carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, tarsal tunnel syndrome, diabetes mellitus neuropathy, cervical radiculopathy, and neuralgic amyotrophy. Twenty items for a questionnaire in this study were chosen from the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, which is a new self-administered questionnaire, as an outcome measure for patients with cervical myelopathy. Data were analyzed by univariate analysis using the chi-square test and by multiple logistic regression analysis. According to the resulting odds ratio, ?-coefficients, and p value, items were chosen and assigned a score. Results Eight items were chosen by univariate and multiple logistic regression analyses and assigned a score. The Hosmer-Lemeshow statistic showed p = 0.805. The area under the receiver operation characteristic curve was 0.86. The developed questionnaire had a sensitivity of 93.5% and a specificity of 67.3%. Conclusions We successfully developed a simple self-administered questionnaire to screen for cervical myelopathy. PMID:21092213

2010-01-01

64

Slow ascending myelopathy, tetraplegia, carcinoma of the bladder and amyloidosis in a patient with ankylosing spondylitis  

Microsoft Academic Search

Objective: We report a case of slow ascending myelopathy in a patient with ankylosing spondylitis (AS). Design: Case Report of a 60-year-old patient suffering from AS, who developed over a period of 39 years a slow ascending myelopathy leading to tetraplegia, squamous cell carcinoma of the bladder and amyloidosis of the small intestine secondary to neuropathic bladder and bowel. Setting:

M Zwecker; A Daich; N Blumen; G Zeilig; A Ohry

2000-01-01

65

Increased seroreactivity to HERV-K10 peptides in patients with HTLV myelopathy  

PubMed Central

Background Previously, we had shown that persons infected with human T-cell lymphoma leukemia virus 1 or 2 (HTLV-1 or 2) had an increased prevalence of antibodies to a peptide in the Pol protein of the retrovirus HERV-K10, homologous to a peptide in HTLV gp21 envelope protein. The prevalence rate was higher in those with myelopathy vs. non-myelopathy. We have now extended our observations to a cohort restricted to North America in whom the diagnosis of HTLV myelopathy was rigorously confirmed to also test for reactivity to another HERV-K10 peptide homologous to the HTLV p24 Gag protein. Methods Sera from 100 volunteer blood donors (VBD), 53 patients with large granular lymphocytic leukemia (LGLL), 74 subjects with HTLV-1 or 2 infection (58 non-myelopathy and 16 myelopathy) and 83 patients with multiple sclerosis (MS) were evaluated in ELISA assays using the above peptides. Results The HTLV myelopathy patients had a statistically significant increased prevalence of antibodies to both HERV-K10 peptides (87.5%) vs. the VBD (0%), LGLL patients (0%), MS patients (4.8%), and the HTLV positive non-myelopathy subjects (5.2%). Conclusion The data suggest that immuno-cross-reactivity to HERV-K10 peptides and/or transactivation of HERV-K10 expression by the HTLV Tax protein may be involved in the pathogenesis of HTLV-associated myelopathy/tropical spastic paraparesis and spastic ataxia. PMID:24365054

2013-01-01

66

Anterior approaches for cervical spondylotic myelopathy: Which? When? How?  

PubMed

Cervical spondylotic myelopathy is a degenerative disorder with an unfavorable natural history. Surgical treatment options have evolved substantially over time, with both anterior and posterior methods proving successful for certain patients with specific characteristics. Anterior decompression of the spinal canal plus fusion techniques for stabilization has several advantages and some disadvantages when compared to posterior options. Understanding the pros and cons of the approaches and techniques is critical for the surgeon to select the best operative treatment strategy for any given patient to achieve the best outcome. Multiple decision-making factors are involved, such as sagittal alignment, number of levels, shape of the pathoanatomy, age and comorbidities, instability, and pre-operative pain levels. Any or all of these factors may be relevant for a given patient, and to varying degrees of importance. Choice of operative approach will therefore be dependent on patient presentation, risks of that approach for a given patient, and to some degree surgeon experience. PMID:25652554

Emery, Sanford E

2015-04-01

67

Progressive Relapse of Ligamentum Flavum Ossification Following Decompressive Surgery  

PubMed Central

Thoracic ossification of the ligamentum flavum (T-OLF) is a relatively rare spinal disorder that generally requires surgical intervention, due to its progressive nature and the poor response to conservative therapy. The prevalence of OLF has been reported at 3.8%-26%, which is similar to that of cervical ossification of the posterior longitudinal ligament (OPLL). The progression of OPLL after cervical laminoplasty for the treatment of OPLL is often shown in long-term follow-up. However, there have been no reports on the progression of OLF following surgery. We report a case of thoracic myelopathy secondary to the progressive relapse of OLF following laminectomy. PMID:25558329

Ando, Kei; Ito, Zenya; Kobayashi, Kazuyoshi; Ukai, Junichi; Muramoto, Akio; Shinjo, Ryuichi; Matsumoto, Tomohiro; Nakashima, Hiroaki; Ishiguro, Naoki

2014-01-01

68

Thoracic extraosseous, epidural, cavernous hemangioma: Case report and review of literature.  

PubMed

A 40-year-old male presented with mid-thoracic backache and progressive, ascending, spastic, paraparesis for one year. Magnetic resonance imaging demonstrated an extraosseous, extradural mass, without any bone invasion at the T2-T4 vertebral levels, located dorsal to the thecal sac. The spinal cord was compressed ventrally. The lesion was totally excised after a T2-T4 laminectomy. Histopathological examination revealed a cavernous hemangioma. The authors reported this case and reviewed the literature, to explain why extraosseous, extradural, cavernous hemangiomas should be considered in the differential diagnosis of extradural thoracic compressive myelopathy. PMID:24250167

Sharma, Manish S; Borkar, Sachin A; Kumar, Amandeep; Sharma, M C; Sharma, Bhawani S; Mahapatra, Ashok K

2013-07-01

69

Maple Syrup Urine Disease Complicated with Kyphoscoliosis and Myelopathy.  

PubMed

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

Hou, Jia-Woei

2014-01-29

70

Regorafenib-induced transverse myelopathy after stereotactic body radiation therapy  

PubMed Central

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

Tian, Sibo; Nissenblatt, Michael

2014-01-01

71

Cervical Myelopathy Secondary to Atlanto-occipital Assimilation: The Usefulness of the Simple Decompressive Surgery  

PubMed Central

Atlanto-occipital assimilation is one of the most common osseous anomalies observed at the craniocervical junction. Most patients with atlas assimilation show no symptom, but some have neurological problems such as myelopathy that may require surgical treatment. Occipitocervical fusion may be required if atlato-occipital assimilation is accompanied by occipito-axial instability. However, in cases of symptomatic atlas assimilation with minor cord compression without instability, simple decompressive surgery may be the treatment modality. This report describes a case of successful treatment of a patient with myelopathy secondary to atlanto-occipital assimilation without instability, using posterior simple decompressive surgery. PMID:24757486

Kim, Kang Rae; Kim, Young Zoon; Cho, Yong Woon; Kim, Joon Soo; Kim, Kyu Hong; Lee, In Chang

2013-01-01

72

Progressive myelopathy, a consequence of intra-thecal chemotherapy: Case report and review of the literature.  

PubMed

Intra-thecal chemotherapy is a recognized therapy for hematological malignancies such as acute lymphoblastic leukemia (ALL). Despite the advantage of these drugs in treating or preventing central nervous system disease, they are not without complications. The authors describe a 12-year-old girl with ALL, who developed progressive myelopathy following intra-thecal administration of cytosine arabinoside. Initial presentation was urine and fecal retention that progressed to paraplegia, and finally encephalopathy. magnetic resonance imaging of the neuroaxis showed T2-weighted foci of increased signal intensity within the substance of the cervical cord indicative of myelopathy. Physicians should be wary of this rare complication of intra-thecal chemotherapy. PMID:25772933

Chukwu, B F; Ukekwe, I F; Ezenwosu, O U; Ani, C O; Ikefuna, A N; Emodi, I J

2015-01-01

73

A rare presentation of subacute progressive ascending myelopathy secondary to cement leakage in percutaneous vertebroplasty.  

PubMed

Percutaneous vertebroplasty is used to manage osteoporotic vertebral body compression fractures. Although it is relatively safe, complications after vertebroplasty ranging from minor to devastatingly major ones have been described. Cement leakage into the spinal canal is one such complication. Subacute progressive ascending myelopathy is an infrequent neurologic complication after spinal cord injury, typically presenting as ascending neurologic deficit within weeks after the initial insult. The precise cause of subacute progressive ascending myelopathy still remains an enigma, considering the rarity of this disorder. The authors present the case of a 62-yr-old woman with osteoporotic vertebral fracture who underwent percutaneous vertebroplasty and developed T6 complete paraplegia because of cement leakage. A few weeks later, the neurologic level ascended to higher cervical level (C3). To date, no case of subacute progressive ascending myelopathy secondary to cement leakage after percutaneous vertebroplasty has been reported. Literature is reviewed regarding subacute progressive ascending myelopathy, and the rehabilitation challenges in the management of this patient are discussed. PMID:24322431

Bhide, Rohit Prakash; Barman, Apurba; Varghese, Shiela Mary; Chatterjee, Ahana; Mammen, Suraj; George, Jacob; Thomas, Raji

2014-05-01

74

Prevalence and Distribution of Thoracic and Lumbar Compressive Lesions in Cervical Spondylotic Myelopathy  

PubMed Central

Study Design Retrospective cross-sectional study. Purpose This study analyzed the prevalence and distribution of horacic and lumbar compressive lesions in cervical spondylotic myelopathy as well as their relationships with cervical developmental spinal canal stenosis (DCS) by using whole-spine postmyelographic computed tomography. Overview of Literature There are few studies on missed compressive lesions of the spinal cord or cauda equina at the thoracolumbar level in cervical spondylotic myelopathy. Furthermore, the relationships between DCS, and the prevalence and distribution of thoracic and lumbar compressive lesions are unknown. Methods Eighty patients with symptomatic cervical spondylotic myelopathy were evaluated. Preoperative image data were obtained. Patients were classified as DCS or non-DCS (n=40 each) if their spinal canal longitudinal diameter was <12 mm at any level or ?12 mm at all levels, respectively. Compressive lesions in the anterior and anteroposterior parts, ligamentum flavum ossification, posterior longitudinal ligament ossification, and spinal cord tumors at the thoracolumbar levels were analyzed. Results Compressive lesions in the anterior and anteroposterior parts were observed in 13 (16.3%) and 45 (56.3%) patients, respectively. Ligamentum flavum and posterior longitudinal ligament ossification were observed in 19 (23.8%) and 3 (3.8%) patients, respectively. No spinal cord tumors were observed. Thoracic and lumbar compressive lesions of various causes tended to be more common in DCS patients than non-DCS patients, although the difference was statistically insignificant. Conclusions Surveying compressive lesions and considering the thoracic and lumbar level in cervical spondylotic myelopathy in DCS patients are important for preventing unexpected neurological deterioration and predicting accurate neurological condition after cervical surgery.

Kodera, Ryuzo; Yoshiiwa, Toyomi; Kawano, Masanori; Kaku, Nobuhiro; Tsumura, Hiroshi

2015-01-01

75

Breed Distribution of SOD1 Alleles Previously Associated with Canine Degenerative Myelopathy  

PubMed Central

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

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

76

Hepatic Myelopathy in a Patient with Decompensated Alcoholic Cirrhosis and Portal Colopathy  

PubMed Central

Cirrhotic or hepatic myelopathy is a rare neurological complication of chronic liver disease usually seen in adults and presents as a progressive pure motor spastic paraparesis which is usually associated with overt liver failure and a surgical or spontaneous systemic portocaval shunt. We describe the development of progressive spastic paraparesis, in a patient with alcoholic cirrhosis with portal hypertension and portal colopathy who presented with the first episode of hepatic encephalopathy. The patient had not undergone any shunt procedure. PMID:25374709

Premkumar, Madhumita; Bagchi, Avishek; Kapoor, Neha; Gupta, Ankit; Maurya, Gaurav; Vatsya, Shubham; Kapahtia, Siddharth; Kar, Premashish

2012-01-01

77

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

PubMed Central

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

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

2014-01-01

78

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

PubMed

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

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

2003-08-15

79

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

Microsoft Academic Search

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.

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

2003-01-01

80

Neuroimmunological aspects of human T cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis.  

PubMed

Human T cell leukemia virus type 1 (HTLV-1) is a human retrovirus etiologically associated with adult T cell leukemia/lymphoma and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Only approximately 0.25-4 % of infected individuals develop HAM/TSP; the majority of infected individuals remain lifelong asymptomatic carriers. Recent data suggest that immunological aspects of host-virus interactions might play an important role in the development and pathogenesis of HAM/TSP. This review outlines and discusses the current understanding, ongoing developments, and future perspectives of HAM/TSP research. PMID:23943469

Saito, Mineki

2014-04-01

81

Treatment Results in the Different Surgery of Intradural Extramedullary Tumor of 122 Cases  

PubMed Central

Study Design A retrospective study of intradural extramedullary tumor. Objective To compare the treatment results in the different surgeries of spinal intradural extramedullary tumor. Methods The study retrospectively reviewed 122 patients. The minimally invasive surgery (MIS) group was divided into Group A (hemilaminectomy + tumor microscopic excision) and Group B (laminectomy + tumor microscopic excision + pedicle screw fixation). Meanwhile, the non-MIS group was divided into Group C (hemilaminectomy + tumor excision), Group D (laminectomy + tumor excision), and Group E (laminectomy + tumor excision + pedicle screw fixation). In order to study postoperative spinal stability, we simultaneously divided all of the subjects into three categories, namely Group HE: hemilaminectomy + tumor excision; Group LE: laminectomy + tumor excision; and Group LEPSF: laminectomy + tumor excision + pedicle screw fixation. Results The MIS group exhibited fewer postoperative complications (p<0.05), better short-term clinical efficacy (p<0.05) and less non-surgical cost (p<0.05) than in non-MIS group. The rate of postoperative spinal instability in hemilaminectomy was lower than in laminectomy in a single spinal segment (p<0.05). The rate of postoperative spinal instability in laminectomy + pedicle screw fixation was lower than in hemilaminectomy and laminectomy in two or more spinal segments (p<0.05). Conclusion In the case of appropriate surgical indications, minimally invasive surgery for intradural extramedullary tumor is a useful method that can successfully produce good clinical results and reduce non-surgical cost. In addition, pedicle screw fixation helps avoid spinal postoperative instability. PMID:25372863

Zong, Shaohui; Zeng, Gaofeng; Du, Li; Fang, Ye; Gao, Taihang; Zhao, Jingmin

2014-01-01

82

Tentorial dural arteriovenous fistula presenting as myelopathy: Case series and review of literature  

PubMed Central

Dural arteriovenous fistula (DAVF) is a rare type of cerebral arteriovenous malformation. Common presenting symptoms are related to hemorrhage. However, rarely these patients may present with myelopathy. We present two cases of DAVF presenting as rapidly progressive myelopathy. Two treatment options are available: microsurgical interruption of the fistula and endovascular embolization. These treatment options of DAVFs have improved significantly in the last decade. The optimal treatment of DAVFs remains controversial, and there is an ongoing debate as to whether primary endovascular or primary microsurgical treatment is the optimal management for these lesions. However, despite treatment a high percentage of patients are still left with severe disability. The potential for functional ambulation in patients with DAVF is related to the time of intervention. This emphasizes the important of early diagnosis and early intervention in DAVF. The eventual outcome may depend on several factors, such as the duration of symptoms, the degree of disability before treatment, and the success of the initial procedure to close the fistula. The usage of magnetic resonance imaging and selective angiography has significantly improved the ability to characterize DAVFs, however, these lesions remain inefficiently diagnosed. If intervention is delayed even prolonged time in rehabilitation does not change the grave prognosis. This review outlines the presentation, classication and management of DAVF as well as discussing patient outcomes. PMID:25516869

Gross, Robert; Ali, Rushna; Kole, Max; Dorbeistein, Curtis; Jayaraman, Mahesh V; Khan, Muhib

2014-01-01

83

Intramedullary Sarcoidosis Presenting with Delayed Spinal Cord Swelling after Cervical Laminoplasty for Compressive Cervical Myelopathy  

PubMed Central

Sarcoidosis is a systemic disease of unknown etiology that may affect any organ in the body. The nervous system is involved in 5-16% of cases of sarcoidosis. Here, we report a case of intramedullary sarcoidosis presenting with delayed spinal cord swelling after laminoplasty for the treatment of compressive cervical myelopathy. A 56-year-old woman was admitted to our hospital complaining of upper extremity pain and gait disturbance. The patient had undergone laminoplasty for compressive cervical myelopathy 3 months previously. Follow-up magnetic resonance imaging revealed a large solitary intramedullary lesion with associated extensive cord swelling, signal changes, and heterogeneous enhancement of spinal cord from C2 to C7. Spinal cord biopsy revealed non-necrotizing granulomas with signs of chronic inflammation. The final diagnosis of sarcoidosis was based upon laboratory data, imaging findings, histological findings, and the exclusion of other diagnoses. Awareness of such presentations and a high degree of suspicion of sarcoidosis may help arrive at the correct diagnosis. PMID:25535524

Kwon, Du Ho; Kim, Eun-Sang; Eoh, Whan

2014-01-01

84

[Human T-cell lymphotropic virus type 1(HTLV-1)-associated myelopathy].  

PubMed

HTLV-1-associated myelopathy (HAM), also known as tropical spastic paraparesis (TSP), is a chronic progressive demyelinating disease that affects the spinal cord and white matter of the central nervous system. The lifetime incidence of HAM in HTLV-1 carriers is estimated to be less than 5%. Typical time of onset is in the fourth decade of life, with a female-to-male rate of 2:1. Gait disturbance and weakness and stiffness of the lower limbs are common presenting signs and symptoms of HAM. Lower extremities are affected to a much greater degree than upper extremities. Spasticity may be moderate to severe, and lower back pain is common. As the disease progresses, bladder and bowel dysfunction can occur. Sensory involvement is generally mild and can result in a variable degree of sensory loss and dysesthesia. Results of magnetic resonance imaging may be normal, or the scans show atrophy of the spinal cord and nonspecific lesions in the brain. Immunologic evidence suggests that an immune mechanism may play a role in the development of HAM. There is no effective treatment for the myelopathy. Corticosteroids, and INF-gamma may produce transient responses. Danazol, an anabolic steroid, does not improve gait and bladder function. The value of zidovudine (anti-retroviral agent) in the treatment has not been defined yet. PMID:12170334

Ribas, João Gabriel Ramos; Melo, Gustavo Correa Netto

2002-01-01

85

Post-anaesthetic myelopathy in a 3-year-old Friesian gelding.  

PubMed

A 3-year-old Friesian stallion was referred to the Department of Equine Sciences at Utrecht University with signs of colic. Laparotomy was performed and the stallion was castrated bilaterally because of an incarcerated inguinal hernia. Intestinal resection was not performed. Eight days postoperatively, the horse showed signs of severe colic and was admitted for re-laparotomy. After resection of 1.5 m of strangulated jejunum and severe intraoperative hypotension, bradycardia, and electrolyte disorders, the horse showed problems during recovery with signs of hindquarter paralysis. There was no pain perception in the hind limbs and there were no patellar or anal reflexes. The muscles of the hindquarters and the long extensor muscles of the back were soft and not painful on palpation. No improvement was seen 60 minutes after intravenous injection of corticosteroids. Because of the tentative diagnosis of post-anaesthetic myelopathy and its poor prognosis, and the fact that the horse was restless and did not accept being lifted with a sling system, the horse was euthanized with the owner's consent. Post-anaesthetic myelopathy is a rare neuropathological condition in the horse. Because of its low incidence, knowledge about its aetiology and contributing factors is rather limited. This case report presents the clinical observations and the anaesthetic protocol and compares this case with previously reported cases in the literature. PMID:20415029

van Loon, J P A M; Meertens, N M; van Oldruitenborgh-Oosterbaan, M M Sloet; van Dijk, R

2010-04-01

86

Spinal Extradural Arachnoid Cyst  

PubMed Central

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

Choi, Seung Won; Seong, Han Yu

2013-01-01

87

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

PubMed Central

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

Choi, Hyu Jin; Kim, Kyoung Beom

2011-01-01

88

Neurologic abnormalities in HTLV-I– and HTLV-II–infected individuals without overt myelopathy  

PubMed Central

Background: Human T-lymphotropic virus (HTLV) type I is the causative agent of HTLV-associated myelopathy (HAM)/tropical spastic paraparesis, and a number of HAM cases with HTLV-II infection have also been reported. However, despite some reports, it is unclear whether HTLV-I or -II infection is associated with other neurologic manifestations. Methods: An analysis of medical histories and screening neurologic examinations from a prospective cohort of 153 HTLV-I, 388 HTLV-II, and 810 HTLV-seronegative individuals followed up for means of 11.5, 12.0, and 12.2 years was performed. Participants diagnosed with HAM were excluded. We calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race or ethnicity, income, educational attainment, body mass index, alcohol and cigarette consumption, injection drug use, diabetes, and hepatitis C virus status, using generalized estimating equations for repeated measures. Results: HTLV-I and -II participants were more likely than seronegative participants to have leg weakness (ORs 1.67 [95% CI 1.28–2.18] and 1.44 [1.16–1.78]), impaired tandem gait (ORs 1.25 [95% CI 1.07–1.47] and 1.45 [1.27–1.64]), Babinski sign (ORs 1.54 [95% CI 1.13–2.08] and 1.51 [1.18–1.93]), impaired vibration sense (ORs 1.16 [95% CI 1.01–1.33] and 1.27 [1.14–1.42]), and urinary incontinence (ORs 1.45 [95% CI 1.23–1.72] and 1.70 [1.50–1.93]). For both HTLV-I and -II participants, higher odds of sensory neuropathy by monofilament examination were no longer significant after adjustment for confounding. Conclusions: These results provide strong evidence that human T-lymphotropic virus (HTLV)-I and -II are associated with a spectrum of predominantly motor abnormalities in patients without overt HTLV-associated myelopathy. Further investigation of the clinical course and etiology of these abnormalities is warranted. GLOSSARY ATL = adult T-cell leukemia/lymphoma; CI = confidence interval; HAM = human T-lymphotropic virus–associated myelopathy; HOST = HTLV Outcomes Study; HTLV = human T-lymphotropic virus; OR = odds ratio; ORa = adjusted odds ratio. PMID:19738173

Biswas, H H.; Engstrom, J W.; Kaidarova, Z; Garratty, G; Gibble, J W.; Newman, B H.; Smith, J W.; Ziman, A; Fridey, J L.; Sacher, R A.; Murphy, E L.

2009-01-01

89

Management of surgical splenorenal shunt-related hepatic myelopathy with endovascular interventional techniques  

PubMed Central

We present a case with hepatic myelopathy (HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques. A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt. A portal venogram identified a widened patent splenorenal shunt. We used an occlusion balloon catheter initially to occlude the shunt. Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength. We then used an Amplatzer vascular plug (AVP) to enable closure of the shunt. During the follow up period of 7 mo, the patient experienced significant clinical improvement and normalization of blood ammonia, without any complications. Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms. PMID:23323015

Wang, Mao-Qiang; Liu, Feng-Yong; Duan, Feng

2012-01-01

90

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

PubMed Central

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

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

2015-01-01

91

Human T Lymphotropic Virus Type-1-associated Myelopathy Manifesting Shortly after Living-donor Renal Transplantation.  

PubMed

A 38-year-old woman experienced numbness in both lower extremities and spastic paralysis a few months after undergoing living-donor renal transplantation. The patient was negative for human T lymphotropic virus type-1 (HTLV-1) antibodies prior to the procedure; however, she was diagnosed with HTLV-1-associated myelopathy (HAM) based on positive serum and cerebrospinal fluid antibody titers after the surgery. Because the donor was also positive for HTLV-1 antibodies, the infection likely originated from the transplanted kidney. Clinical and imaging improvements were noted following the administration of interferon-?. HAM has been reported to occur after living-donor renal transplantation; however, there are no previous reports of onset within such a short period. PMID:25742898

Nagamine, Yuito; Hayashi, Takeshi; Kato, Yuji; Horiuchi, Yohsuke; Tanahashi, Norio

2015-01-01

92

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

PubMed

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

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

2014-05-28

93

[Combined spinal-epidural anesthesia for a patient with HTLV-1 associated myelopathy].  

PubMed

An 81-year-old female with HTLV-1 associated myelopathy (HAM) was scheduled for transurethral lithotomy. She had had paresthesia and spastic paresis in the lower extremities for the past 15 years. The preoperative respiratory function test revealed a vital capacity of 1.3 l (58% of the predicted value). We selected combined spinal-epidural anesthesia (CSEA) for her to avoid postoperative respiratory complications due to general anesthesia. After placement of a thoracic epidural catheter, spinal anesthesia was achieved by administration of bupivacaine 7.5 mg, resulting in the sensory block level to T 6, five min later. The intraoperative blood pressure remained high at 150-200 mmHg, in spite of the administration of nicardipine. Postoperatively, neither the deterioration in the neurological findings of HAM nor the exacerbation of respiratory function was observed. The present report suggests that CSEA can be one of the choices of anesthesia for a patient with HAM. PMID:25199333

Yokomizo, Taishi; Hiraki, Teruyuki; Mishima, Yasunori; Ushijima, Kazuo

2014-08-01

94

[Pathophysiology, treatment and biomarkers for HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP)].  

PubMed

HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a rare neurodegenerative disease of the central nervous system caused by infection with human T-lymphotropic virus type-1 (HTLV-1). HAM/TSP is characterized by chronic inflammation in spinal cord, leading to neurodegeneration and consequently the patients with HAM/TSP suffer from unremitting myelopathic symptoms such as spastic paraparesis, lower limb sensory disturbance, and bladder/bowel dysfunction. In the past quarter century since the discovery of this disease, significant advances have been made in the field of HAM/TSP research. Here we summarize current clinical and pathophysiological knowledge on HAM/TSP and discusses future focus areas for research on this disease. PMID:23777097

Yamano, Yoshihisa; Sato, Tomoo

2013-05-01

95

Motor evoked potentials in the post-surgical follow-up of cervical spondylotic myelopathy.  

PubMed

Eighteen patients (6 female, 12 male; average age 51 years, range 37-79) with clinical and radiological evidence (MRI) of cervical spondylotic myelopathy (CSM) were examined. The subjects were divided into two groups depending on whether radiology indicated single level (9 patients) or multilevel (9 patients) compression of the cervical cord. All of the patients underwent surgical decompression. Seriate exam with trans-cranial magnetic stimulation was performed in double session before surgery, and 3 and 12 months after surgery. The follow-up study of these patients revealed a statistically significant neurophysiological improvement only in those patients with single-level compression. In these cases, the cervical cord pathology revealed by MRI signal hyperintensity in T2 may at least partially consist of an edematous component and/or an initial demyelinization that has still a chance of recovery. In patients with multilevel damage, the compression may cause irreversible lesions. PMID:7591676

De Mattei, M; Paschero, B; Cocito, D; Cassano, D; Campanella, A; Rizzo, L; Morgando, E

1995-05-01

96

Comparisons of three anterior cervical surgeries in treating cervical spondylotic myelopathy  

PubMed Central

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). 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?myelopathy. But each group has respective advantages and disadvantages. PMID:25012927

2014-01-01

97

Diffusion Tensor Imaging Studies of Cervical Spondylotic Myelopathy: A Systemic Review and Meta-Analysis  

PubMed Central

A meta-analysis was conducted to assess alterations in measures of diffusion tensor imaging (DTI) in the patients of cervical spondylotic myelopathy (CSM), exploring the potential role of DTI as a diagnosis biomarker. A systematic search of all related studies written in English was conducted using PubMed, Web of Science, EMBASE, CINAHL, and Cochrane comparing CSM patients with healthy controls. Key details for each study regarding participants, imaging techniques, and results were extracted. DTI measurements, such as fractional anisotropy (FA), apparent diffusion coefficient (ADC), and mean diffusivity (MD) were pooled to calculate the effect size (ES) by fixed or random effects meta-analysis. 14 studies involving 479 CSM patients and 278 controls were identified. Meta-analysis of the most compressed levels (MCL) of CSM patients demonstrated that FA was significantly reduced (ES -1.52, 95% CI -1.87 to -1.16, P < 0.001) and ADC was significantly increased (ES 1.09, 95% CI 0.89 to 1.28, P < 0.001). In addition, a notable ES was found for lowered FA at C2-C3 for CSM vs. controls (ES -0.83, 95% CI -1.09 to -0.570, P < 0.001). Meta-regression analysis revealed that male ratio of CSM patients had a significant effect on reduction of FA at MCL (P = 0.03). The meta-analysis of DTI studies of CSM patients clearly demonstrated a significant FA reduction and ADC increase compared with healthy subjects. This result supports the use of DTI parameters in differentiating CSM patients from health subjects. Future researches are required to investigate the diagnosis performance of DTI in cervical spondylotic myelopathy. PMID:25671624

Guan, Xiaofei; Fan, Guoxin; Wu, Xinbo; Gu, Guangfei; Gu, Xin; Zhang, Hailong; He, Shisheng

2015-01-01

98

Syphilitic myelopathy  

MedlinePLUS

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

99

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

PubMed Central

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

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

100

Interferon beta-1a treatment in HTLV-1-associated myelopathy/tropical spastic paraparesis: a case report.  

PubMed

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

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

2014-01-01

101

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

PubMed

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

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

2013-12-01

102

Synovial chondromatosis of the lumbar spine with compressive myelopathy: a case report with review of the literature  

Microsoft Academic Search

Synovial chondromatosis has been rarely reported to occur in the spine with only one case found in the lumbar spine. We describe\\u000a another case of synovial chondromatosis in the lumbar spine in a 41-year-old man who presented with compressive myelopathy.\\u000a The tumor was located in the left ventrolateral corner of the epidural space just below the L4–L5 intervertebral space. Besides

Ibrahim Fikry Abdelwahab; Daniel Contractor; Stefano Bianchi; George Hermann; Benjamin Hoch

2008-01-01

103

Occurrence of primary biliary cirrhosis, CREST syndrome and Sjögren's syndrome in a patient with HTLV-I-associated myelopathy.  

PubMed

We report the occurrence of three autoimmune diseases (primary biliary cirrhosis, CREST syndrome and Sjögren's syndrome) in a patient with HTLV-I-associated myelopathy (HAM). The patient had the depressed cell-mediated immune responses but the infiltration of CD8-T cells was found in the cerebrospinal fluid and liver. The clinical and immunological features of this case are similar to those of chronic graft-versus-host disease. PMID:8509804

Kuroda, Y; Fukuoka, M; Endo, C; Matsui, M; Kurohara, K; Kakigi, R; Tokunaga, O

1993-05-01

104

Cervical vertebral canal endoscopy in a horse with cervical vertebral stenotic myelopathy.  

PubMed

A 3-year-old Thoroughbred gelding presented with a history of neurological signs, including incoordination in his hindlimbs, of about 7 months' duration. On initial examination, the horse exhibited ataxia and paresis in all limbs with more severe deficits in the hindlimbs. Cervical radiographs displayed severe osteoarthritis of the articular processes between C5 and C6. On subsequent cervical myelography the dorsal contrast column was reduced by 90% at the level of the intervertebral space between C5 and C6. Cervical vertebral canal endoscopy, including epidural (epiduroscopy) and subarachnoid endoscopy (myeloscopy), was performed under general anaesthesia. A substantial narrowing of the subarachnoid space at the level between C6 and C7 was seen during myeloscopy, while no compression was apparent between C5 and C6. Epiduroscopy showed no abnormalities. After completion of the procedure, the horse was subjected to euthanasia and the cervical spinal cord submitted for histopathological examination. Severe myelin and axon degeneration of the white matter was diagnosed at the level of the intervertebral space between C6 and C7, with Wallerian degeneration cranially and caudally, indicating chronic spinal cord compression at this site. Myeloscopy was successfully used to identify the site of spinal cord compression in a horse with cervical vertebral stenotic myelopathy, while myelography results were misleading. PMID:21696435

Prange, T; Carr, E A; Stick, J A; Garcia-Pereira, F L; Patterson, J S; Derksen, F J

2012-01-01

105

Positive feedback loop via astrocytes causes chronic inflammation in virus-associated myelopathy.  

PubMed

Human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a rare neurodegenerative disease characterized by chronic inflammation in the spinal cord. We hypothesized that a positive feedback loop driven by chemokines may be responsible for the chronic inflammation in HAM/TSP. We aimed to determine the identity of these chemokines, where they are produced, and how they drive chronic inflammation in HAM/TSP. We found that patients with HAM/TSP have extraordinarily high levels of the chemokine CXCL10 (also known as IP-10) and an abundance of cells expressing the CXCL10-binding receptor CXCR3 in the cerebrospinal fluid. Histological analysis revealed that astrocytes are the main producers of CXCL10 in the spinal cords of patients with HAM/TSP. Co-culture of human astrocytoma cells with CD4+ T cells from patients with HAM/TSP revealed that astrocytes produce CXCL10 in response to IFN-? secreted by CD4+ T cells. Chemotaxis assays results suggest that CXCL10 induces migration of peripheral blood mononuclear cells to the central nervous system and that anti-CXCL10 neutralizing antibody can disrupt this migration. In short, we inferred that human T-lymphotropic virus type 1-infected cells in the central nervous system produce IFN-? that induces astrocytes to secrete CXCL10, which recruits more infected cells to the area via CXCR3, constituting a T helper type 1-centric positive feedback loop that results in chronic inflammation. PMID:23892452

Ando, Hitoshi; Sato, Tomoo; Tomaru, Utano; Yoshida, Mari; Utsunomiya, Atae; Yamauchi, Junji; Araya, Natsumi; Yagishita, Naoko; Coler-Reilly, Ariella; Shimizu, Yukiko; Yudoh, Kazuo; Hasegawa, Yasuhiro; Nishioka, Kusuki; Nakajima, Toshihiro; Jacobson, Steven; Yamano, Yoshihisa

2013-09-01

106

Characterization of Intercostal Muscle Pathology in Canine Degenerative Myelopathy: A Disease Model for Amyotrophic Lateral Sclerosis  

PubMed Central

Dogs homozygous for missense mutations in the SOD1 gene develop a late-onset neuromuscular disorder called degenerative myelopathy (DM) that has many similarities to amyotrophic lateral sclerosis (ALS). Both disorders are characterized by widespread progressive declines in motor functions accompanied by atrophic changes in the descending spinal cord tracts , and some forms of ALS are also associated with SOD1 mutations. In end-stage ALS, death usually occurs as a result of respiratory failure due to severe functional impairment of respiratory muscles. The mechanisms that lead to this loss of function are not known. Dogs with DM are euthanized at all stages of disease progression providing an opportunity to characterize the onset and progression of any pathological changes in the respiratory muscles that may precede respiratory failure. To characterize such potential disease-related pathology we evaluated intercostal muscles from Boxer and Pembroke Welsh Corgi dogs that were euthanized at various stages of DM disease progression. DM was found to result in intercostal muscle atrophy, fibrosis, increased variability in muscle fiber size and shape, and an alteration in muscle fiber type composition. This pathology was not accompanied by retraction of the motor neuron terminals from the muscle acetylcholine receptor complexes, suggesting that the muscle atrophy did not result from physical denervation. These findings provide a better understanding of the mechanisms that likely lead to respiratory failure in at least some forms of ALS and will be useful in the development and evaluation of potential therapeutic interventions using the DM model. PMID:24043596

Morgan, Brandie R.; Coates, Joan R.; Johnson, Gayle C.; Bujnak, Alyssa C.; Katz, Martin L.

2014-01-01

107

Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy.  

PubMed

The purposes of the study reported here were to evaluate the signalment and clinical presentation in 50 dogs with degenerative myelopathy, to evaluate whether mean survival time was significantly affected by various means of physiotherapy performed in 22 dogs, and to determine whether neurologic status, anatomic localization, or age at onset had an influence on survival time in dogs that received physiotherapy. We found a significant (P < .05) breed predisposition for the German Shepherd Dog, Kuvasz, Hovawart, and Bernese Mountain Dog. Mean age at diagnosis was 9.1 years, and both sexes were affected equally. The anatomic localization of the lesion was spinal cord segment T3-L3 in 56% (n = 28) and L3-S3 in 44% (n = 22) of the dogs. Animals that received intensive (n = 9) physiotherapy had longer (P < .05) survival time (mean 255 days), compared with that for animals with moderate (n = 6; mean 130 days) or no (n = 7; mean 55 days) physiotherapy. In addition, our results indicate that affected dogs which received physiotherapy remained ambulatory longer than did animals that did not receive physical treatment. PMID:16955818

Kathmann, I; Cizinauskas, S; Doherr, M G; Steffen, F; Jaggy, A

2006-01-01

108

Phosphorylated neurofilament subunit NF-H becomes elevated in the cerebrospinal fluid of patients with acutely worsening symptoms of compression myelopathy.  

PubMed

It is known that the severity of compression myelopathy sometimes worsens rapidly and results in poor functional recovery because of limited axonal regeneration. Levels of phosphorylated neurofilament subunit NF-H (pNF-H), which indicate axonal degeneration, are elevated in other neurological disorders. To our knowledge, there has been no examination of pNF-H levels in compression myelopathy. Therefore, we conducted a pilot cross-sectional study to evaluate pNF-H levels in the cerebrospinal fluid (CSF) of patients with worsening symptoms of cervical compression myelopathy. From January 2011 to March 2013, 51 samples of CSF were collected from patients at the time of myelography before spinal surgery. The indications for surgery were acutely worsening compression myelopathy (AM) in eight, chronic compression myelopathy (CM) in six, and lumbar canal stenosis (LCS) in 37 patients. The pNF-H levels were measured using a standard enzyme-linked immunosorbent assay. The mean ± standard deviation pNF-H value was 2127.1 ± 556.8 pg/ml in AM patients, 175.8 ± 67.38 pg/ml in CM patients and 518.7 ± 665.7 pg/ml in LCS patients. A significant increase in pNF-H levels was detected in the CSF of patients with AM compared with those with either CM or LCS. The clinical outcome of surgical treatment for patients with cervical myelopathy was satisfactory in both AM and CM patients. Despite the limitations of small sample size and lack of healthy CSF control data due to ethical considerations, our results suggest that pNF-H in CSF can act as a biomarker that reflects the severity of AM. PMID:25065845

Takahashi, Hiroshi; Aoki, Yasuchika; Nakajima, Arata; Sonobe, Masato; Terajima, Fumiaki; Saito, Masahiko; Taniguchi, Shinji; Yamada, Manabu; Watanabe, Fusako; Furuya, Takeo; Koda, Masao; Yamazaki, Masashi; Takahashi, Kazuhisa; Nakagawa, Koichi

2014-12-01

109

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

PubMed Central

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

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

2015-01-01

110

Percutaneous transplantation of human umbilical cord-derived mesenchymal stem cells in a dog suspected to have fibrocartilaginous embolic myelopathy  

PubMed Central

The use of human umbilical cord blood-derived mesenchymal stem cells for cell transplantation therapy holds great promise for repairing spinal cord injury. Here we report the first clinical trial transplantation of human umbilical cord (hUCB)-derived mesenchymal stem cells (MSCs) into the spinal cord of a dog suspected to have fibrocartilaginous embolic myelopathy (FCEM) and that experienced a loss of deep pain sensation. Locomotor functions improved following transplantation in a dog. Based on our findings, we suggest that transplantation of hUCB-derived MSCs will have beneficial therapeutic effects on FCEM patients lacking deep pain sensation. PMID:23820160

Chung, Wook-Hun; Park, Seon-Ah; Lee, Jae-Hoon; Chung, Dai-Jung; Yang, Wo-Jong; Kang, Eun-Hee; Choi, Chi-Bong; Chang, Hwa-Seok; Kim, Dae-Hyun; Hwang, Soo-Han; Han, Hoon

2013-01-01

111

Cervical Spondylotic Myelopathy Caused by Single-Level Vertebral Spontaneous Fusion  

PubMed Central

Purpose To evaluate the clinical features, imaging characteristics, surgical options, and clinical outcomes of patients with Cervical spondylotic myelopathy (CSM) caused by single-level vertebral spontaneous fusion (SLVSF). Methods Sixteen consecutive patients with SLVSF who underwent anterior surgery were included in this study and 38 patients with CSM caused by spinal degeneration were enrolled as a control group. Demographic features, clinical presentations, imaging characteristics, surgery strategy, Nurick grade, Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and complications were evaluated. Results There were significant differences between the two groups in the mean age and the average duration of neck pain. There was no significant difference between the two groups in length of cervical spine. In the SLVSF group, 13 patients had upper segment translational instability and none had rotational instability. Pre- and postoperative Nurick grades were 2.94±0.77 and 2.19±0.54 in the SLVSF group, and 2.97±0.72 and 2.16±0.64 in the control group. Pre- and postoperative JOA scores were 9.25±2.02 and 11.69±1.62 in the SLVSF group, and 9.87±2.58 and 12.53±2.69 in the control group. Pre- and postoperative NDI values were 28.5±7.75 and 15.56±5.51 in the SLVSF group, and 16±6.13 and 11.29±4.58 in the control group. Conclusions Patients with SLVSF have necks of normal lengths, which can be used to distinguish this disorder from Klippel-Feil syndrome. There are three main features of SLVSF: (1) hypoplasia at both of the spontaneously fused vertebral bodies; (2) a major pathological feature of translational instability of the upper vertebra to the fused level; and (3) severe neck pain. Anterior surgery has a good therapeutic effect for patients with cervical SLVSF. PMID:25380388

Hou, Tiesheng; Gu, Guangfei; Zhang, Hailong; Zhao, Shan; He, Shisheng

2014-01-01

112

Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spondylotic myelopathy.  

PubMed

Study design:Prospective study.Objectives:To investigate whether preoperative and postoperative changes of signal intensity (SI) and transverse area (TA) of the spinal cord reflect the surgical outcome in patients with cervical spondylotic myelopathy (CSM).Setting:The Second Hospital of Tangshan, Tangshan, Hebei, China.Methods:In 45 consecutive prospective patients, magnetic resonance imaging (MRI) was performed preoperatively and 3 months postoperatively. The Japanese Orthopedic Association (JOA) scale was used to quantify the neurological status at admission and of at least 12-month follow-up. Preoperative and postoperative TA of the spinal cord at the site of maximal compression and grayscale of signal intensity (GSI) were measured using the image analysis software. Ratio of transverse area (RTA) and ratio of grayscale of signal intensity (RGSI) were used to assess the extent of spinal cord re-expansion and extent of SI regression. Preoperative status and postoperative recovery were assessed in relation to MRI parameters preoperatively and postoperatively using univariate and multivariate analysis.Results:Higher baseline JOA scores were associated with larger TA. Greater recovery rate was associated with larger preoperative and postoperative TA, along with greater RTA. Recovery rate negatively correlated with RGSI and age. Higher baseline JOA score was associated with greater recovery rate. RGSI negatively correlated with RTA. Multivariate stepwise regression analysis showed that the optimal combination of surgical outcome predictors included age, postoperative TA and RGSI.Conclusion:Quantitative MRI analysis in CSM may provide reliable information for the prediction of the postoperative outcome of CSM patients. MRI indicators of good outcome include the larger postoperative TA and greater RGSI.Spinal Cord advance online publication, 18 November 2014; doi:10.1038/sc.2014.204. PMID:25403500

Sun, L-Q; Li, Y-M; Wang, X; Cao, H-C

2014-11-18

113

A plasma diagnostic model of human T-cell leukemia virus-1 associated myelopathy  

PubMed Central

Objective Human T-cell leukemia virus-1 (HTLV-1) associated myelopathy/tropic spastic paraparesis (HAM/TSP) is induced by chronic inflammation in spinal cord due to HTLV-1 infection. Cerebrospinal fluid (CSF) neopterin or proviral load are clinically measured as disease grading biomarkers, however, they are not exactly specific to HAM/TSP. Therefore, we aimed to identify HAM/TSP-specific biomarker molecules and establish a novel less-invasive plasma diagnostic model for HAM/TSP. Methods Proteome-wide quantitative profiling of CSFs from six asymptomatic HTLV-1 carriers (AC) and 51 HAM/TSP patients was performed. Fourteen severity grade biomarker proteins were further examined plasma enzyme-linked immunosorbent assay (ELISA) assays (n = 71). Finally, we constructed three-factor logistic regression model and evaluated the diagnostic power using 105 plasma samples. Results Quantitative analysis for 1871 nonredundant CSF proteins identified from 57 individuals defined 14 CSF proteins showing significant correlation with Osame's motor disability score (OMDS). Subsequent ELISA experiments using 71 plasma specimens confirmed secreted protein acidic and rich in cysteine (SPARC) and vascular cell adhesion molecule-1 (VCAM-1) demonstrated the same correlations in plasma (R = ?0.373 and R = 0.431, respectively). In this training set, we constructed a HAM/TSP diagnostic model using SPARC, VCAM1, and viral load. Sensitivity and specificity to diagnose HAM/TSP patients from AC (AC vs. OMDS 1–11) were 85.3% and 81.1%, respectively. Importantly, this model could be also useful for determination of therapeutic intervention point (OMDS 1–3 + AC vs. OMDS 4–11), exhibiting 80.0% sensitivity and 82.9% specificity. Interpretation We propose a novel less-invasive diagnostic model for early detection and clinical stratification of HAM/TSP.

Ishihara, Makoto; Araya, Natsumi; Sato, Tomoo; Saichi, Naomi; Fujii, Risa; Yamano, Yoshihisa; Ueda, Koji

2015-01-01

114

Novel complications with HTLV-1-associated myelopathy/tropical spastic paraparesis: interstitial cystitis and persistent prostatitis.  

PubMed

Lower urinary symptoms associated with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) are common, but have been regarded as 'neurogenic' due to spinal involvements. However, in some cases, these symptoms are persistent, progressive, and not directly correlated with the severity of other neurologic symptoms of the lower spinal cord. These findings prompted us to locate organic lesions in the lower urinary tract and to correlate them with HTLV-1 infection. Among 35 HAM patients with lower urinary symptoms, we found 4 cases with the symptoms persistent and progressive: 3 with contracted bladder and another with persistent prostatitis. Histological or cytological examinations indicated local lymphocytic infiltrations in the lower urinary tract in all cases: 3 by the infiltration in the bladder and the other by a high concentration of lymphocytes in expressed prostatic secretions. Of 3 cases whose urinary samples were available, 2 showed significant increase in the concentration of urinary anti-HTLV-1 antibody of IgA class. The urinary IgA antibody of the third case was not elevated, but the sample had been obtained after resection of the affected bladder. None of the control cases showed significant anti-HTLV-1 IgA antibody in urine except for a case of gross hematuria due to chemotherapy directed against adult T-cell leukemia. We suggest inclusion of these processes into the spectrum of complications for HAM/TSP. The elevated excretion of anti-HTLV-1 of IgA class in urine may be an indicator of these complications. PMID:1353753

Nomata, K; Nakamura, T; Suzu, H; Yushita, Y; Kanetake, H; Sawada, T; Ikeda, S; Hino, S; Nagataki, S; Saito, Y

1992-06-01

115

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

SciTech Connect

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.

Sahgal, Arjun, E-mail: arjun.sahgal@rmp.uhn.on.ca [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada) [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Weinberg, Vivian [University of California San Francisco Helen Diller Family Comprehensive Cancer Center Biostatistics Core, San Francisco, California (United States)] [University of California San Francisco Helen Diller Family Comprehensive Cancer Center Biostatistics Core, San Francisco, California (United States); Ma, Lijun [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States)] [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States); Chang, Eric [Department of Radiation Oncology, University of Southern California and University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas (United States)] [Department of Radiation Oncology, University of Southern California and University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas (United States); Chao, Sam [Department of Radiation Oncology and Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States)] [Department of Radiation Oncology and Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States); Muacevic, Alexander [European Cyberknife Center Munich in affiliation with University Hospitals of Munich, Munich (Germany)] [European Cyberknife Center Munich in affiliation with University Hospitals of Munich, Munich (Germany); Gorgulho, Alessandra [Department of Neurosurgery, University of California at Los Angeles, Los Angeles, California (United States)] [Department of Neurosurgery, University of California at Los Angeles, Los Angeles, California (United States); Soltys, Scott [Department of Radiation Oncology, Stanford University, Stanford, California (United States)] [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Gerszten, Peter C. [Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States)] [Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Ryu, Sam [Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan (United States)] [Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan (United States); Angelov, Lilyana [Department of Radiation Oncology and Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States)] [Department of Radiation Oncology and Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States); Gibbs, Iris [Department of Radiation Oncology, Stanford University, Stanford, California (United States)] [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Wong, C. Shun [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada)] [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Larson, David A. [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States)] [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States)

2013-02-01

116

Successful conservative treatment of rheumatoid subaxial subluxation resulting in improvement of myelopathy, reduction of subluxation, and stabilisation of the cervical spine. A report of two cases  

Microsoft Academic Search

OBJECTIVETo report the efficacy of conservative treatment with cervical traction and immobilisation with a Halo vest, in two consecutive rheumatoid arthritis patients with progressive cervical myelopathy caused by subaxial subluxation.METHODSDescription of neurological symptoms and signs and findings in plain radiography (PR) and magnetic resonance imaging (MRI) of the cervical spine before and after treatment of the subaxial subluxation by traction

Johanna C M Oostveen; Martin A F J van de Laar; Jan A G Geelen; Ron de Graaff

1999-01-01

117

Radiation myelopathy: Estimates of risk in 1048 patients in three randomized trials of palliative radiotherapy for non-small cell lung cancer  

Microsoft Academic Search

Radiation myelopathy (RM) is an uncommon but serious late effect of thoracic radiotherapy (RT), which oncologists try to avoid by careful planning and dose selection. Five patients with RM are described from among 1048 with inoperable non-small cell lung cancer treated with palliative RT in three randomized trials conducted by the Medical Research Council Lung Cancer Working Party. Seven RT

F. R. Macbeth; T. E. Wheldon; D. J. Girling; R. J. Stephens; D. Machin; N. M. Bleehen; A. Lamont; D. J. Radstone; N. S. Reed

1996-01-01

118

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

PubMed

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

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

119

Familial Clusters of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis  

PubMed Central

Objective HTLV-1 proviral loads (PVLs) and some genetic factors are reported to be associated with the development of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, there are very few reports on HAM/TSP having family history. We aimed to define the clinical features and laboratory indications associated with HAM/TSP having family history. Methods Records of 784 HAM/TSP patients who were hospitalized in Kagoshima University Hospital and related hospitals from 1987 to 2012 were reviewed. Using an unmatched case-control design, 40 patients of HAM/TSP having family history (f-HAM/TSP) were compared with 124 patients suffering from sporadic HAM/TSP, who were admitted in series over the last 10 years for associated clinical features. Results Of the 784 patients, 40 (5.1%) were f-HAM/TSP cases. Compared with sporadic cases, the age of onset was earlier (41.3 vs. 51.6 years, p<0.001), motor disability grades were lower (4.0 vs. 4.9, p?=?0.043) despite longer duration of illness (14.3 vs. 10.2 years, p?=?0.026), time elapsed between onset and wheelchair use in daily life was longer (18.3 vs. 10.0 years, p?=?0.025), cases with rapid disease progression were fewer (10.0% vs. 28.2%, p?=?0.019), and protein levels in cerebrospinal fluid (CSF) were significantly lower in f-HAM/TSP cases (29.9 vs. 42.5 mg, p<0.001). There was no difference in HTLV-1 PVLs, anti-HTLV-1 antibody titers in serum and CSF, or cell number and neopterin levels in CSF. Furthermore, HTLV-1 PVLs were lower in cases with rapid disease progression than in those with slow progression in both f-HAM/TSP and sporadic cases. Conclusions We demonstrated that HAM/TSP aggregates in the family, with a younger age of onset and a slow rate of progression in f-HAM/TSP cases compared with sporadic cases. These data also suggested that factors other than HTLV-1 PVLs contribute to the disease course of HAM/TSP. PMID:24802839

Nozuma, Satoshi; Matsuura, Eiji; Matsuzaki, Toshio; Watanabe, Osamu; Kubota, Ryuji; Izumo, Shuji; Takashima, Hiroshi

2014-01-01

120

Comparison of the Japanese Orthopaedic Association Score and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire Scores: Time-Dependent Changes in Patients with Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament  

PubMed Central

Study Design Prospective cohort study. Purpose To identify differences in time-dependent perioperative changes between the Japanese Orthopaedic Association (JOA) score and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) score in patients with cervical spondylotic myelopathy (CSM) and posterior longitudinal ligament (OPLL) who underwent cervical laminoplasty. Overview of Literature The JOA score does not take into consideration patient satisfaction or quality of life. Accordingly, the JOACMEQ was designed in 2007 as a patient-centered assessment tool. Methods We studied 21 patients who underwent cervical laminoplasty. We objectively evaluated the time-dependent changes in JOACMEQ scores and JOA scores for all patients before surgery and at 2 weeks, 3 months, 6 months, and 1 year after surgery. Results The average total JOA score and the recovery rate improved significantly after surgery in both groups, with a slightly better recovery rate in the OPLL group. Cervical spine function improved significantly in the CSM group but not in the OPLL group. Upper- and lower-extremity functions were more stable in the CSM group than in the OPLL group. The effectiveness rate of the JOACMEQ for measuring quality of life was quite low in both groups. In both groups, the Spearman contingency coefficients were dispersed widely except for upper- and lower-extremity function. Conclusions Scores for upper- and lower-extremity function on the JOACMEQ correlated well with JOA scores. Because the JOACMEQ can also assess cervical spine function and quality of life, factors that cannot be assessed by the JOA score alone, the JOACMEQ is a more comprehensive evaluation tool. PMID:25705334

Iwasaki, Motoki; Sakaura, Hironobu; Fujimori, Takahito; Nagamoto, Yukitaka; Yoshikawa, Hideki

2015-01-01

121

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

PubMed

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

AlHassany, Ali Abdul Jabbar

2014-01-01

122

Human T-lymphotropic virus type 1–associated myelopathy/tropical spastic paraparesis: Viral load and muscle tone are correlated  

PubMed Central

Human T-lymphotropic virus type 1 (HTLV-1) infections are associated with varying degrees of HTLV-1 viral load and spasticity. Increased viral load is associated with higher risk of developing HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP). The authors performed a cross-sectional study of 24 people with HAM/TSP in Lima, Perú, to determine if higher HTLV-1 viral load was correlated with increased muscle tone, measured with a device providing quantitative spasticity assessment (QSA). Median HTLV-1 viral load was 17.0 copies/100 peripheral blood mononuclear cells and QSA value was 39.9 Newton-meters/radian. HTLV-1 viral load was significantly correlated with QSA value (Spearman rho = .48, P = .02), suggesting viral load may play a role in expression of symptomatic neurologic disease. Longitudinal studies are needed to determine if treatments that reduce viral load will reduce muscle tone. PMID:17162662

Zunt, JR; Montano, SM; Beck, I; Alarcón, JOV; Frenkel, LM; Bautista, CT; Price, R; Longstreth, WT

2009-01-01

123

Alopecia areata possibly induced by autoimmune reaction in a patient with human T-cell lymphotropic virus-1-associated myelopathy.  

PubMed

A 38-year-old female patient suffered from alopecia areata totalis followed by human T-cell lymphotropic virus-1-associated myelopathy (HAM). These two diseases have recently been considered to be related to cell-mediated autoimmune reactions. Immunohistochemistry revealed accumulation of CXCR3+ CD8+ T cells around hair bulbs in alopecic lesions. Furthermore, flow cytometric analysis showed the elevated frequency of CD8+ human leukocyte antigen DR+ -activated T cells at the initial time and declined at the hair regrowth phase with HAM. CD4+ CD25+ adult T-cell leukemia/lymphoma cells were elevated at hair loss phase and decreased after improvement of hair loss. These results suggest that autoreactive and cytotoxic CD8(+) T cells induce not only alopecia areata but also HAM in ATL patients. This case highlights that the autoimmune reactions may play an important role in the pathogenesis of alopecia areata and HAM. PMID:23668541

Ito, Taisuke; Shimada, Shinichiro; Mori, Tatsuyoshi; Tokura, Yoshiki

2013-05-01

124

Contribution of Galvanic Vestibular Stimulation for the Diagnosis of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis  

PubMed Central

Background and Purpose Galvanic vestibular stimulation (GVS) is a low-cost and safe examination for testing the vestibulospinal pathway. Human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive disease that affects the vestibulospinal tract early in its course. This study compared the electromyographic (EMG) responses triggered by GVS of asymptomatic HTLV-1-infected subjects and subjects with HAM/TSP. Methods Bipolar galvanic stimuli (400 ms and 2 mA) were applied to the mastoid processes of 39 subjects (n=120 stimulations per subject, with 60 from each lower limb). Both the short latency (SL) and medium latency (ML) components of the EMG response were recorded from the soleus muscles of 13 healthy, HTLV-1-negative adults (56±5 years, mean±SD), and 26 individuals infected with HTLV-1, of whom 13 were asymptomatic (56±8 years) and 13 had HAM/TSP (60±6 years). Results The SL and ML EMG components were 55±4 and 112±10 ms, respectively, in the group of healthy subjects, 61±6 and 112±10 ms and in the HTLV-1-asymptomatic group, and 67±8 and 130±3 ms in the HAM/TSP group (p=0.001). The SL component was delayed in 4/13 (31%) of the examinations in the HTLV-1-asymptomatic group, while the ML component was normal in all of them. In the HAM/TSP group, the most common alteration was the absence of waves. Conclusions A pattern of abnormal vestibular-evoked EMG responses was found in HTLV-1-neurological disease, ranging from delayed latency among asymptomatic carriers to the absence of a response in HAM/TSP. GVS may contribute to the early diagnosis and monitoring of nontraumatic myelopathies. PMID:24285967

Matos Cunha, Luciana Cristina; Campelo Tavares, Maurício; Tierra Criollo, Carlos Julio; Labanca, Ludimila; Cardoso dos Santos Couto Paz, Clarissa; Resende Martins, Henrique; de Freitas Carneiro-Proietti, Anna Bárbara

2013-01-01

125

Juvenile Xanthogranuloma of adult spine: A rare case and review of literature  

PubMed Central

Juvenile Xanthogranuloma (JXG) is a rare disorder of central nervous system. It rarely produces compressive myelopathy. On reviewing world literature, we could find only nine cases of this disease involving spine and of which only four cases were in adults’ i.e., 18 years and above. We are presenting a case of Spinal JXG in an 18-year-old male with thoracic compressive myelopathy presenting as short duration progressive paraparesis. Magnetic Resonance Imaging of Spine showed mass lesion in epidural space compressing cord from behind without any bony involvement at D7 to D10 vertebral segment. It was isointense on T1 and hyperintense on T2 with no contrast enhancement. D7 to D10 Laminectomy with complete excision of firm epidural mass was carried out. The histopathology with tumor markers confirmed the diagnosis of JXG. Post-operative neurological recovery in this patient was good. His power improved to grade 5/5 with decreased spasticity. Follow-up MRI at 3 months showed no residual tumor. This case appears to be the first in the series with entirely extradural component in adult thoracic spine. PMID:25685229

Purohit, Devendra; Chanduka, Amit Kumar; Sharma, Vinod; Mittal, Radhey Shyam; Singhvi, Shashi

2014-01-01

126

Complications corner: Quadriplegia after a minor hyperextension injury with severe OPLL teaching case and illustrative images  

PubMed Central

Background: A previously healthy and asymptomatic male surviving well into his ninth decade (86 years of age) was rendered immediately and completely quadriplegic after a minor fall associated with cervical hyperextension. Methods: Since he was unable to undergo a magnetic resonance (MR) scan due to the presence of a cardiac pacemaker, a non-contrast computed tomography (CT) was performed. This study demonstrated extremely severe cervical spinal canal stenosis secondary to previously undiagnosed ossification of the posterior longitudinal ligament (OPLL) resulting in marked spinal cord compression between C5 and C6. Results: Secondary to his severe and irreversible quadriplegia, the patient elected not to undergo any intervention; he expired 4 days later. Had his deficit not been so severe, and had he been diagnosed earlier and undergone prophylactic/preventive posterior decompression (e.g. laminectomy C4-C7) sufficient to allow his cord to migrate dorsally, his irreversible quadriplegic deficit might have been avoided. Conclusions: Older patients with symptoms of progressive myelopathy should undergo early cervical MR (or CT if they have a pacemaker) screening looking for “silent” cord compression due to stenosis, spondyloarthrosis, and/or OPLL. This case highlights the devastating consequences of even a mild hyperextension injury in a patient harboring extremely severe but previously undiagnosed OPLL. Devastating life-threatening or life-ending injuries may be avoided by maintaining a low threshold for performing screening” cervical studies in elderly patients with vague complaints that might signal the onset of myelopathy. PMID:25289162

Spitzer, Daniel

2014-01-01

127

Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine.  

PubMed

Although classically associated with patients of East Asian origin, ossification of the posterior longitudinal ligament (OPLL) may cause myelopathy in patients of any ethnic origin. Degeneration of the PLL is followed by endochondral ossification, resulting in spinal cord compression. Specific genetic polymorphisms and medical comorbidities have been implicated in the development of OPLL. Patients should be evaluated with a full history and neurologic examination, along with cervical radiographs. Advanced imaging with CT and MRI allows three-dimensional evaluation of OPLL. Minimally symptomatic patients can be treated nonsurgically, but patients with myelopathy or severe stenosis are best treated with surgical decompression. OPLL can be treated via an anterior (ie, corpectomy and fusion) or posterior (ie, laminectomy and fusion or laminoplasty) approach, or both. The optimal approach is dictated by the classification and extent of OPLL, cervical spine sagittal alignment, severity of stenosis, and history of previous surgery. Anterior surgery is associated with superior outcomes when OPLL occupies >50% to 60% of the canal, despite increased technical difficulty and higher complication rates. Posterior surgery is technically easier and allows decompression of the entire cervical spine, but patients may experience late deterioration because of disease progression. PMID:24966248

An, Howard S; Al-Shihabi, Laith; Kurd, Mark

2014-07-01

128

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

PubMed Central

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

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

2014-01-01

129

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review  

PubMed Central

The objective of the study is to perform a systematic review to compare the clinical outcomes and complications of anterior surgery with posterior surgery for multilevel cervical myelopathy (MCM). MEDLINE, EMBASE databases and other databases were searched for all the relevant original articles published from January 1991 to November 2009 comparing anterior with posterior surgery for MCM. Subgroup analysis was performed according to the follow-up years. The following end points were mainly evaluated: final follow-up JOA (Japanese Orthopaedic Association) scale, recovery rate and complication outcomes. Ten articles fulfilled all inclusion criteria. For multilevel CSM patients, the final follow-up JOA score for the anterior group was significantly higher than the posterior group (p < 0.05, WMD 0.83 [0.24, 1.43]) in the ‘follow-up time ?5 years’ subgroup, but had no significant differences in the ‘follow-up time >5 years’ subgroup (p > 0.05). The recovery rate for the anterior group was significantly higher than the posterior group (p < 0.05, WMD 10.08 [1.39, 18.78]) in the ‘follow-up time ?5 years’ subgroup. No study reported the recovery rate for the follow-up time >5 years. For multilevel OPLL patients, the final follow-up JOA score and recovery rate for the anterior group were both significantly higher than the posterior group in the ‘follow-up time ?5 years’ subgroup (p < 0.05, WMD 2.50 [0.16, 4.85]; p < 0.05, WMD 29.48 [29.09, 29.87], respectively). One study [31] which mean follow-up time was 6 years was enrolled in the ‘follow-up time >5 years’ subgroup. The results showed there was no significant difference in final follow-up JOA score and recovery rate between anterior and posterior group for patients with occupying ratio of OPLL <60% (p > 0.05), while in patients with occupying ratio ?60%, the final follow-up JOA score and recovery rate of anterior surgery were both superior to that of posterior surgery (p < 0.05). For both multilevel CSM and OPLL patients, the complications for the anterior group were significantly more than the posterior group in the ‘follow-up time ?5 years’ subgroup (p < 0.05, OR 7.33 [2.96, 18.20] for CSM patients; p < 0.05, OR 4.44 [1.80, 10.98] for OPLL patients), but were similar to the posterior group in the ‘follow-up time >5 years’ subgroup (p > 0.05). In conclusion, anterior surgery had better clinical outcomes and more complications at the early stage after operation for both multilevel CSM and OPLL patients. At the late stage, posterior surgery had similar clinical outcomes and complications to anterior surgery for CSM patients, and OPLL patients with occupying ratio of OPLL <60%. While for OPLL patients with occupying ratio ?60%, anterior surgery had superior clinical outcome to posterior surgery. PMID:20582710

Liu, Tao; Xu, Wen; Cheng, Tao

2010-01-01

130

Recurrent Spontaneous Rupture of the Urinary Bladder in a Patient With Human T-lymphotropic Virus Type 1-Associated Myelopathy: A Case Report and Literature Review  

PubMed Central

Recurrent spontaneous rupture of the urinary bladder has rarely been reported in English articles. This condition may be difficult to diagnosis before a laparotomy due to acute peritonitis. Herein we describe a case of recurrent spontaneous rupture of the bladder in a 39-year-old woman with human T-lymphotropic virus type 1 (HTLV-1) -associated myelopathy/topical spastic paraparesis (HAM/TSP). PMID:24719820

Feizzadeh Kerigh, Behzad; Boostani, Reza; Ghoreifi, Alireza

2014-01-01

131

Clustering of HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and infective dermatitis associated with HTLV-1 (IDH) in Salvador, Bahia, Brazil.  

PubMed

Fifteen families with clustering of infective dermatitis associated with HTLV-1 (IDH) and/or HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) were observed among 28 families of IDH index cases, 93% of them occurring in two generations. With the exception of two mothers of children with IDH, all the mothers with HAM/TSP had at least one child with HAM/TSP. This is the first report of such clustering involving many families. PMID:23932323

da Silva, José Lucas Sena; Primo, Janeusa Rita L; de Oliveira, Maria de Fátima S P; Batista, Everton da Silva; Moreno-Carvalho, Otávio; Farré, Lourdes; Bittencourt, Achiléa L

2013-10-01

132

A role for motor and somatosensory evoked potentials during anterior cervical discectomy and fusion for patients without myelopathy: Analysis of 57 consecutive cases  

PubMed Central

Background: Although the usage of combined motor and sensory intraoperative monitoring has been shown to improve the surgical outcome of patients with cervical myelopathy, the role of transcranial electric motor evoked potentials (tceMEP) used in conjunction with somatosensory evoked potentials (SSEP) in patients presenting with radiculopathy but without myelopathy has been less clear. Methods: We retrospectively reviewed all patients (n = 57) with radiculopathy but without myelopathy, undergoing anterior cervical decompression and fusion at a single institution over the past 3 years, who had intraoperative monitoring with both tceMEPs and SSEPs. Results: Fifty-seven (100%) patients presented with radiculopathy, 53 (93.0%) with mechanical neck pain, 35 (61.4%) with motor dysfunction, and 29 (50.9%) with sensory deficits. Intraoperatively, 3 (5.3%) patients experienced decreases in SSEP signal amplitudes and 4 (6.9%) had tceMEP signal changes. There were three instances where a change in neuromonitoring signal required intraoperative alteration of the surgical procedure: these were deemed clinically significant events/true positives. SSEP monitoring showed two false positives and two false negatives, whereas tceMEP monitoring only had one false positive and no false negatives. Thus, tceMEP monitoring exhibited higher sensitivity (33.3% vs. 100%), specificity (95.6% vs. 98.1%), positive predictive value (33.3% vs. 75.0%), negative predictive value (97.7% vs. 100%), and efficiency (91.7% vs. 98.2%) compared to SSEP monitoring alone. Conclusions: Here, we present a retrospective series of 57 patients where tceMEP/SSEP monitoring likely prevented irreversible neurologic damage. Though further prospective studies are needed, there may be a role for combined tceMEP/SSEP monitoring for patients undergoing anterior cervical decompression without myelopathy. PMID:22059128

Xu, Risheng; Ritzl, Eva K.; Sait, Mohammed; Sciubba, Daniel M.; Wolinsky, Jean-Paul; Witham, Timothy F.; Gokaslan, Ziya L.; Bydon, Ali

2011-01-01

133

Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament?  

Microsoft Academic Search

Some controversy still exists over the optimal treatment time and the surgical approach for cervical myelopathy due to ossification\\u000a of the posterior longitudinal ligament (OPLL). The aim of the current study was first to analyze the effect of intramedullary\\u000a spinal cord changes in signal intensity (hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging) on\\u000a magnetic resonance imaging (MRI) on

Qizhi SunHongwei; Hongwei Hu; Ying Zhang; Yang Li; Linwei Chen; Huajiang Chen; Wen Yuan

134

Venous Congestive Myelopathy due to Chronic Inferior Vena Cava Thrombosis Treated with Endovascular Stenting: Case Report and Review of the Literature  

PubMed Central

Objective Impaired inferior vena cava (IVC) outflow can lead to collateralization of blood to the valveless epidural venous plexus, causing epidural venous engorgement and venous congestion. Herein we describe a case of chronic IVC thrombosis presenting as venous congestive myelopathy treated with angioplasty and endovascular stenting. The pathophysiological mechanisms of cord injury are hypothesized, and IVC stenting application is evaluated. Methods Case report and review of the literature. Results IVC outflow obstruction has only rarely been associated with neurologic dysfunction, with reports of lumbosacral nerve root compression in the cases of IVC agenesis, compression, or occlusion. Although endovascular angioplasty with stenting is emerging as a leading treatment option for chronic IVC thrombosis, its use to treat neurologic complications is limited to one case report for intractable sciatica. Our case is the first description of IVC thrombosis presenting with venous congestive myelopathy, and treated successfully with IVC stenting. Conclusion Venous congestive myelopathy should be seen as a broader clinical condition, including not only typical dural arteriovenous fistulas, but also disorders of venous outflow. Therefore, identifying a rare, but potentially treatable, etiology is important to avoid permanent neurologic deficits. IVC stenting is proposed as a novel and effective treatment approach.

Carvalho, Diego Z.; Hughes, Joshua D.; Liebo, Greta B.; Bendel, Emily C.; Bjarnason, Haraldur; Klaas, James P.

2015-01-01

135

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

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

Joachim, George C.

2014-01-01

136

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

PubMed Central

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.

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

2015-01-01

137

Biomechanical analysis of cervical spondylotic myelopathy: The influence of dynamic factors and morphometry of the spinal cord  

PubMed Central

Objective Patients with cervical spondylotic myelopathy (CSM) have the same clinical symptoms that vary according to the degree of spinal cord compression and the cross-sectional cord shape. We used a three-dimensional finite element method (3D-FEM) to analyze the stress distributions of the spinal cord with neck extension under three cross-sectional cord shapes. Methods Experimental condition for the 3D-FEM spinal cord, ligamentum flavum, and anterior compression shape (central, lateral, and diffuse types) was established. To simulate neck extension, the spinal cord was extended by 20° and the ligamentum flavum was shifted distally according to movement of the cephalad lamina. Results The stress distribution in the spinal cord increased due to invagination of the ligamentum flavum into the neck extension. The range of stress distribution observed for the diffuse type was wider than for the central and lateral types. In addition, the stress distribution in the spinal cord was increased by the pincer movement of the ligamentum flavum and by the anterior compression of the spinal cord. The range of stress distribution observed for the diffuse type under antero-posterior compression was also wider than for the central and lateral types. Conclusion This simulation model showed that the clinical symptoms of CSM due to compression of the diffuse type may be stronger than for the central and lateral types. Therefore, careful follow-up is recommended for anterior compression of the spinal cord of diffuse type. PMID:22925752

Nishida, Norihiro; Kato, Yoshihiko; Imajo, Yasuaki; Kawano, Syunichi; Taguchi, Toshihiko

2012-01-01

138

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

PubMed

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

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

2015-01-01

139

Clinical Pathophysiology of Human T-Lymphotropic Virus-Type 1-Associated Myelopathy/Tropical Spastic Paraparesis  

PubMed Central

Human T-lymphotropic virus type 1 (HTLV-1), a human retrovirus, is the causative agent of a progressive neurological disease termed HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HAM/TSP is a chronic inflammatory disease of the central nervous system and is characterized by unremitting myelopathic symptoms such as spastic paraparesis, lower limb sensory disturbance, and bladder/bowel dysfunction. Approximately 0.25–3.8% of HTLV-1-infected individuals develop HAM/TSP, which is more common in women than in men. Since the discovery of HAM/TSP, significant advances have been made with respect to elucidating the virological, molecular, and immunopathological mechanisms underlying this disease. These findings suggest that spinal cord invasion by HTLV-1-infected T cells triggers a strong virus-specific immune response and increases proinflammatory cytokine and chemokine production, leading to chronic lymphocytic inflammation and tissue damage in spinal cord lesions. However, little progress has been made in the development of an optimal treatment for HAM/TSP, more specifically in the identification of biomarkers for predicting disease progression and of molecular targets for novel therapeutic strategies targeting the underlying pathological mechanisms. This review summarizes current clinical and pathophysiological knowledge on HAM/TSP and discusses future focus areas for research on this disease. PMID:23162542

Yamano, Yoshihisa; Sato, Tomoo

2012-01-01

140

Tax mutation associated with tropical spastic paraparesis/human T-cell leukemia virus type I-associated myelopathy.  

PubMed Central

Tumaco, Colombia, is an area with elevated rates of tropical spastic paraparesis/human T-cell leukemia virus type I (HTLV-I)-associated myelopathy (TSP/HAM). We have identified a mutation in nucleotide 7959 of the tax gene of 14 Tumaco HTLV-I isolates (14 positive of 14 tested) that was present in 5 of 14 (35%) TSP/HAM patients from Japan and in 8 of 11 (72%) TSP/HAM patients from other geographic locations. In contrast, this mutation was found in only 2 of 21 (9.5%) HTLV-I-infected subjects outside of Tumaco who did not have TSP/HAM. tax clones with nucleotide mutations including one at nucleotide 7959 showed a greater ability to transactivate the HTLV-I U3 promoter. However, this effect was not observed when two clones that differed only in nucleotide 7959 were compared. These results suggest that HTLV-I-infected individuals carrying isolates with this tax mutation are at higher risk for developing TSP/HAM. PMID:7884912

Renjifo, B; Borrero, I; Essex, M

1995-01-01

141

Clinical features of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in northeast Iran.  

PubMed

This study aimed to introduce clinical manifestations of patients in northeast Iran with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and describe the epidemiological features, as well as risk factors for HTLV-1 infection. This is a cross-sectional study of HTLV-1 infected cases and HAM/TSP patients referred by outpatient neurology clinics as well as Mashhad Blood Transfusion Center from 2005 to 2010. The study comprises 513 cases, including 358 healthy carriers (HCs) and 145 HAM/TSP patients. The majority of carriers were male (73.5%), whereas 67.6% of HAM/TSP sufferers were female (P < 0.001). The mean age of HAM/TSP patients and HCs was 45.9 ± 13.6 and 39.5 ± 11.58 years, respectively (P < 0.001). The history of transfusion, surgery, hospitalization and cupping was observed in a significant greater number of HAM/TSP patients than the HCs (P < 0.001, P < 0.001, P < 0.001 and P = 0.029, respectively). Gait disturbance was the most common complaint in HAM/TSP patients (72.4%). This research develops an HTLV-1 data registry in an endemic area such as Mashhad which can serve useful purposes, including evaluation of clinical and laboratory characteristics of HAM/TSP patients and epidemiological data of HTLV-1-infected cases. PMID:23568138

Shoeibi, Ali; Rafatpanah, Houshang; Azarpazhooh, Amir; Mokhber, Naghme; Hedayati-Moghaddam, Mohammad Reza; Amiri, Amin; Hashemi, Peyman; Foroghipour, Mohsen; Hoseini, Reza Farid; Bazarbachi, Ali; Azarpazhooh, Mahmoud Reza

2013-12-01

142

HIF-1? Polymorphism in the Susceptibility of Cervical Spondylotic Myelopathy and Its Outcome after Anterior Cervical Corpectomy and Fusion Treatment  

PubMed Central

Background To investigate the association between the single nucleotide polymorphism (SNP) of hypoxia-inducible factor1 ? (HIF-1?) and the susceptibility to cervical spondylotic myelopathy (CSM) and its outcome after surgical treatment. Method A total of 230 CSM patients and 284 healthy controls were recruited. All patients received anterior cervical corpectomy and fusion (ACF) and were followed for 12 months. The genotypes for two HIF-1? variants (1772C>T and 1790G>A) were determined. Results In the present study, we found that the HIF-1? polymorphism at 1790G>A significantly affects the susceptibility to CSM and its clinical features, including severity and onset age. In addition, the 1790A>G polymorphism also determines the prognosis of CSM patients after ACF treatment. The GG genotype of 1790G>A polymorphism is associated with a higher risk to develop CSM, higher severity and earlier onset age. More importantly, we found that the 1790G>A polymorphism determines the clinical outcome in CSM patients who underwent ACF treatment. Conclusion Our findings suggest that the HIF-1? 1790G>A polymorphism is associated with the susceptibility to CSM and can be used as predictor for the clinical outcome in CSM patients receiving ACF treatment. PMID:25401740

Wang, Zhan-Chao; Hou, Xu-Wei; Shao, Jiang; Ji, Yong-Jing; Li, Lulu; Zhou, Qiang; Yu, Si-Ming; Mao, Yu-Lun; Zhang, Hao-Jie; Zhang, Ping-Chao; Lu, Hua

2014-01-01

143

A case of acute progressive myelopathy due to intravascular large B cell lymphoma diagnosed with only random skin biopsy.  

PubMed

A 64-year old woman was admitted to our hospital with subacute onset paraparesis and sensory disturbance at a level below Th10. Spinal MRI showed a T2 weighted high-signal intensity lesion at a level from Th5 to Th12, and an abdominal CT showed a mass in the left kidney. Her paraparesis deteriorated rapidly, and administration of high dose methyl prednisolone followed by oral steroid therapy was started before obtaining of a definitive diagnosis. However her symptoms did not improve after the beginning of treatment. At the same time, a bone marrow puncture, and biopsies from kidney and spinal cord were performed. These biopsies demonstrated no clues, diagnostically. Therefore a random skin biopsy was performed at the five sites on the 17th day after the steroid dosage end. From this, pathological evidence of intravascular large B cell lymphoma (IVLBCL) was shown. For rapid diagnosis of acute myelopathy with mass lesion of another organ due to IVLBCL, a biopsy is taken not only from spinal cord or mass lesions, but is also taken of multiple sites in skin randomly. This must be performed without a delay before a sudden deterioration of neurologic symptoms can occur from ischemic events not responsive to steroid therapy. PMID:25746076

Yamazaki, Hidekazu; Imai, Keisuke; Hamanaka, Masashi; Yamada, Takehiro; Tsuto, Kazuma; Yamamoto, Atsushi; Tsutumi P D, Yasuhiko

2015-01-01

144

Canine degenerative myelopathy: biochemical characterization of superoxide dismutase 1 in the first naturally occurring non-human amyotrophic lateral sclerosis model.  

PubMed

Mutations in canine superoxide dismutase 1 (SOD1) have recently been shown to cause canine degenerative myelopathy, a disabling neurodegenerative disorder affecting specific breeds of dogs characterized by progressive motor neuron loss and paralysis until death, or more common, euthanasia. This discovery makes canine degenerative myelopathy the first and only naturally occurring non-human model of amyotrophic lateral sclerosis (ALS), closely paralleling the clinical, pathological, and genetic presentation of its human counterpart, SOD1-mediated familial ALS. To further understand the biochemical role that canine SOD1 plays in this disease and how it may be similar to human SOD1, we characterized the only two SOD1 mutations described in affected dogs to date, E40K and T18S. We show that a detergent-insoluble species of mutant SOD1 is present in spinal cords of affected dogs that increases with disease progression. Our in vitro results indicate that both canine SOD1 mutants form enzymatically active dimers, arguing against a loss of function in affected homozygous animals. Further studies show that these mutants, like most human SOD1 mutants, have an increased propensity to form aggregates in cell culture, with 10-20% of cells possessing visible aggregates. Creation of the E40K mutation in human SOD1 recapitulates the normal enzymatic activity but not the aggregation propensity seen with the canine mutant. Our findings lend strong biochemical support to the toxic role of SOD1 in canine degenerative myelopathy and establish close parallels for the role mutant SOD1 plays in both canine and human disorders. PMID:23707216

Crisp, Matthew J; Beckett, Jeffrey; Coates, Joan R; Miller, Timothy M

2013-10-01

145

Canine Degenerative Myelopathy: Biochemical characterization of superoxide dismutase 1 in the first naturally occurring non-human amyotrophic lateral sclerosis model1  

PubMed Central

Mutations in canine superoxide dismutase 1 (SOD1) have recently been shown to cause canine degenerative myelopathy, a disabling neurodegenerative disorder affecting specific breeds of dogs characterized by progressive motor neuron loss and paralysis until death, or more common, euthanasia. This discovery makes canine degenerative myelopathy the first and only naturally occurring non-human model of amyotrophic lateral sclerosis (ALS), closely paralleling the clinical, pathological, and genetic presentation of its human counterpart, SOD1-mediated familial ALS. To further understand the biochemical role that canine SOD1 plays in this disease and how it may be similar to human SOD1, we characterized the only two SOD1 mutations described in affected dogs to date, E40K and T18S. We show that a detergent-insoluble species of mutant SOD1 is present in spinal cords of affected dogs that increases with disease progression. Our in vitro results indicate that both canine SOD1 mutants form enzymatically active dimers, arguing against a loss of function in affected homozygous animals. Further studies show that these mutants, like most human SOD1 mutants, have an increased propensity to form aggregates in cell culture, with 10-20% of cells possessing visible aggregates. Creation of the E40K mutation in human SOD1 recapitulates the normal enzymatic activity but not the aggregation propensity seen with the canine mutant. Our findings lend strong biochemical support to the toxic role of SOD1 in canine degenerative myelopathy and establish close parallels for the role mutant SOD1 plays in both canine and human disorders. PMID:23707216

Crisp, Matthew J.; Beckett, Jeffrey; Coates, Joan R.; Miller, Timothy M.

2013-01-01

146

Acute spontaneous cervical disc herniation causing rapidly progressive myelopathy in a patient with comorbid ossified posterior longitudinal ligament: Case report and literature review  

PubMed Central

Background: Ossification of the posterior longitudinal ligament (OPLL) and cervical disc herniation are commonly encountered neurosurgical conditions. Here we present an unusual case of nontraumatic rapidly progressive myelopathy due to cervical disc herniation with comorbid OPLL and conduct a literature review focusing on the frequency and management of disc herniations with OPLL. Case Description: A 52-year-old healthy female presented with a 72-h history of rapid progression of dense quadriparesis with sensory deficits, with a precedent 4-week history of nontraumatic midline neck pain. Clinical examination revealed profound motor deficits below the C5 myotome. Spinal neuroimaging revealed OPLL (computed tomography [CT]) and a cervical disc herniation spanning from C4/5 to C5/6 with significant retrovertebral disease (magnetic resonance imaging [MRI]). Operative management involved an anterior cervical corpectomy and instrumented fusion, with removal of both the sequestered disc material and the locally compressive OPLL. The patient recovered full motor function and independent ambulation with no residual signs or symptoms of myelopathy at the time of discharge. Conclusion: This unique case of a spontaneous cervical disc herniation in the context of OPLL causing rapidly progressive myelopathy illustrates the complementarity of CT and MRI in diagnosing the underlying cause of a rapidly progressive neurologic deficit in the absence of antecedent trauma. Though the optimal surgical management of such pathology remains uncertain; in this case, the anterior approach was motivated by the significant retrovertebral ventrally compressive sequestrum, and provided for excellent neurologic outcome. This article also reviews the occurrence/management of such acute cervical discs with OPLL. PMID:25289163

Westwick, Harrison J.; Goldstein, Christina L.; Shamji, Mohammed F.

2014-01-01

147

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

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.

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

2015-01-01

148

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

PubMed Central

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

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

149

Ciclosporin A Proof of Concept Study in Patients with Active, Progressive HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis  

PubMed Central

Introduction Patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) become progressively impaired, with chronic pain, immobility and bladder, bowel and sexual dysfunction. Tested antiretroviral therapies have not been effective and most patients are offered a short course of corticosteroids or interferon-?, physiotherapy and symptomatic management. Pathogenesis studies implicate activated T-lymphocytes and cytokines in tissue damage. We therefore tested the hypothesis that inhibition of T-cell activation with ciclosporin A would be safe and clinically beneficial in patients with early and/or clinically progressing HAM/TSP. Materials and Methods Open label, proof of concept, pilot study of 48 weeks therapy with the calcineurin antagonist, ciclosporin A (CsA), in seven patients with ‘early’ (50% deterioration in timed walk during the preceding three months) HAM/TSP. Primary outcomes were incidence of clinical failure at 48 weeks and time to clinical failure. Results All patients completed 72 weeks study participation and five showed objective evidence of clinical improvement after 3 months treatment with CsA. Two patients exhibited clinical failure over 6.4 person-years of follow-up to week 48. One patient had a >2 point deterioration in IPEC (Insituto de Pesquisa Clinica Evandro Chagas) disability score at weeks 8 and 12, and then stopped treatment. The other stopped treatment at week 4 because of headache and tremor and deterioration in timed walk, which occurred at week 45. Overall pain, mobility, spasticity and bladder function improved by 48 weeks. Two patients recommenced CsA during follow-up due to relapse. Conclusions These data provide initial evidence that treatment with CsA is safe and may partially reverse the clinical deterioration seen in patients with early/progressive HAM/TSP. This trial supports further investigation of this agent's safety and effectiveness in larger, randomised controlled studies in carefully selected patients with disease progression. PMID:22720101

Martin, Fabiola; Castro, Hannah; Gabriel, Carolyn; Adonis, Adine; Fedina, Alexandra; Harrison, Linda; Brodnicki, Liz; Demontis, Maria A.; Babiker, Abdel G.; Weber, Jonathan N.; Bangham, Charles R. M.; Taylor, Graham P.

2012-01-01

150

Role of Neuronal Interferon-? in the Development of Myelopathy in Rats Infected with Human T-Cell Leukemia Virus Type 1  

PubMed Central

Human T-cell leukemia virus type 1 (HTLV-1) is the causative agent of not only adult T-cell leukemia but also HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Among the rat strains infected with HTLV-1, chronic progressive myelopathy, named HAM rat disease, occurs exclusively in WKAH rats. In the present study, we found that HTLV-1 infection induces interferon (IFN)-? production in the spinal cords of HAM-resistant strains but not in those of WKAH rats. Neurons were the major cells that produced IFN-? in HTLV-1-infected, HAM-resistant strains. Administration of IFN-? suppressed expression of pX, the gene critically involved in the onset of HAM rat disease, in an HTLV-1-immortalized rat T-cell line, indicating that IFN-? protects against the development of HAM rat disease. The inability of WKAH spinal cord neurons to produce IFN-? after infection appeared to stem from defects in signaling through the interleukin (IL)-12 receptor. Specifically, WKAH-derived spinal cord cells were unable to up-regulate the IL-12 receptor ?2 gene in response to IL-12 stimulation. We suggest that the failure of spinal cord neurons to produce IFN-? through the IL-12 pathway is involved in the development of HAM rat disease. PMID:16816372

Miyatake, Yukiko; Ikeda, Hitoshi; Ishizu, Akihiro; Baba, Tomohisa; Ichihashi, Toru; Suzuki, Akira; Tomaru, Utano; Kasahara, Masanori; Yoshiki, Takashi

2006-01-01

151

Increased seroreactivity to human T cell lymphoma/leukemia virus-related endogenous sequence-1 gag peptides in patients with human T cell lymphoma/leukemia virus myelopathy.  

PubMed

Previously, we had shown that although only 8% of patients with large granular lymphocytic leukemia (LGLL) were infected with human T cell lymphoma/leukemia virus (HTLV)-2, almost half had antibodies to HTLV Gag and Env peptides. Herein, we investigated whether this could be due to cross-reactive antibodies to two homologous peptides in the Gag protein of the endogenous retrovirus HTLV-related endogenous sequence-1 (HRES-1). In addition, we had previously shown that patients with HTLV neurodegenerative diseases had increased seroreactivity to homologous HERV-K10 endogenous retrovirus peptides. Hence, in this study we also examined whether these patients had increased seroreactivity to the aforementioned HRES-1 Gag peptides. Sera from 100 volunteer blood donors (VBD), 53 patients with LGLL, 74 subjects with HTLV-1 or 2 infection (58 nonmyelopathy and 16 myelopathy), and 83 patients with multiple sclerosis (MS) were evaluated. The HTLV-positive myelopathy (HAM) patients had a statistically increased prevalence of antibodies to both HRES-1 Gag peptides (81%) vs. the VBD (0%), LGLL patients (13%), and MS patients (1%), and the HTLV-positive nonmyelopathy subjects (21%). The data suggest that cross-reactivity to HRES-1 peptides could be involved in the pathogenesis of HAM. The difference between the VBD and LGLL patients was also statistically significant, also suggesting a possible association in a minority of patients. PMID:25295378

Perzova, Raisa; Graziano, Elliot; Sanghi, Swathi; Welch, Caitlin; Benz, Patricia; Abbott, Lynn; Lalone, Danielle; Glaser, Jordan; Loughran, Thomas; Sheremata, William; Poiesz, Bernard J

2015-02-01

152

Human T-lymphotropic virus type I (HTLV-I) and tropical spastic paraparesis or HTLV-I-associated myelopathy in Hawaii.  

PubMed Central

Tropical spastic paraparesis or human T-lymphotropic virus type I (HTLV-I)-associated myelopathy is a degenerative encephalomyelopathy with pyramidal tract dysfunction affecting the lower extremities. It is associated with HTLV-I infection and found primarily in the Caribbean region and in southwestern Japan. Five cases of tropical spastic paraparesis (or HTLV-I-associated myelopathy) in Hawaii are reported. All five patients were born in Hawaii; four are women. Each of the patients has parents who were from HTLV-I-endemic areas of Japan. Two of these patients had serum antibodies to HTLV-I. Five of six of the spouses and children of the seropositive patients were also seropositive. Viral cultures of lymphocytes from both seropositive patients and two of the three seropositive children were positive for HTLV-I. None of the five patients had a history of antecedent blood transfusion, multiple sexual partners, or intravenous drug use. There is no evidence of adult T-cell leukemia or lymphoma in any of the patients or their families. Given the increasing seroprevalence of HTLV-I in the United States, clinicians need to be alert to new cases of this disorder. Images PMID:2139754

Dixon, P. S.; Bodner, A. J.; Okihiro, M.; Milbourne, A.; Diwan, A.; Nakamura, J. M.

1990-01-01

153

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

PubMed Central

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 ?2 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

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

2014-01-01

154

Comparison of the Japanese Orthopaedic Association (JOA) Score and Modified JOA (mJOA) Score for the Assessment of Cervical Myelopathy: A Multicenter Observational Study  

PubMed Central

Objectives The Japanese Orthopaedic Association (JOA) score is widely used to assess the severity of clinical symptoms in patients with cervical compressive myelopathy, particularly in East Asian countries. In contrast, modified versions of the JOA score are currently accepted as the standard tool for assessment in Western countries. The objective of the present study is to compare these scales and clarify their differences and interchangeability and verify their validity by comparing them to other outcome measures. Materials and Methods Five institutions participated in this prospective multicenter observational study. The JOA and modified JOA (mJOA) proposed by Benzel were recorded preoperatively and at three months postoperatively in patients with cervical compressive myelopathy who underwent decompression surgery. Patient reported outcome (PRO) measures, including Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), the Short Form-12 (SF-12) and the Neck Disability Index (NDI), were also recorded. The preoperative JOA score and mJOA score were compared to each other and the PRO values. A Bland-Altman analysis was performed to investigate their limits of agreement. Results A total of ninety-two patients were included. The correlation coefficient (Spearman’s rho) between the JOA and mJOA was 0.87. In contrast, the correlations between JOA/mJOA and the other PRO values were moderate (|rho| = 0.03 – 0.51). The correlation coefficient of the recovery rate between the JOA and mJOA was 0.75. The Bland-Altman analyses showed that limits of agreement were 3.6 to -1.2 for the total score, and 55.1% to -68.8% for the recovery rates. Conclusions In the present study, the JOA score and the mJOA score showed good correlation with each other in terms of their total scores and recovery rates. Previous studies using the JOA can be interpreted based on the mJOA; however it is not ideal to use them interchangeably. The validity of both scores was demonstrated by comparing these values to the PRO values. PMID:25837285

Kato, So; Oshima, Yasushi; Oka, Hiroyuki; Chikuda, Hirotaka; Takeshita, Yujiro; Miyoshi, Kota; Kawamura, Naohiro; Masuda, Kazuhiro; Kunogi, Junichi; Okazaki, Rentaro; Azuma, Seiichi; Hara, Nobuhiro; Tanaka, Sakae; Takeshita, Katsushi

2015-01-01

155

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

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

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

2005-10-15

156

Enlarged, multifocal upper limb neuropathy with HTLV-I associated myelopathy in a patient with chronic adult T-cell leukemia.  

PubMed

The authors herein describe a case of multifocal peripheral neuropathy with HTLV-I-associated myelopathy (HAM) in a patient with chronic adult T-cell leukemia (ATL). The clinical features included subacute progressive sensory-motor neuropathy in the bilateral upper limbs, and bilateral pyramidal tract involvement with bladder dysfunction. An MRI with (67)gadolinium enhancement revealed enlargement of the affected peripheral nerves. (8)FDG positron emission tomography (PET) disclosed increased uptake in the affected nerves, suggesting neurolymphomatosis or inflammation. Anti-HTLV-I antibody was positive in both the serum and CSF. The HTLV-I proviral load in the peripheral blood mononuclear cells was high. Chemotherapy for ATL resulted in marked improvement of motor functions in the upper limbs. This is the first case of multifocal upper limb neuropathy with HAM in a patient with chronic ATL. PMID:18096188

Umehara, Fujio; Hagiwara, Takaaki; Yoshimura, Michiyoshi; Higashi, Keiko; Arimura, Kimiyoshi

2008-03-15

157

[Progressive myelopathy caused by human T-cell lymphotropic virus type I (HTLV-I) in 3 patients in The Netherlands].  

PubMed

One man and two women (aged 30, 44 and 46, respectively) were seen between 1987 and 1992 with a myelopathy caused by the human T-cell lymphotropic virus type I (HTLV-I). The first symptoms were impaired gait in the man and micturition disorders in the women. Diagnosing took 2 to 4 years, possibly due to the fact that many Dutch physicians are unfamiliar with the disease. The diagnosis was based on originating from an endemic area (i.e. Surinam and the Caribbean basin), the clinical picture and the presence of antibodies against HTLV-I in blood and CSF. The disease in a number of years leads to spastic paraparesis, incontinence for urine and dependence on a wheelchair. PMID:9557001

Makdoembaks, A M

1998-01-10

158

Spondylolisthesis of the thoracic spine. Case report.  

PubMed

The thoracic spine is stabilized in the anteroposterior direction by the rib cage and the facet joints. Spondylolisthesis of the thoracic spine is less common than that of the lumbar spine. The authors describe a rare case of thoracic spondylolisthesis in which the patient suffered back pain and myelopathy. The patient was a 44-year-old woman. Plain radiography revealed Grade I T11-12 spondylolisthesis. The pedicle-facet joint angle at T-11 was 118 degrees, greater than that of T-10 or T-12. Postmyelography computerized tomography scanning revealed posterior compression of the dural sac as well as enlargement of and degenerative changes in the facet joint at T-11. Magnetic resonance imaging showed anterior and posterior compression of the spinal cord at the level of the spondylolisthesis. To achieve posterior T10-12 decompression, the surgeons performed a laminectomy and posterolateral fusion in which a pedicle screw fixation system was placed. The patient's back pain disappeared immediately after the operation. The authors conclude that the enlargement of the pedicle-facet joint angle and the degenerative changes of the facet joint caused the thoracolumbar spondylolisthesis. PMID:16703910

Shimada, Yoichi; Kasukawa, Yuji; Miyakoshi, Naohisa; Hongo, Michio; Ando, Shigeru; Itoi, Eiji

2006-05-01

159

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

PubMed

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

Grob, D

2004-10-01

160

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

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

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

2014-01-01

161

Biomechanical analysis of cervical myelopathy due to ossification of the posterior longitudinal ligament: Effects of posterior decompression and kyphosis following decompression  

PubMed Central

Cervical ossification of the posterior longitudinal ligament (OPLL) results in myelopathy. Conservative treatment is usually ineffective, thus, surgical treatment is required. One of the reasons for the poor surgical outcome following laminoplasty for cervical OPLL is kyphosis. In the present study, a 3-dimensional finite element method (3D-FEM) was used to analyze the stress distribution in preoperative, posterior decompression and kyphosis models of OPLL. The 3D-FEM spinal cord model established in this study consisted of gray and white matter, as well as pia mater. For the preoperative model, 30% anterior static compression was applied to OPLL. For the posterior decompression model, the lamina was shifted backwards and for the kyphosis model, the spinal cord was studied at 10, 20, 30, 40 and 50° kyphosis. In the preoperative model, high stress distributions were observed in the spinal cord. In the posterior decompression model, stresses were lower than those observed in the preoperative model. In the kyphosis model, an increase in the angle of kyphosis resulted in augmented stress on the spinal cord. Therefore, the results of the present study indicated that posterior decompression was effective, but stress distribution increased with the progression of kyphosis. In cases where kyphosis progresses following surgery, detailed follow-ups are required in case the symptoms worsen. PMID:24940393

NISHIDA, NORIHIRO; KANCHIKU, TSUKASA; KATO, YOSHIHIKO; IMAJO, YASUAKI; YOSHIDA, YUICHIRO; KAWANO, SYUNICHI; TAGUCHI, TOSHIHIKO

2014-01-01

162

Visualization of HTLV-1-specific cytotoxic T lymphocytes in the spinal cords of patients with HTLV-1-associated myelopathy/tropical spastic paraparesis.  

PubMed

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-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), an HTLV-1-induced inflammatory disease of the CNS. Although virus-specific CTLs play a pivotal role to eliminate virus-infected cells, the potential role of HTLV-1-specific CTLs in the pathogenesis of HAM/TSP remains unclear. To address this issue, we evaluated the infiltration of HTLV-1-specific 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-1-specific CTLs infiltrating the CNS of the HAM/TSP patients. The frequency of HTLV-1-specific 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-1-infected CD4-positive lymphocytes migrating into the CNS resulted in bystander neural damage. PMID:25470342

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

2015-01-01

163

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

PubMed

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

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

1997-08-15

164

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

PubMed Central

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

2013-01-01

165

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

PubMed

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

Kira, Jun-Ichi

2013-01-01

166

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

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

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

2015-01-01

167

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

SciTech Connect

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.

LaGrenade, L.; Miller, W.; Pate, E.; Rodgers-Johnson, P. [Univ. of the West Indies, Mona (Jamaica)] [and others] [Univ. of the West Indies, Mona (Jamaica); and others

1996-01-02

168

Anti-HTLV antibody profiling reveals an antibody signature for HTLV-I-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP)  

PubMed Central

Background HTLV-I is the causal agent of adult T cell leukemia (ATLL) and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Biomarkers are needed to diagnose and/or predict patients who are at risk for HAM/TSP or ATLL. Therefore, we investigated using luciferase immunoprecipitation technology (LIPS) antibody responses to seven HTLV-I proteins in non-infected controls, asymptomatic HTLV-I-carriers, ATLL and HAM/TSP sera samples. Antibody profiles were correlated with viral load and examined in longitudinal samples. Results Anti-GAG antibody titers detected by LIPS differentiated HTLV-infected subjects from uninfected controls with 100% sensitivity and 100% specificity, but did not differ between HTLV-I infected subgroups. However, anti-Env antibody titers were over 4-fold higher in HAM/TSP compared to both asymptomatic HTLV-I (P < 0.0001) and ATLL patients (P < 0.0005). Anti-Env antibody titers above 100,000 LU had 75% positive predictive value and 79% negative predictive value for identifying the HAM/TSP sub-type. Anti-Tax antibody titers were also higher (P < 0.0005) in the HAM/TSP compared to the asymptomatic HTLV-I carriers. Proviral load correlated with anti-Env antibodies in asymptomatic carriers (R = 0.76), but not in HAM/TSP. Conclusion These studies indicate that anti-HTLV-I antibody responses detected by LIPS are useful for diagnosis and suggest that elevated anti-Env antibodies are a common feature found in HAM/TSP patients. PMID:18937847

Burbelo, Peter D; Meoli, Elise; Leahy, Hannah P; Graham, Jhanelle; Yao, Karen; Oh, Unsong; Janik, John E; Mahieux, Renaud; Kashanchi, Fatah; Iadarola, Michael J; Jacobson, Steven

2008-01-01

169

Isokinetic trunk and knee muscle strengths and gait performance in walking patients with T-cell lymphotropic virus type 1-associated myelopathy/ tropical spastic paraparesis (HAM/TSP)  

PubMed Central

The aim of this study was to investigate the isokinetic trunk and knee muscle strengths, and examine the clinical relevance of dynamic muscle strengths and gait performance in walking patients with human T-cell lymphotropic virus type 1-associated myelopathy/ tropical spastic paraparesis (HAM/TSP). Thirteen patients with HAM/TSP (8 females and 5 males, aged 38–76) and 13 sex- and age-matched healthy control subjects participated in the study. We assessed gait speed, stride length, cadence; and maximal isokinetic torque of trunk and knee extensors and flexors at 30°/s, 60°/s and 90°/s using a Biodex System 3 dynamometer. Furthermore, we calculated the isokinetic trunk extensor/flexor (E/F) and hamstrings/quadriceps (H/Q) strength ratios (parameter of the muscle strength balance about the trunk and knee joint). Compared with the age-matched controls, the patients with HAM/TSP had significantly reduced gait speed, stride length and cadence (P < 0.05). Peak torque values related to body weight (PTBW) were significantly reduced, especially for the knee flexors (P < 0.05). For the knee extensors, the PTBW values were significantly reduced at an increased angular velocity (P < 0.05). The PTBW of knee flexors was positively correlated with gait speed and cadence in the patients with HAM/TSP. The H/Q ratio but not E/F ratio was significantly decreased compared with the control. Our results indicated that the isokinetic trunk and knee muscle performance had reduced from the ambulatory stage, and suggested the deterioration in knee muscle performance to be associated with gait disturbance in walking HAM/TSP patients.

Miyazaki, Masashi; Goto, Tatsushi; Kiyama, Ryoji; Matsuzaki, Toshio; Ijiri, Kosei; Yoshida, Yoshihiro

2011-01-01

170

Ascorbic Acid Has Superior Ex Vivo Antiproliferative, Cell Death-Inducing and Immunomodulatory Effects over IFN-? in HTLV-1-Associated Myelopathy  

PubMed Central

Background Clear therapeutic guidelines for HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) are missing due to the lack of randomized double-blind controlled clinical trials. Moderate yet similar clinical benefit has been demonstrated for IFN-? and high-dose ascorbic acid (AA) monotherapy in a large open clinical trial. However, there is a lack of in vivo and in vitro studies exploring and comparing the effects of high-dose AA and IFN-? treatment in the context of HAM/TSP. Therefore, we performed the first comparative analysis of the ex vivo and in vitro molecular and cellular mechanisms of action of IFN-? and high-dose AA in HAM/TSP. Principal Findings Through thymidine incorporation and quantification of Th1/Th2/Th17 cytokines, we demonstrate that high-dose AA displays differential and superior antiproliferative and immunomodulatory effects over IFN-? in HAM/TSP PBMCs ex vivo. In addition, high-dose AA, but not IFN-?, induced cell death in both HAM/TSP PBMCs and HTLV-1-infected T-cell lines MT-2 and MT-4. Microarray data combined with pathway analysis of MT-2 cells revealed AA-induced regulation of genes associated with cell death, including miR-155. Since miR-155 has recently been demonstrated to up-regulate IFN-?, this microRNA might represent a novel therapeutic target in HAM/TSP, as recently demonstrated in multiple sclerosis, another neuroinflammatory disease. On the other hand, IFN-? selectively up-regulated antiviral and immune-related genes. Conclusions In comparison to IFN-?, high-dose AA treatment has superior ex vivo and in vitro cell death-inducing, antiproliferative and immunomodulatory anti-HTLV-1 effects. Differential pathway activation by both drugs opens up avenues for targeted treatment in specific patient subsets. PMID:22848768

Moens, Britta; Decanine, Daniele; Menezes, Soraya Maria; Khouri, Ricardo; Silva-Santos, Gilvanéia; Lopez, Giovanni; Alvarez, Carolina; Talledo, Michael; Gotuzzo, Eduardo; de Almeida Kruschewsky, Ramon; Galvão-Castro, Bernardo; Vandamme, Anne-Mieke; Van Weyenbergh, Johan

2012-01-01

171

Marked Suppression of T Cells by a Benzothiophene Derivative in Patients with Human T-Lymphotropic Virus Type I-Associated Myelopathy/Tropical Spastic Paraparesis  

PubMed Central

In a search for new anti-autoimmune agents that selectively suppress activation of autoreactive T cells, one such agent, 5-methyl-3-(1-methylethoxy)benzo[b]thiophene-2-carboxamide (CI-959-A), was found to be effective. This compound, which is known to suppress tumor necrosis factor alpha (TNF-?)-induced CD54 expression, inhibited the primary proliferative response of the T cell to antigen (Ag)-presenting cells (APCs) including allogenic dendritic cells (DCs), autologous Epstein-Barr virus-infected B cells, and human T lymphotropic virus type I (HTLV-I)-infected T cells. Autoreactive T cells from patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) spontaneously proliferate in vitro, and their activation is reported to be associated with CD54 expression. The spontaneous proliferation of T cells from patients with HAM/TSP was entirely blocked by CI-959-A. However, in this study, the T-cell proliferation in 15 patients with HAM/TSP was found to depend more extensively on major histocompatibility complex (MHC) class II and CD86 than on CD54 Ags. Since most important APCs for the development of HAM/TSP are DCs and HTLV-I-infected T cells, the effect of CI-959-A on DC generation and on the expression of surface molecules on activated T cells is examined. CI-959-A suppressed recombinant granulocyte-macrophage colony stimulating factor (GM-CSF)- and recombinant interleukin-4-dependent differentiation of DCs from monocytes and inhibited the expression of CD54 and, more extensively, MHC class II and CD86 Ags. CI-959-A showed little toxicity toward lymphoma or HTLV-I-infected T-cell lines or toward monocytes and cultured DCs. These results suggest that CI-959-A might be a potent anti-HAM/TSP agent. PMID:10225829

Makino, Masahiko; Azuma, Miyuki; Wakamatsu, Shin-Ichi; Suruga, Yukio; Izumo, Shuji; Yokoyama, Mitchel M.; Baba, Masanori

1999-01-01

172

Cerebral phaeohyphomycosis caused by Xylohypha bantiana, with a review of the literature  

Microsoft Academic Search

A 76-year-old male with chief complaints of back and right leg sciatica was hospitalized. His abdominal CT scan revealed lumber spondylitic stenosis. A laminectomy was performed. Postoperatively, he became febrile, aphasic and had grand mal seizure. A left craniotomy of the front abscess, seen in the CT scan, was performed. H and E stained smears of drainage revealed dematiaceous, septate

A. S. Sekhon; J. Galbraith; B. W. Mielke; A. K. Garg; G. Sheehan

1992-01-01

173

Successful staged surgical correction of congenital segmental spinal dysgenesis and complete rotary subluxation of the thoracolumbar spine in an infant  

Microsoft Academic Search

Congenital segmental spinal dysgenesis is a rare lesion that usually is associated with neurological deficits. Affected infants who are neurologically intact may suffer progressive kyphosis and subsequent neurological deterioration. Results of external casting, laminectomy with spinal fixation, or bone grafting of the defect have been disappointing. The authors present a successful staged surgical management scheme consisting of complete resection of

Edward G Ford; Bruce A Jaufmann; Sue C Kaste; Lawrence J Foody; Thomas E Kuivila

1996-01-01

174

Sciatic neuropathy secondary to total hip arthroplasty wear debris  

Microsoft Academic Search

Sciatic neuropathy after total hip arthroplasty can result from several causes. We present a case in which a large cystic mass developed around a failed total hip arthroplasty. The lesion extended through the greater sciatic notch and into the pelvis producing sciatic nerve compression. The diagnosis was delayed, and the patient underwent a laminectomy without relief of symptoms before an

Steven R. Fischer; David J. Christ; Bernard A. Roehr

1999-01-01

175

Effect of changing lumbar stiffness by single facet joint dysfunction on the responsiveness of lumbar muscle spindles to vertebral movement  

PubMed Central

Objective: Individuals experiencing low back pain often present clinically with intervertebral joint dysfunction. The purpose of this study was to determine whether relative changes in stiffness at a single spinal joint alters neural responsiveness of lumbar muscle spindles to either vertebral movement or position. Methods: Muscle spindle discharge was recorded in response to 1mm L6 ramp and hold movements (0.5mm/s) in the same animal for lumbar laminectomy-only (n=23), laminectomy & L5/6 facet screw (n=19), laminectomy & L5/6 facetectomy (n=5) conditions. Mean instantaneous frequency (MIF) was calculated for the ramp-up, hold, ramp-down and post-ramp phases during each joint condition. Results: Mean MIFs were not significantly different between the laminectomy-only and the other two types of joint dysfunction for the ramp-up, hold, ramp-down, or post-ramp phases. Conclusion: Stiffness changes caused by single facet joint dysfunction failed to alter spindle responses during slow 1mm ramp and hold movements of the L6 vertebra. PMID:24932020

Reed, William R.; Pickar, Joel G.; Long, Cynthia R.

2014-01-01

176

Epidural extension of infected chest wall haematoma and empyema causing spinal cord compression.  

PubMed

We report a case of thoracic epidural extension of an infected extra-pleural and chest wall haematoma with evidence of spinal cord compression and signs of cauda equina. Emergency spinal cord decompression with laminectomy followed by thoracotomy was performed. PMID:23962887

Wong, Marilyn; Lanka, Laxmi; Hussain, Zakier; Parkinson, Grant

2014-01-01

177

Cerebral Palsy Spasticity. Selective Posterior Rhizotomy  

Microsoft Academic Search

We have performed selective posterior rhizotomies on 60 children with cerebral palsy. The procedure involves lumbar laminectomy with stimulation of the rootlets (fascicles) of the second lumbar to the first sacral posterior roots bilaterally; those rootlets associated with an abnormal motor response, as evidenced by sustained or diffused muscular contraction, are divided leaving intact rootlets associated with a brief localized

Warwick J. Peacock; Leila J. Arens; Barbara Berman

1987-01-01

178

Intradural spinal arachnoid cyst in a dog.  

PubMed Central

An 8-month-old, spayed female dog was presented with signs localizing a neurologic lesion between the 3rd thoracic and 3rd lumbar vertebrae. An arachnoid cyst was diagnosed by myelography, and a dorsal laminectomy with durotomy was performed. The dog continues to do well 1-1/2 year after surgery. Images Figure 1. PMID:12001342

Webb, A A

1999-01-01

179

Behavioral and Histopathological Study of Changes in Spinal Cord Injured Rats Supplemented with Spirulina platensis  

PubMed Central

Spinal cord injury (SCI) is a devastating disease that leads to permanent disability and causes great suffering. The resulting neurological dysfunction and paralysis is proportional to the severity of the trauma itself. Spirulina is widely used as a nutritional supplement due to its high protein and antioxidant content. In the present study, the protective effect of the Spirulina treatment on locomotor function and morphological damage after SCI was investigated. Seventy Sprague-Dawley (SD) rats were divided into three groups: Sham (laminectomy alone), Control (laminectomy with SCI), and Experimental (laminectomy with SCI +180?mg/kg per day Spirulina platensis). A laminectomy was performed at T12 and an Inox No.2 modified forceps was used to perform a partial crush injury on the spinal cord. The rats were then perfused at 3, 7, 14, 21, and 28 days after injury for morphological investigations. The injured rat spinal cord indicated a presence of hemorrhage, cavity, and necrosis. Pretreatment with Spirulina significantly improved the locomotor function and showed a significant reduction on the histological changes. The experimental results observed in this study suggest that treatment with Spirulina platensis possesses potential benefits in improving hind limb locomotor function and reducing morphological damage to the spinal cord. PMID:25152764

Che Ramli, Muhammad Danial

2014-01-01

180

Solitary fibrous tumor of the spinal cord: A clinicopathologic study of two cases  

Microsoft Academic Search

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

Stefano Pizzolitto; Giovanni Falconieri; Giovanna DeMaglio

2004-01-01

181

Hemorrhagic onset of spinal angiolipoma.  

PubMed

Spinal angiolipomas are rare benign tumors that generally induce slow progressive cord compression. Here, the authors describe a case of sudden-onset palsy of the lower extremities caused by hemorrhagic spinal angiolipoma. An emergent laminectomy was performed to achieve total lesion removal. Follow-up examinations indicated neurological improvement and the absence of recurrence. PMID:25303620

da Costa, Marcos Devanir Silva; Paz, Daniel de Araujo; Rodrigues, Thiago Pereira; Gandolfi, Ana Camila de Castro; Lamis, Fabricio Correa; Stavale, João Norberto; Suriano, Italo Capraro; Cetl, Luiz Daniel Marques Neves; Cavalheiro, Sergio

2014-12-01

182

High-level production of alternatively spliced soluble interleukin-6 receptor in serum of patients with adult T-cell leukaemia/HTLV-I-associated myelopathy.  

PubMed Central

We have previously shown, using human T-cell lymphocytotrophic virus-I (HTLV-I)-infected cell lines, that soluble interleukin-6 receptor (sIL-6R) is generated through an alternative splicing mechanism. In this study, we examined human sera for the presence of alternatively spliced soluble IL-6R (AS-sIL-6R). We produced a monoclonal antibody (mAb) recognizing the unique sequence of AS-sIL-6R peptide, generated by an altered reading frame. We also made recombinant AS-sIL-6R protein in Spodoptera frugiperda-9 (Sf-9) cells carrying baculovirus, which encoded altered sIL-6R or conventional IL-6R cDNA. mAbs specifically recognized AS-sIL-6R, but not conventional IL-6R, as demonstrated by Western blot analyses, fluorescence-activated cell sorter, immunofluorescence analyses and enzyme-linked immunosorbent assay (ELISA). We adapted an ELISA system and used it for detection of altered sIL-6R in sera from 23 healthy persons, 12 patients with adult T-cell leukaemia (ATL) and 13 patients with HTLV-I-associated myelopathy (HAM). Serum levels of AS-sIL-6R were 6.4 or 6.1 times greater in ATL (28.7+/-20.4 ng/ml, P<0.0001) and in HAM patients (27.5+/-12.1 ng/ml, P<0.0001) than in healthy individuals (4.5+/-2.1 ng/ml). High levels of AS-sIL-6R were also observed in plasma from rheumatoid arthritis patients and in persons with elevated levels of alanine aminotransferase (ALT), antinuclear antibody (ANA), or alpha-fetoprotein (AFP). However, in human immunodeficiency virus-1 (HIV-1), hepatitis B virus (HBV) or hepatitis C virus (HCV)-infected individuals, AS-sIL-6R levels were not elevated. In this study, we confirmed that AS-sIL-6R is indeed present in human sera. These observations suggest that alternative splicing of IL-6R mRNA is of consequence in ATL, HAM and in some autoimmune diseases. The HTLV-I-infected T cells appeared to play an important role in AS-sIL-6R production. Images Figure 1 Figure 2 Figure 4 PMID:9824498

Horiuchi, S; Ampofo, W; Koyanagi, Y; Yamashita, A; Waki, M; Matsumoto, A; Yamamoto, M; Yamamoto, N

1998-01-01

183

Effects of Low and High Molecular Weight Hyaluronic Acids on Peridural Fibrosis and Inflammation in Lumbar Laminectomized Rats  

PubMed Central

Background Postlaminectomy peridural fibrosis is inevitable. Some studies have compared and identified the effects of high molecular weight hyaluronic acids (HMWHA) and low molecular weight hyaluronic acids (LMWHA) on peridural fibrosis in postlaminectomy animal models. However, no studies have been found that compare pain behaviors between hyaluronic acids or among hyaluronic acids and other solid materials. The purpose of this study was to examine the correlation between pain-related behaviors and histopathologic changes in laminectomized rats using various peridurally administered materials. Methods Forty male Sprague-Dawley rats, laminectomized at the L5 and L6 levels, were divided into four groups: group C, laminectomy only; group L, laminectomy and LMWHA application; group H, laminectomy and HMWHA application; group F, laminectomy and fat interposition. Pain behaviors were checked before, 3 days, 1 week, and 3 weeks after surgery. Histopathological changes were checked at the L5 level 3 weeks after the surgery. Results The 50% withdrawal thresholds in groups L and H were higher than that in groups C and F three days after laminectomy (P < 0.05). The paw withdrawal time did not change among the groups and in each group during the study period. Peridural fibrosis in group F was significantly lower than in the other groups (P < 0.05). Conclusions Hyaluronic acids significantly reduced mechanical allodynia but not thermal hyperalgesia. Peridural fibrosis did not show any correlation with pain behaviors. There have been limited studies on the correlation between peridural fibrosis and pain behavioral change, which should be verified by further studies. PMID:22220240

Lee, Jun Geol; Lee, Sang Chul; Kim, Yong Chul; Lim, Young Jin; Shin, Jae Hyuck; Kim, Jae Hun; Park, Sang Hyun; Choi, Yun Ra

2011-01-01

184

Incidence of human T cell lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis in a long-term prospective cohort study of initially asymptomatic individuals in Brazil.  

PubMed

The incidence of human T cell lymphotropic virus type 1 (HLTV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is not well defined in the literature. Several studies have reported different incidence rates, and recent publications suggest a higher incidence and prevalence of HAM/TSP. The interdisciplinary HTLV Research Group (GIPH) is a prospective open cohort study of individuals infected with HTLV-1/2. This study describes the demographic data and HAM/TSP incidence rate observed in 181 HTLV-1-seropositive individuals and compares the results with previous reports in the literature. HAM/TSP was diagnosed on the basis of the World Health Organization diagnostic criteria and De Castro-Costa et al. [Proposal for diagnostic criteria of tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). AIDS Res Hum Retroviruses 2006;22:931-935]. Seven HAM/TSP incident cases were observed during the follow-up. The HAM/TSP incidence density was 5.3 cases per 1,000 HTLV-1-seropositive cases per year (95% confidence interval: 2.6-10.9), with a mean follow-up of 7±4 years (range: 1 month to 15 years). HAM/TSP was more frequent in women in their 40s and 50s with probable infection via the sexual route. The HAM/TSP incidence density among HTLV-1-seropositive cases observed in the present study is higher than that in previous studies. HAM/TSP may be underdiagnosed in countries like Brazil where HTLV infection is prevalent. Orientation and prevent transmission of HTLV programs are needed. Currently, preventing HTLV-1 transmission is the most effective way to reduce the impact of HAM/TSP on society. PMID:23617363

Romanelli, Luiz Cláudio Ferreira; Caramelli, Paulo; Martins, Marina Lobato; Gonçalves, Denise Utsch; Proietti, Fernando Augusto; Ribas, João Gabriel Ramos; Araújo, Marcelo Grossi; Carneiro-Proietti, Anna Bárbara de Freitas

2013-09-01

185

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

PubMed

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

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

2015-04-01

186

Neck Pain Following Cervical Laminoplasty: Does Preservation of the C2 Muscle Attachments and/or C7 Matter?  

PubMed Central

Study Design?Systematic review. Objective?In patients aged 18 years or older, with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament (OPLL), does sparing the C2 muscle attachments and/or C7-preserving cervical laminoplasty lead to reduced postoperative axial pain compared with conventional C3 to C7 laminoplasty? Do these results vary based on early active postoperative cervical motion? Methods?A systematic review of the English-language literature was undertaken for articles published between 1970 and August 17, 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating C2/C3- or C7-preserving cervical laminoplasty for the treatment of cervical spondylotic myelopathy (CSM) or OPLL in adults. Studies involving traumatic onset, cervical fracture, infection, deformity, or neoplasms were excluded, as were noncomparative studies. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results?We identified 11 articles meeting our inclusion criteria. Only the randomized controlled trial (RCT) showed no significant difference in late axial pain (at 12 months) when C7 spinous muscle preservation was compared with no preservation. However, seven other retrospective cohort studies showed significant pain relief in the preserved group compared with the nonpreserved group. The preservation group included those with preservation of the C7 spinous process and/or attached muscles, the deep extensor muscles, or C2 muscle attachment and/or C3 laminectomy (as opposed to laminoplasty). One study that included preservation of either the C2 or C7 posterior paraspinal muscles found that only preservation of the muscles attached to C2 resulted in reduced postoperative pain. Another study that included preservation of either the C7 spinous process or the deep extensor muscles found that only preservation of C7 resulted in reduced postoperative pain. Conclusion?Although there is conflicting data regarding the importance of preserving C7 and/or the semispinalis cervicis muscle attachments to C2, there is enough evidence to suggest that surgeons should make every attempt to preserve these structures whenever possible since there appears to be little downside to doing so, unless it compromises the neurologic decompression. PMID:24436698

Riew, K. Daniel; Raich, Annie L.; Dettori, Joseph R.; Heller, John G.

2013-01-01

187

Neck Pain Following Cervical Laminoplasty: Does Preservation of the C2 Muscle Attachments and/or C7 Matter?  

PubMed

Study Design?Systematic review. Objective?In patients aged 18 years or older, with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament (OPLL), does sparing the C2 muscle attachments and/or C7-preserving cervical laminoplasty lead to reduced postoperative axial pain compared with conventional C3 to C7 laminoplasty? Do these results vary based on early active postoperative cervical motion? Methods?A systematic review of the English-language literature was undertaken for articles published between 1970 and August 17, 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating C2/C3- or C7-preserving cervical laminoplasty for the treatment of cervical spondylotic myelopathy (CSM) or OPLL in adults. Studies involving traumatic onset, cervical fracture, infection, deformity, or neoplasms were excluded, as were noncomparative studies. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results?We identified 11 articles meeting our inclusion criteria. Only the randomized controlled trial (RCT) showed no significant difference in late axial pain (at 12 months) when C7 spinous muscle preservation was compared with no preservation. However, seven other retrospective cohort studies showed significant pain relief in the preserved group compared with the nonpreserved group. The preservation group included those with preservation of the C7 spinous process and/or attached muscles, the deep extensor muscles, or C2 muscle attachment and/or C3 laminectomy (as opposed to laminoplasty). One study that included preservation of either the C2 or C7 posterior paraspinal muscles found that only preservation of the muscles attached to C2 resulted in reduced postoperative pain. Another study that included preservation of either the C7 spinous process or the deep extensor muscles found that only preservation of C7 resulted in reduced postoperative pain. Conclusion?Although there is conflicting data regarding the importance of preserving C7 and/or the semispinalis cervicis muscle attachments to C2, there is enough evidence to suggest that surgeons should make every attempt to preserve these structures whenever possible since there appears to be little downside to doing so, unless it compromises the neurologic decompression. PMID:24436698

Riew, K Daniel; Raich, Annie L; Dettori, Joseph R; Heller, John G

2013-04-01

188

Temporal lesions and widespread involvement of white matter associated with multi-organ inflammatory disease in human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP).  

PubMed

Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic inflammatory disease of the spinal cord, characterized by spastic paraparesis, back pain, and sphincter disorders. Involvement of multiple organs and encephalopathy are uncommon in HAM/TSP. Nonspecific small white matter lesions of unknown etiology, mainly in the periventricular and subcortical regions, have been found on brain magnetic resonance imaging of HAM/TSP patients. Bitemporal lesions have rarely been described. We report the case of a 54-year-old woman diagnosed with HAM/TSP who presented subclinical cognitive deficits associated with bitemporal and widespread white matter lesions. The cerebrospinal fluid (CSF) was inflammatory (blood-CSF barrier dysfunction, intrathecal synthesis of total and HTLV-1 IgG). The proviral load was higher in cerebrospinal fluid than in peripheral blood mononuclear cells. The neurological picture was complicated by multi-organ inflammatory disease (Hashimoto's thyroiditis, uveitis, anemia, and chronic renal failure). This case highlights the potential multisystem inflammatory nature of HTLV-1 infection, with a wide spectrum of manifestations. In cases of HAM/TSP with multi-organ inflammatory disease, encephalic involvement should be investigated, even in the absence of clinical manifestations. Also bitemporal lesions can be the consequence of intense and diffuse inflammation associated with HTLV-1 infection. PMID:24815740

Mendes, Gustavo B; Kalil, Rosangela S; Rosadas, Carolina; de Freitas, Marcos R G; Puccioni-Sohler, Marzia

2014-08-01

189

Minimally invasive lumbar decompression for lumbar stenosis: review of clinical outcomes and cost effectiveness.  

PubMed

Lumbar stenosis patients typically present with neurogenic claudication or radiculopathy. Studies have shown the benefit of surgical management of lumbar stenosis for patients who fail medical management. Surgical management traditionally involved an open laminectomy and foramenotomies. The emergence of minimally invasive spinal surgery has allowed for comparable clinical outcomes to open laminectomies, with the potential additional benefits of decreased blood loss, shorter hospital stay, decreased postoperative narcotic requirement, decreased rate of infection, and the potential benefit of decreasing the risk of postoperative instability. A shorter length of stay and faster return to work after minimally invasive lumbar decompression may result in the minimally invasive approach being more cost effective than an open approach. A literature review was performed to evaluate the clinical outcomes and cost effectiveness associated with minimally invasive decompression of lumbar stenosis. PMID:25370820

Johans, S J; Amin, B Y; Mummaneni, P V

2015-03-01

190

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

PubMed Central

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

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

191

Chiari I Malformation Associated with Atlanto-Occipital Assimilation Presenting as Orthopnea and Cough Syncope: A Case Report and Review of Literature  

PubMed Central

Although it is not uncommon for patients with Chiari I malformations to present with respiratory complaints, cough syncope is a rare presenting symptom. We report an adult patient who harbored both a Chiari I malformation and atlanto-occipital assimilation who complained of cough syncope, orthopnea, and central sleep apnea. The patient underwent decompressive craniectomy of the posterior fossa and cervical level 2 laminectomy. However, due to a possible initial underappreciation of the profound narrowing of the foramen magnum as a result of these concomitant pathologies, the patient may have had continued impaired cerebrospinal fluid flow, leading to a symptomatic pseudomeningocele and requiring a more extensive decompression that included a cervical level 3 laminectomy as well as a temporary lumbar drain. On 2-year follow-up, he has remained asymptomatic. PMID:25083365

Mangubat, Erwin Zeta; Wilson, Tom; Mitchell, Brian A.; Byrne, Richard W.

2013-01-01

192

Lumbosacral intervertebral disk disease in six cats.  

PubMed

Medical records of six cats diagnosed with lumbosacral intervertebral disk disease were reviewed. Clinical signs included reluctance to jump, low tail carriage, elimination outside the litter box, reluctance to ambulate, pelvic-limb paresis, urinary incontinence, and constipation. All cats had lumbosacral hyperpathia on palpation. Computed tomography in four cats revealed evidence of extradural spinal cord compression at the seventh lumbar (L(7)) to first sacral (S(1)) vertebral interspace. Compression was confirmed via myelography in three of these four cats, with confirmation in the fourth cat at the time of decompressive laminectomy. Each of the six cats underwent dorsal decompressive laminectomy at the L(7) to S(1) interspace. Postoperative clinical follow-up lasted 3 to 35 months, with most cats having excellent outcomes. PMID:18451068

Harris, Jennipher E; Dhupa, Sarit

2008-01-01

193

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

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

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; Kashima, Simone

2014-06-01

194

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

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

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

2014-04-01

195

A rare case of complete C2–C3 dislocation with mild neurological symptoms  

Microsoft Academic Search

The authors report a rare case of complete C2–C3 dislocation with unexpectedly mild neurological symptoms in a 57 year old\\u000a man involved in a motor vehicle accident, who had previously undergone posterior laminectomy from C3 through C7. A retrospective\\u000a chart analysis and a thorough radiographic review were performed. X-rays and CT of the cervical spine demonstrated a complete\\u000a dislocation at the

Theofilos G. Machinis; Kostas N. Fountas; E. Z. Kapsalaki; I. Kapsalakis; A. A. Grigorian

2006-01-01

196

Surgical strategies for managing foraminal nerve sheath tumors: the emerging role of CyberKnife ablation  

PubMed Central

Sixteen Stanford University Medical Center (SUMC) patients with foraminal nerve sheath tumors had charts reviewed. CyberKnife radiosurgery was innovative in management. Parameters were evaluated for 16 foraminal nerve sheath tumors undergoing surgery, some with CyberKnife. Three neurofibromas had associated neurofibromatosis type 1 (NF1). Eleven patients had one resection; others had CyberKnife after one (two) and two (three) operations. The malignant peripheral nerve sheath tumor (MPNST) had prior field-radiation and adds another case. Approaches included laminotomy and laminectomies with partial (three) or total (two) facetectomies/fusions. Two cases each had supraclavicular, lateral extracavitary, retroperitoneal and Wiltze and costotransversectomy/thoracotomy procedures. Two underwent a laminectomy/partial facetectomy, then CyberKnife. Pre-CyberKnife, one of two others had a laminectomy/partial facetectomy, then total facetectomy/fusion and the other, two supraclavicular approaches. The MPNST had a hemi-laminotomy then laminectomy/total facetectomy/fusion, followed by CyberKnife. Roots were preserved, except in two. Of 11 single-operation-peripheral nerve sheath tumors, the asymptomatic case remained stable, nine (92%) improved and one (9%) worsened. Examinations remained intact in three (27%) and improved in seven (64%). Two having a single operation then CyberKnife had improvement after both. Of two undergoing two operations, one had symptom resolution post-operatively, worsened 4 years post-CyberKnife then has remained unchanged after re-operation. The other such patient improved post-operatively, had no change after re-operation and improved post-CyberKnife. The MPNST had presentation improvement after the first operation, worsened and after the second surgery \\and CyberKnife, the patient expired from tumor spread. In conclusion, surgery is beneficial for pain relief and function preservation in foraminal nerve sheath tumors. Open surgery with CyberKnife is an innovation in these tumors’ management. PMID:19798517

Murovic, Judith A.; Charles Cho, S.

2009-01-01

197

Lumbar spinal epidural angiolipoma  

Microsoft Academic Search

Spinal angiolipomas are rare benign tumours most commonly found in the thoracic spine. A case of an extradural lumbar angiolipoma in a 47-year-old female is described. She had a recent history of lower back pain accompanied by sciatica. Lumbar MRI revealed a dorsal epidural mass at the L2–L3 level. The patient underwent a bilateral laminectomy, in which the tumour was

Kimon Nanassis; Parmenion Tsitsopoulos; Dimitrios Marinopoulos; Apostolos Mintelis; Philippos Tsitsopoulos

2008-01-01

198

Hemodynamic evaluation of the prone position by transesophageal echocardiography  

Microsoft Academic Search

Study Objective: To evaluate the hemodynamic response in the prone position in surgical patients by measuring the effects of prone positioning on cardiac function using transesophageal echocardiography (TEE).Design: Prospective study.Setting: Elective surgery at a university hospital.Patients: 15 adult ASA physical status I and II patients free of significant coexisting disease undergoing lumbar laminectomy.Interventions and Measurements: Approximately 15 minutes after the

Shigeyoshi Toyota; Yoshikiyo Amaki

1998-01-01

199

Aspergillus spinal epidural abscess  

SciTech Connect

A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host.

Byrd, B.F. III (Vanderbilt Univ. School of Medicine, Nashville, TN); Weiner, M.H.; McGee, Z.A.

1982-12-17

200

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

PubMed Central

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

Epstein, Nancy E.

2014-01-01

201

Results of Cervical Recapping Laminoplasty: Gross Anatomical Changes, Biomechanical Evaluation at Different Time Points and Degrees of Level Involvement  

PubMed Central

Background Recapping laminoplasty has become the frequently-used approach to the spinal canal when bone decompression of the vertebral canal is not the goal. However, what changes will occur after surgery, and whether recapping laminoplasty can actually reduce the risk of delayed deformities remains unknown. Methodology We designed an animal experiment using a caprine model, and partitioned the animals into in vitro and in vivo surgical groups. We performed recapping laminoplasty on one group and laminectomy on another group. These animals were sacrificed six months after operating, cervical spines removed, biomechanically tested, and these data were compared to determine whether the recapping laminoplasty technique leads to subsequent differences in range of motion. Image data were also obtained before the surgery and when the animals were killed. Besides, we investigated the initial differences in kinetics between recapping laminoplasty and laminectomy. We did this by comparing data obtained from biomechanical testing of in vitro-performed recapping laminoplasty and laminectomy. Finally, we investigated the effect that longitudinal distance has on cervical mechanics. This was determined by performing a two-level recapping laminoplasty, and then extending the laminoplasty to the next level and repeating the mechanical testing at each step. Principal Findings There were three mainly morphological changes at the six months after laminoplasty: volume reduction and bone nonunion of the recapping laminae, irregular fibrosis formation around the facet joints and re-implanted lamina-ligamentous complex. In the biomechanical test, comparing with laminectomy, recapping laminoplasty didn’t show significant differences in the immediate postoperative comparison, while recapping laminoplasty demonstrated significantly decreased motion in flexion/extension six months later. Inclusion of additional levels in the laminotomy procedure didn’t lead to changes in immediate biomechanics. Conclusions Recapping laminoplasty can’t fully restore the posterior structure, but still reduced the risk of delayed cervical instability in a caprine model. PMID:24950103

Si, Yu; Wang, Zhenyu; Yu, Tao; Lin, Guo zhong; Zhang, Jia; Zhang, Kuo; Zhang, Hua; Li, Yuan chao

2014-01-01

202

Scanning electron microscopic findings on the rabbit meninges after local lavage with Polyvinylpyrrolidon-Jod-Komplex  

Microsoft Academic Search

Summary The microbicide Polyvinylpyrrolidon-Jod-Komplex (P.J.K.) was experimentally evaluated for its use in local lavage of the epidural space. In 20 rabbits a lumbar laminectomy was performed followed either by local lavage with P.J.K. or with NaCl. After one month the meningeal covering of the operated spinal cords revealed no signs of fibrosis or arachnoid adhesions when studied macroscopically or by

J. Strohecker; A. Lametschwandtner; W. P. Piotrowski

1985-01-01

203

Vulnerability of the spinal cord to injury from extracorporeal shock waves in rabbits  

Microsoft Academic Search

We studied the vulnerability of the spinal cord to extracorporeal shock wave treatment (ESWT). In this experiment, 12 rabbits were divided into three groups (4 in each group). All animals underwent a preceding lumbar laminectomy at L4 1 week before ESWT. In group 1, 2000 impulses of high dose (0.62 mJ\\/mm2 energy flux density) shockwave energy were applied to the

Tao-Chen Lee; Hsiu-Yu Huang; Yu-Lin Yang; Kuo-Sheng Hung; Ching-Hsiao Cheng; Nyuk-Kong Chang; Yueh-Hua Chung; Min-Shou Hu; Ching-Jen Wang

2007-01-01

204

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

PubMed Central

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

Akeda, Koji; Tsujii, Masaya; Sudo, Akihiro

2013-01-01

205

Delayed diagnosis of cauda eqina syndrome with perineural cyst after combined spinal-epidural anesthesia in hemodialysis patient.  

PubMed

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

Ishiguro, Shigeo; Akeda, Koji; Tsujii, Masaya; Sudo, Akihiro

2013-09-01

206

Acute spinal cord compression due to epidural lipomatosis complicated by an abscess: magnetic resonance and pathology findings  

PubMed Central

A 68-year-old male presented with rapidly progressive paraplegia. MR images of the thoracic spine were interpreted as being consistent with an abscess within an epidural lipomatosis compressing the spinal cord. Laminectomy was performed, and a large amount of pus was drained from the epidural lipomatosis, from which Staphylococcus aureus was isolated. This is the first reported case of an abscess involving an epidural lipomatosis. PMID:20372939

Pipitone, Nicolò; De Carli, Nicola; Vecchia, Luigi; Bartoletti, Stefano C.

2010-01-01

207

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

PubMed Central

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

Cagle, Laura

2010-01-01

208

Cervical synovial cyst: case report and review of literature  

Microsoft Academic Search

Synovial cysts, typically observed in the lumbar spine eventually associated with degenerative changes of the facet joints,\\u000a only rarely present in the cervical spine. Up to now, only 28 symptomatic cases are described in literature. Typically, the\\u000a treatment of these cases is a decompressive laminectomy followed by complete surgical removal of the lesion. The authors present\\u000a the case of an

Francesco Costa; Claudia Menghetti; Andrea Cardia; Maurizio Fornari; Alessandro Ortolina

2010-01-01

209

Commentary: Unnecessary preoperative epidural steroid injections lead to cerebrospinal fluid leaks confirmed during spinal stenosis surgery  

PubMed Central

Background: Increasingly, older patients with severe spinal stenosis/instability undergo multiple unnecessary preoperative epidural spinal injections (ESI), despite their risks and lack of long-term benefits. Here we add to the list of risks by showing how often preoperative ESI lead to punctate cerebrospinal fluid (CSF) fistulas documented during subsequent surgery (e.g. multilevel laminectomies with non-instrumented fusions). Methods: A series of 39 patients with spinal stenosis/instability prospectively underwent multilevel laminectomy/non-instrumented fusion utilizing lamina autograft and NanOss Bioactive. We asked how often preoperative ESI were performed in this population and how frequently they contributed to operatively confirmed punctate cerebrospinal fluid (CSF) fistulas. Notably, CSF leaks were clearly attributed to ESI, as they were located centrally/paracentrally at the L4-L5 level, just below hypertrophied/ossified yellow ligament (OYL), and were the exact size of a Tuohy needle with clean edges. Results: An average of 4.1 (range 2-12) preoperative ESI were performed in 33 of 39 patients undergoing average 4.3 level laminectomies and 1.3 level non-instrumented fusions; 6 (18.2%) patients exhibited operatively confirmed, punctate CSF fistulas attributed to these ESI. The most recent injections were administered between 2 and 5 weeks prior to surgery (average 3.9 weeks). Fistulas were primarily repaired with 7-0 GORE-TEX sutures and fibrin Sealant (Tisseel). Conclusions: Of 33 patients undergoing multilevel laminectomies with non-instrumented fusions receiving preoperative ESI, 6 (18.2%) had operatively confirmed punctate CSF fistulas due to preoperative ESI performed an average of 4.1 times per patient. PMID:25289153

Epstein, Nancy E.

2014-01-01

210

Effects of tadalafil-Type-V phosphodiesterase enzyme inhibitor-On rats with spinal trauma.  

PubMed

In this research, the effect of tadalafil, a selective inhibitor of cyclic guanosine monophosphate-specific phosphodiesterase type 5, on rats with spinal trauma was evaluated. The evaluation consisted of neurological examination and biochemical parameters. Twenty healthy male Wistar albino rats were used in this study. They were separated into three groups: tadalafil-receiving (TD) group (n = 7), laminectomy and trauma (LT) group (n = 7), and just laminectomy group (n = 6). The TD group received daily dose of tadalafil (10 mg/kg) for a week along with bait and water. Each rat's spinal cord was dissected with utter caution. The spinal cord was traumatized by Allen's weight-drop method. Using a standard apparatus, 5 g of weight was dropped from a height of 10 cm on the spinal cords of the TD and LT (laminectomy + trauma) group. No extra maneuvers were conducted on the laminectomy group. A day later, the rat's functional neurological status was examined followed by re-exploration of the spinal cord for sampling 1 cm of tissue. The Tarlov scale was used to evaluate the functional neurological status. The modified Tarlov scale was rated to be significantly higher in the TD group than that in the LT group. For the biochemical parameters, malondialdehyde (MDA) and cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-? (TNF-?) involved in the inflammatory process were examined. MDA-an indicator of lipid peroxidation-was found to be significantly lower in the TD group compared with that in the LT group. TNF-? and IL-6 levels were also found to be lower in the TD group compared with those in the LT group. Shortly, this research showed that the use of TD group in spinal trauma resulted in better neurological outcome and significant improvement in biochemical parameters. PMID:25380483

Senturk, Salim; Gurcay, Ahmet Gurhan; Bozkurt, Ismail; Gurcan, Oktay; Eroglu, Hakan; Turkoglu, Omer Faruk; Bodur, Ebru; Bavbek, Murad

2014-11-01

211

Duraplasty with freeze-dried cadaveric dura versus occipital pericranium for Chiari type I malformation: Comparative study  

Microsoft Academic Search

Summary  During the period from October 1, 1989 to October 1, 1995 a total of 26 cases of Chiari type I malformation not associated\\u000a with syringomyelia were attended in our Hospital. All patients underwent cranio-cervical decompression, with occipital craniectomy\\u000a and removal of the posterior arch of C1. In 3\\/26 (11.5%) cases an additional C2 laminectomy had to be performed and in

V. Vanaclocha; N. Saiz-Sapena

1997-01-01

212

Acute spinal cord compression due to intraspinal bleeding from a vertebral hemangioma: two case-reports  

Microsoft Academic Search

Vertebral hemangiomas can cause acute spinal cord compression either after a minor trauma or during the last 3 months of\\u000a pregnancy. Failure to recognize the lesion can lead to potentially serious treatment delays. An emergency MRI scan usually\\u000a establishes the diagnosis of vertebral hemangioma responsible for spinal cord compression requiring laminectomy. We report\\u000a two cases showing that posterior fixation should

E. Castel; J. Y. Lazennec; J. Chiras; E. Enkaoua; G. Saillant

1999-01-01

213

Symptomatic vertebral hemangioma related to pregnancy  

Microsoft Academic Search

In this paper, we report a case of vertebral hemangioma during pregnancy in a 21-year-old woman presenting with paraparesis\\u000a of rapid onset. An emergency MRI scan of the dorsal spine showed a lesion of the ninth thoracic vertebra with extradural extension\\u000a and marked spinal cord compression. A cesarean section was done, and this was followed by emergent laminectomy. Her symptoms

Murvet Yuksel; K. Zafer Yuksel; Deniz Tuncel; Beyazit Zencirci; Sevgi Bakaris

2007-01-01

214

Intraneural capillary hemangioma of the cauda equina  

Microsoft Academic Search

A case of intraneural capillary hemangioma involving the dorsal root of a spinal nerve of the cauda equina is reported. The patient was a 41-year-old man with a 3-month history of intermittent left lumbosciatalgia. MRI and CT myelography showed a space-occupying mass at the level of the cauda equina. Laminectomy of L5 and complete removal of the lesion were performed

L. Mastronardi; A. Guiducci; D. Frondizi; S. Carletti; C. Spera; G. Maira

1997-01-01

215

Potential risk of mitomycin C at high concentrations on peripheral nerve structure  

PubMed Central

Although the local application of mitomycin C may prevent epidural adhesion after laminectomy, mitomycin C can induce neurotoxicity in optic and acoustic nerves at high concentrations. To determine the safe concentration range for mitomycin C, cotton pads soaked with mitomycin C at different concentrations (0.1, 0.3, 0.5, and 0.7 mg/mL) were immediately applied for 5 minutes to the operation area of rats that had undergone laminectomy at L1. Rat sciatic nerves, instead of dorsal nerves, were used in this study. The results showed that mitomycin C at 0.1-0.5 mg/mL did not damage the structure and function of the sciatic nerve, while at 0.7 mg/mL, mitomycin C significantly reduced the thickness of the sciatic nerve myelin sheath compared with lower concentrations, though no functional change was found. These experimental findings indicate that the local application of mitomycin C at low concentrations is safe to prevent scar adhesion following laminectomy, but that mitomycin C at high concentrations (> 0.7 mg/mL) has potential safety risks to peripheral nerve structures. PMID:25206895

Sui, Tao; Zhang, Jinhong; Du, Shihao; Su, Changhui; Que, Jun; Cao, Xiaojian

2014-01-01

216

Marfan syndrome and symptomatic sacral cyst: Report of two cases  

PubMed Central

Context Meningeal abnormalities such as dural ectasia are seen in Marfan syndrome, but spinal meningeal cysts are rarely seen. These cysts usually asymptomatic and often found incidentally on magnetic resonance imaging, large cysts may cause neurological deficits and pain secondary to nerve root compression. Design Case reports. Findings Two patients with Marfan syndrome presented with urinary symptoms secondary to dural ectasia and sacral cysts. Patient 1 had a history of low back pain, erectile dysfunction, and occasional urinary incontinence and groin pain with recent symptom worsening. He underwent L5 partial laminectomy and S1-S2 laminectomy with sacral cyst decompression. Nine weeks later, he underwent drainage of a sacral pseudomeningocele. Pain and urinary symptoms resolved, and he remains neurologically normal 2 years after surgery. Patient 2 presented after a fall on his tailbone, complaining of low back pain and difficulty urinating. Physical therapy was implemented, but after 4 weeks, urinary retention had not improved. He then underwent resection of the sacral cyst and S1-S3 laminectomy. Pain and paresthesias resolved and bowel function returned to normal. Other than needing intermittent self-catheterization, all other neurologic findings were normal 30 months after surgery. Conclusion/clinical relevance Surgical goals for sacral cysts include resection as well as closure of the dura, which can be challenging due to thinning from ectasia. Neurosurgical intervention in Marfan syndrome is associated with a high risk of dural tears and osseous complications, and should be performed only when symptoms are severe. PMID:23941798

Arnold, Paul M.; Teuber, Jan

2013-01-01

217

Evaluation of Anterior Cervical Reconstruction with Titanium Mesh Cages versus Nano-Hydroxyapatite/Polyamide66 Cages after 1- or 2-Level Corpectomy for Multilevel Cervical Spondylotic Myelopathy: A Retrospective Study of 117 Patients  

PubMed Central

Objective To retrospectively compare the efficacy of the titanium mesh cage (TMC) and the nano-hydroxyapatite/polyamide66 cage (n-HA/PA66 cage) for 1- or 2-level anterior cervical corpectomy and fusion (ACCF) to treat multilevel cervical spondylotic myelopathy (MCSM). Methods A total of 117 consecutive patients with MCSM who underwent 1- or 2-level ACCF using a TMC or an n-HA/PA66 cage were studied retrospectively at a mean follow-up of 45.28±12.83 months. The patients were divided into four groups according to the level of corpectomy (1- or 2-level corpectomy) and cage type used (TMC or n-HA/PA66 cage). Clinical and radiological parameters were used to evaluate outcomes. Results At the one-year follow-up, the fusion rate in the n-HA/PA66 group was higher, albeit non-significantly, than that in the TMC group for both 1- and 2-level ACCF, but the fusion rates of the procedures were almost equal at the final follow-up. The incidence of cage subsidence at the final follow-up was significantly higher in the TMC group than in the n-HA/PA66 group for the 1-level ACCF (24% vs. 4%, p?=?0.01), and the difference was greater for the 2-level ACCF between the TMC group and the n-HA/PA66 group (38% vs. 5%, p?=?0.01). Meanwhile, a much greater loss of fused height was observed in the TMC group compared with the n-HA/PA66 group for both the 1- and 2-level ACCF. All four groups demonstrated increases in C2-C7 Cobb angle and JOA scores and decreases in VAS at the final follow-up compared with preoperative values. Conclusion The lower incidence of cage subsidence, better maintenance of the height of the fused segment and similar excellent bony fusion indicate that the n-HA/PA66 cage may be a superior alternative to the TMC for cervical reconstruction after cervical corpectomy, in particular for 2-level ACCF. PMID:24789144

Zhang, Yuan; Quan, Zhengxue; Zhao, Zenghui; Luo, Xiaoji; Tang, Ke; Li, Jie; Zhou, Xu; Jiang, Dianming

2014-01-01

218

The Prevalence and Phenotype of Activated Microglia/Macrophages within the Spinal Cord of the Hyperostotic Mouse (twy/twy) Changes in Response to Chronic Progressive Spinal Cord Compression: Implications for Human Cervical Compressive Myelopathy  

PubMed Central

Background Cervical compressive myelopathy, e.g. due to spondylosis or ossification of the posterior longitudinal ligament is a common cause of spinal cord dysfunction. Although human pathological studies have reported neuronal loss and demyelination in the chronically compressed spinal cord, little is known about the mechanisms involved. In particular, the neuroinflammatory processes that are thought to underlie the condition are poorly understood. The present study assessed the localized prevalence of activated M1 and M2 microglia/macrophages in twy/twy mice that develop spontaneous cervical spinal cord compression, as a model of human disease. Methods Inflammatory cells and cytokines were assessed in compressed lesions of the spinal cords in 12-, 18- and 24-weeks old twy/twy mice by immunohistochemical, immunoblot and flow cytometric analysis. Computed tomography and standard histology confirmed a progressive spinal cord compression through the spontaneously development of an impinging calcified mass. Results The prevalence of CD11b-positive cells, in the compressed spinal cord increased over time with a concurrent decrease in neurons. The CD11b-positive cell population was initially formed of arginase-1- and CD206-positive M2 microglia/macrophages, which later shifted towards iNOS- and CD16/32-positive M1 microglia/macrophages. There was a transient increase in levels of T helper 2 (Th2) cytokines at 18 weeks, whereas levels of Th1 cytokines as well as brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF) and macrophage antigen (Mac) ?2 progressively increased. Conclusions Spinal cord compression was associated with a temporal M2 microglia/macrophage response, which may act as a possible repair or neuroprotective mechanism. However, the persistence of the neural insult also associated with persistent expression of Th1 cytokines and increased prevalence of activated M1 microglia/macrophages, which may lead to neuronal loss and demyelination despite the presence of neurotrophic factors. This understanding of the aetiopathology of chronic spinal cord compression is of importance in the development of new treatment targets in human disease. PMID:23717624

Hirai, Takayuki; Uchida, Kenzo; Nakajima, Hideaki; Guerrero, Alexander Rodriguez; Takeura, Naoto; Watanabe, Shuji; Sugita, Daisuke; Yoshida, Ai; Johnson, William E. B.; Baba, Hisatoshi

2013-01-01

219

Risk factors for scoliosis in children with neuroblastoma  

SciTech Connect

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.

Paulino, Arnold C. [Department of Radiation Oncology, Emory Clinic, Emory University (United States) and Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, GA (United States)]. E-mail: apaulino@tmh.tmc.edu; Fowler, B. Zach [Department of Radiation Oncology, Emory Clinic, Emory University (United States)

2005-03-01

220

Myelopathy and amnesia following accidental electrical injury  

Microsoft Academic Search

Objective: Documentation of MRI and neurophysiological changes following accidental electrical injury.Setting: Tertiary care referral teaching hospital at Lucknow, India.Results: A 30-year-old lady developed amnesia and spastic paraparesis with loss of pin prick sensation below the second thoracic spinal segment following electrocution. Her spinal MRI was normal and cranial MRI revealed T2 hyperintensity in the right putamen. Peroneal, sural and electromyography

J Kalita; M Jose; UK Misra

2002-01-01

221

Incidence and Risk Factors of C5 Palsy following Posterior Cervical Decompression: A Systematic Review  

PubMed Central

Background C5 palsy is a serious but poorly understood complication after posterior cervical decompression that could lead to muscle weakness, brachialgia and numbness of the upper limbs. The incidence of C5 palsy varies greatly between studies. The risk factors are inconclusive and even conflicting. Object To perform a systematic review on the incidence and risk factors of C5 palsy after posterior cervical decompression. Materials and Methods Four databases, PubMed, Embase, Web of Science and Cochrane CENTRAL, were searched to identify eligible studies. Either a fixed- or a random-effects model was used to calculate the pooled odd ratio (RR) or standardized mean difference (SMD) with its 95% confidence interval (95%CI). Results Of the 589 pre-recruited studies, 25 were included in this study for systematic review. The pooled incidence of C5 palsy after posterior decompression was 5.8% (95%CI: 4.4–7.2%). The incidence after open-door laminoplasty, double-door laminoplasty and laminectomy was 4.5%, 3.1% and 11.3%, respectively. The significant risk factors of C5 palsy were OPLL (OR, 2.188; 95%CI, 1.307–3.665), narrower intervertebral foramen (SMD, ?0.972; 95%CI, ?1.398 to ?0.545), laminectomy (vs. open-door laminoplasty, OR, 2.988; 95%CI, 1.298–6.876), excessive spinal cord drift (SMD, 1.289, 95%CI, 0,197–2.381) and male gender (OR, 1.54; 95%CI, 1.036–2.301). Conclusions The results of this systematic review suggest that patients with excessive spinal cord drift, preexisting intervertebral foramenal stenosis, OPLL, laminectomy and male gender are at high risk for postoperative C5 palsy, and risk-reduction options should be considered for such patients. PMID:25162509

Tian, Ye; Liang, Lei; Wang, Ce; Yang, Lili; Yuan, Wen

2014-01-01

222

The Effects of Lumbar Facet Dowels on Joint Stiffness: A Biomechanical Study  

PubMed Central

Background Facet joint arthrosis may play a significant role in low back pain generation. The placement of facet dowels is a percutaneous treatment that aims to fuse the facets and increase joint stiffness. In this cadaveric study, we evaluated spine stiffness after facet dowel insertion in combination with several surgical procedures and determined which motions promote dowel migration. Methods Six fresh frozen lumbar spines were tested in flexion-extension, lateral bending, and axial rotation. Spine stiffness was determined for the intact specimens, after L4 laminectomy, and after bilateral L4-L5 facet dowel placement, respectively. One specimen underwent a unilateral transforaminal lumbar interbody fusion (TLIF) construct and another underwent extreme lateral interbody fusion (XLIF) graft (22 mm) placement, followed by placement of facet dowels. Afterwards, the specimens were subjected to 10,000 cycles of fatigue testing in flexion-extension or axial rotation. Results The overall decrease in stiffness after laminectomy was 4.6%. Facet dowel placement increased overall stiffness by 7.2%. The greatest increase was seen with axial rotation (13%), compared to flexion, extension, and lateral bending (9.5%, 2.3%, and 5.6%, respectively). The TLIF and XLIF plus dowel construct increased specimen stiffness to 266% and 163% of baseline, respectively. After fatigue testing, dowel migration was detected by computed tomography in the 2 uninstrumented specimens undergoing axial rotation cycling. Conclusion Facet dowels increase the stiffness of the motion segment to which they are applied and can be used in conjunction with laminectomy procedures to increase the stiffness of the joint. However, dowel migration can occur after axial rotation movements. Hybrid TLIF or XLIF plus facet dowel constructs have significantly higher stiffness than noninstrumented ones and may prevent dowel migration. PMID:24688332

Trahan, Jayme; Morales, Eric; Richter, Erich O.; Tender, Gabriel C.

2014-01-01

223

Amitriptyline pharmacokinetics in experimental spinal cord injury in the rabbit.  

PubMed

Previous studies have demonstrated that pharmacokinetic behavior of several drugs such as paracetamol, theophylline, and aminoglycosides are significantly altered in spinal cord injured patients. No pharmacokinetic study of amitriptyline has been performed in patients and experimental models of spinal cord injury. Pharmacokinetic parameters of amitriptyline in orally treated rabbits subjected to laminectomy and spinal cord injury compared with those underwent laminectomy alone. Among twenty four male rabbits were included in this study, nine of them subjected to spinal cord injury at the 8(th) thoracic level by knife severance method and six rabbits underwent laminectomy alone (sham group) and nine rabbits treated as control. All received a single oral dose of amitriptyline (20 mg/kg) 24 h after injury. Blood sampling were done at predetermined times to 36 h after drug administration. Amitriptyline concentration in serum samples was determined by high-performance liquid chromatography. Pharmacokinetic parameters including maximum concentration (C(max)), time to reach maximum concentration (T(max)), half life, and the area under the curve to last detectable concentration time point (AUC(0-t)) were directly determined from the concentration-time curve. Maximum concentration was observed at 6.5 h after administration in sham group with a concentration of 439.6 ng/ml, whereas in SCI group T(max) was at 2.7 h with a concentration of 2763.9 ng/ml. In control group it was 3.3 h and 396 ng/ml, respectively. In SCI group, AUC was 9465.6 ng.h/ml and half life was 6 h and for control group it was 2817.4 ng.h/ml and 6.4 h, respectively. Statistical analysis of data showed that SCI didn't induce significant changes in amitriptyline pharmacokinetic parameters. PMID:21369441

Reihanikermani, H; Ansari, M; Soltani, A; Meymandi, M S

2008-11-01

224

United States Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003  

PubMed Central

Study Design Repeated cross-sectional analysis using national Medicare data from the Dartmouth Atlas Project. Objectives To describe recent trends and geographic variation in population-based rates of lumbar fusion spine surgery. Summary of Background Data Lumbar fusion rates have increased dramatically during the 80s and even more so in the 90s. The most rapid increase appeared to follow the approval of a new surgical implant device. Methods Medicare claims and enrollment data were used to calculate age-, sex- and race-adjusted rates of lumbar laminectomy/discectomy and lumbar fusion for fee-for-service Medicare beneficiaries over age 65 in each of the 306 U.S. Hospital Referral Regions between 1992 and 2003. Results Lumbar fusion rates have increased steadily since 1992 (0.3 per 1000 enrollees in 1992 to 1.1 per 1000 enrollees in 2003). Regional rates of lumbar discectomy, laminectomy, and fusion in 1992–1993 were highly correlated to rates of discectomy, laminectomy (R2=0.44) and fusion (R2=0.28) in 2002–2003. There was a nearly 8-fold variation in regional rates of lumbar discectomy and laminectomy between 2002 and 2003. In the case of lumbar fusion there was nearly a 20-fold range in rates among Medicare enrollees between 2002–2003. This represents the largest coefficient of variation seen with any surgical procedure. Medicare spending for inpatient back surgery more than doubled over the decade. Spending for lumbar fusion increased more than 500%, from $75 million to $482 million. In 1992, lumbar fusion represented 14% of total spending for back surgery; by 2003, lumbar fusion accounted for 47% of spending. Conclusions The rate of specific procedures within a region or “surgical signature” is remarkably stable over time. However, there has been a marked increase in rates of fusion and a coincident shift and increase in cost. Rates of back surgery were not correlated with the per-capita supply of orthopaedic and neurosurgeons. PMID:17077740

Weinstein, James N.; Lurie, Jon D.; Olson, Patrick; Bronner, Kristen K.; Fisher, Elliott S.; Morgan, Tamara S

2010-01-01

225

Reconstruction of posterior neck and skull with vertical trapezius musculocutaneous flap  

SciTech Connect

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.

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

1988-10-01

226

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

SciTech Connect

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.

Rades, Dirk, E-mail: Rades.Dirk@gmx.ne [Department of Radiation Oncology, University Hospital Schleswig-Holstein, Lubeck (Germany); Douglas, Sarah; Huttenlocher, Stefan [Department of Radiation Oncology, University Hospital Schleswig-Holstein, Lubeck (Germany); Rudat, Volker [Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar (Saudi Arabia); Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf (Germany); Veninga, Theo [Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg (Netherlands); Stalpers, Lukas J.A. [Department of Radiotherapy, Academic Medical Center, Amsterdam (Netherlands); Basic, Hiba [Department of Radiation Oncology, University Hospital Sarajevo (Bosnia and Herzegowina); Karstens, Johann H. [Department of Radiation Oncology, Medical School Hannover (Germany); Hoskin, Peter J. [Department of Clinical Oncology, Mount Vernon Cancer Center, Northwood (United Kingdom); Adamietz, Irenaeus A. [Department of Radiation Oncology, Ruhr University Bochum (Germany); Schild, Steven E. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona (United States)

2011-04-01

227

Nocardia brasiliensis vertebral osteomyelitis and epidural abscess.  

PubMed

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

Johnson, Philip; Ammar, Hussam

2013-01-01

228

Giant pseudomeningocele after spinal surgery: A case report  

PubMed Central

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

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

2012-01-01

229

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

PubMed Central

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

Rihani, Farouk Bassam

2013-01-01

230

Computed tomography of the postoperative lumbar spine  

SciTech Connect

In the postoperative patient ordinary radiographs of the spine generally add very little information, revealing the usual postoperative bone changes and often postoperative narrowing of the intervertebral space. Myelography may sometimes be informative, showing evidence of focal arachnoiditis or a focal defect at the surgical site. However, the latter finding is difficult to interpret. As experience with high-resolution CT scanning of the lumbar spine has been increasing, it is becoming apparent that this noninvasive and easily performed study can give considerably more information about the postoperative spine than any of the other current imaging methods. About 750 patients with previous lumbar laminectomies had CT scanning within a 28 month period.

Teplick, J.G.; Haskin, M.E.

1983-11-01

231

Development of intraspinal ectopic endometrial tissue in connection with tethered cord syndrome.  

PubMed

We herein report a rare case of intraspinal ectopic endometrial tissue associated with tethered cord syndrome. The patient underwent MR imaging of the lumbar spine and CT spinal angiography. Asymptomatic dysraphism was also detected, including spinal bifida, low-lying conus medullaris, spinal meningocele and a lumbosacral lipoma. Venous reflux obstruction was also suggested. The patient underwent L2-S1 laminectomy and microdecompression of the lesion. The histological and immunohistochemical features were characteristic of ectopic endometrial tissue. Since the surgery, no neurological signs have been noted, either during or outside the patient's menstrual periods. The two-month follow-up MRI scans showed a regression of the lesion. PMID:25447661

Cui, Ling-ling; Cao, Ji-bin; Fan, Guo-guang; Lin, Xu-yong; Xu, Ke

2014-01-01

232

Epidural hematoma after thoracic epidural analgesia in a patient treated with ketorolac, mefenamic acid, and naftazone: a case report.  

PubMed

A 26-year-old male undergoing thoracotomy and bleeding control received a preoperative thoracic epidural for postoperative analgesia. On the fifth postoperative day, paralysis of both lower limbs occurred and urgent magnetic resonance imaging showed massive anterior epidural hematoma. During laminectomy and decompression, platelet dysfunction was diagnosed and preoperative non-steroidal anti-inflammatory drugs medications were supposed to the cause of platelet dysfunction. After infusion of ten units of platelet concentrate, coagulopathy was improved. We should be more careful to drugs with antiplatelet effect when using regional analgesia. PMID:24729848

Jeon, Dae Geun; Song, Jae Gyok; Kim, Seok-Kon; Kim, Juri

2014-03-01

233

Epidural hematoma after thoracic epidural analgesia in a patient treated with ketorolac, mefenamic acid, and naftazone: a case report  

PubMed Central

A 26-year-old male undergoing thoracotomy and bleeding control received a preoperative thoracic epidural for postoperative analgesia. On the fifth postoperative day, paralysis of both lower limbs occurred and urgent magnetic resonance imaging showed massive anterior epidural hematoma. During laminectomy and decompression, platelet dysfunction was diagnosed and preoperative non-steroidal anti-inflammatory drugs medications were supposed to the cause of platelet dysfunction. After infusion of ten units of platelet concentrate, coagulopathy was improved. We should be more careful to drugs with antiplatelet effect when using regional analgesia. PMID:24729848

Jeon, Dae Geun; Kim, Seok-Kon; Kim, Juri

2014-01-01

234

[Sacral osteochondrosis dissecans in a Bernese Mountain Dog: diagnosis and treatment].  

PubMed

A 18-month-old female Bernese Mountain Dog with chronic pain at jumping, extension of the right hind leg and paresis of the tail was referred to the Neurological Service of the Veterinary Hospital of the University of Zurich. Upon radiological examination a mineralised fragment at the dorsal aspect of the endplate of S1 was detected. The diagnosis of Osteochondrosis dissecans was confirmed by linear and computed tomography as well as histologic examination of the fragment, which was surgically removed. Preoperative imaging allowed a minimal surgical approach using a unilateral, modified dorsal laminectomy. Outcome was evaluated by neurological reevaluation and a CT scan performed 6 months after surgery. PMID:15185460

Michal, U; Steffen, F; Hauser, B; Damur, D; Philipp, M

2004-05-01

235

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

PubMed Central

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

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

2015-01-01

236

Regulation of nitric oxide generation by up-regulated arginase I in rat spinal cord injury  

PubMed Central

Recently, arginase is suggested to regulate nitric oxide production by competing with nitric oxide synthase for the same substrate, L-arginine, in experimental asthma. We investigated the role of arginase and its relationship to nitric oxide production after spinal cord injury. Rats were subjected to laminectomy and complete transection of their spinal cords (injury group) or laminectomy only (sham group). In the injury group, arginase I was increased in the macrophages at the transection edge, and the peak was observed 48 h after spinal cord injury. However, nitric oxide production decreased significantly in the injury group despite increased nitric oxide synthase2 mRNA expression compared with the sham group. We also demonstrated the reduction in L-arginine concentrations, which was inversely associated with changes in arginase activity. Therefore, arginase appeared to regulate nitric oxide production by consuming L-arginine. The regulation of arginase activity and L-arginine levels may improve nitroxidative stress and reduce tissue damage in spinal cord injury. PMID:22798716

Imagama, Takashi; Ogino, Keiki; Takemoto, Kei; Kato, Yoshihiko; Kataoka, Hideo; Suzuki, Hidenori; Ran, Zhang; Setiawan, Heri; Fujikura, Yoshihisa; Taguchi, Toshihiko

2012-01-01

237

Spontaneous epidural hematoma of spine associated with clopidogrel: A case study and review of the literature.  

PubMed

Spontaneous spinal epidural hematoma (SSEH) is an uncommon neurological emergency which can present with the features ranging from simple back pain with radiculopathy to complete paraplegia or quadriplegia depending on the site and severity of the compression. Spinal hemorrhage associated with anti-platelet drugs is rarely seen. We report a case of SSEH in a 68-year-old hypertensive male who was on a low dose clopidogrel for secondary stroke prophylaxis and presented with bilateral lower limb paralysis, preceeded by severe back bain. A spinal magnetic resonance imaging scan was performed which revealed a posterior epidural hematoma of the thoraco-lumbar spine. To the best of our knowledge, not more than four cases of clopidogrel related spinal epidural hematoma have been reported. Emergent decompressive laminectomy was done within 4 hours of the presentation with excellent clinical outcome. Clinicians should, therefore, consider the remote risk of SSEH in hypertensive patients who are on anti-platelet drugs as early decompressive laminectomy and evacuation of the hematoma minimizes the permanent neurological damage. PMID:25767588

Bhat, Khalid Javid; Kapoor, Sidhart; Watali, Yamin Zahoor; Sharma, Jaggatar Ram

2015-01-01

238

Metastatic renal cell carcinoma, with a radiographically occult primary tumor, presenting in the operative site of a thoracic meningioma: long-term follow-up: Case report.  

PubMed

Lesions metastatic to the site of a meningioma resection from a different primary tumor are rare. Metastasis of a tumor without a known primary tumor is also rare. Metastasis of a renal cell carcinoma, without an identifiable primary tumor, to the bed of a meningioma resection has not been previously reported. The authors describe the case of a 54-year-old man who presented with decreased sensory and motor function in the lower extremities. He underwent T3-5 laminectomies and gross-total removal of an intradural, extramedullary meningioma. The postoperative course was uneventful, and the patient regained full neurological function. After a 3-year period, he developed progressive upper thoracic pain and lower-extremity paresthesias. Imaging studies showed an epidural mass at the T2-4 levels and what appeared to be blastic involvement of the T2-4 vertebrae. A metastatic workup was negative. Emergency revision laminectomies yielded a fibrous, nonvascular mass. Neuropathology was consistent with metastatic renal cell carcinoma. After 6 months, the patient's symptoms of pain and paresthesias recurred. Repeat excision, with decompression of the spinal cord, revealed tumor cells morphologically and immunophenotypically similar to those obtained from the prior surgery. Cytogenetic analysis confirmed the presence of metastatic renal cell carcinoma. A novel case of an epidural metastatic renal cell carcinoma, of unknown primary origin, in the same operative bed of a previously resected intradural, extramedullary meningioma of the thoracic spine is reported. PMID:25014504

Heary, Robert F; Agarwal, Nitin; Barrese, James C; Barry, Maureen T; Baisre, Ada

2014-10-01

239

The lumbar epidural space in patients examined with epiduroscopy.  

PubMed

Percutaneous epiduroscopy was performed in 10 patients with the aim of comparing the lumbar epidural space of the patients with the findings made earlier in autopsy subjects. The patients were scheduled for partial laminectomy for a herniated lumbar disc. A complete examination was possible in eight subjects. The extent of view was very limited. The epidural space opened up only temporarily as air was injected. The dura mater lay very close to the dorsal aspect of the epidural space and was attached to the flaval ligaments by a dorsomedian connective tissue band. The band was identified in all eight subjects and was found to cause a dorsal fold in the dura mater. An epidural catheter was introduced 2-5 cm into the space by midline puncture in four patients and by the paramedian approach in the other four. The catheter was visualized in two patients only when the paramedian approach was used. None of the midline catheters could be seen in the space. In 2 of the 10 subjects a moderate bleeding impaired the view and made complete examination impossible. Smaller bleeding occurred in three other subjects. The partial laminectomy performed one to two interspaces caudad to the level of endoscopy did not reveal any evidence of epidural bleeding in any subject. The postoperative course of all patients was uneventful. PMID:2913849

Blomberg, R G; Olsson, S S

1989-02-01

240

Signal-to-noise ratio comparison of phased-array vs. implantable coil for rat spinal cord MRI.  

PubMed

The signal-to-noise ratio (SNR) performance and practicality issues of a four-element phased-array coil and an implantable coil system were compared for rat spinal cord magnetic resonance imaging (MRI) at 7 T. MRI scans of the rat spinal cord at T10 were acquired from eight rats over a 3 week period using both coil systems, with and without laminectomy. The results demonstrate that both the phased array and the implantable coil systems are feasible options for rat spinal cord imaging at 7 T, with both systems providing adequate SNR for 100-mum spatial resolution at reasonable imaging times. The implantable coils provided significantly higher SNR, as compared to the phased array (average SNR gain of 5.3x between the laminectomy groups and 2.5x between the nonlaminectomy groups). The implantable coil system should be used if maximal SNR is critical, whereas the phased array is a good choice for its ease of use and lesser invasiveness. PMID:17905249

Yung, Andrew C; Kozlowski, Piotr

2007-10-01

241

Spontaneous epidural hematoma of spine associated with clopidogrel: A case study and review of the literature  

PubMed Central

Spontaneous spinal epidural hematoma (SSEH) is an uncommon neurological emergency which can present with the features ranging from simple back pain with radiculopathy to complete paraplegia or quadriplegia depending on the site and severity of the compression. Spinal hemorrhage associated with anti-platelet drugs is rarely seen. We report a case of SSEH in a 68-year-old hypertensive male who was on a low dose clopidogrel for secondary stroke prophylaxis and presented with bilateral lower limb paralysis, preceeded by severe back bain. A spinal magnetic resonance imaging scan was performed which revealed a posterior epidural hematoma of the thoraco-lumbar spine. To the best of our knowledge, not more than four cases of clopidogrel related spinal epidural hematoma have been reported. Emergent decompressive laminectomy was done within 4 hours of the presentation with excellent clinical outcome. Clinicians should, therefore, consider the remote risk of SSEH in hypertensive patients who are on anti-platelet drugs as early decompressive laminectomy and evacuation of the hematoma minimizes the permanent neurological damage.

Bhat, Khalid Javid; Kapoor, Sidhart; Watali, Yamin Zahoor; Sharma, Jaggatar Ram

2015-01-01

242

Spinal deformity after selective dorsal rhizotomy in ambulatory patients with cerebral palsy.  

PubMed

Thirty-four patients with ambulatory spastic diplegia (ages 10-19.8 years) who were part of a prospective study of selective dorsal rhizotomy (SDR) had standardized radiographs before and after SDR. Follow-up ranged from 5 to 11.6 years after surgery. Two different surgical approaches were used: laminectomy (14 patients) and laminoplasty (20 patients). Radiographs were measured for coronal and sagittal balance. Thirty patients had a spinal deformity at long-term follow-up compared with 10 patients before surgery. Seventeen patients (50%) developed lumbar hyperlordosis greater than 60 degrees. Six patients (18%) developed grade 1 spondylolisthesis, Scoliosis occurred de novo in eight patients (24%) and progressed by greater than 5 degrees in two patients with preoperative scoliosis. No significant differences were found between laminoplasty and laminectomy patients. None of the patients have undergone any surgical intervention for spinal deformity. There was a higher incidence of spinal deformity after SDR than in normals and an historical control population, which warrants clinical and radiographic long-term follow-up. PMID:15308903

Johnson, Michael B; Goldstein, Liav; Thomas, Susan Sienko; Piatt, Joseph; Aiona, Michael; Sussman, Michael

2004-01-01

243

Foramen Magnum Meningioma: Some Anatomical and Surgical Remarks through Five Cases  

PubMed Central

Study Design Foramen magnum meningioma foramen magnum meningioma (FMM) represents 2% all of meningiomas. The clinical symptomatology is usually insidious and consists of headache, neck pain and hypoesthesia in C2 dermatome. Because of their location, the management is challenging. Purpose The purpose of this paper is to present our experience in the surgery of FMM. Overview of Literature Since 1938, numerous series have been published but they are very heterogeneous with high variability of location and surgical approaches. Methods During two years, we operated 5 patients with FMM. All the patients had magnetic resonance imaging (MRI) with angio-MRI to study the relationship between tumour and vertebral artery (VA). In all the cases, we used prone position. Results In one case, considering the tumour localization (posterior and pure intradural) the tumour was removed via a midline suboccipital approach with craniotomy and C1-C2 laminectomy. In all other cases, meningiomas were posterolateral (classification of George) with extradural extension in one case. In all cases, VA was surrounded by tumor. So, we opted for a modified postero-lateral approach with inverted L incision, craniotomy and C1-C2 laminectomy without resect occipital condyle. Epidural part of VA was identified and mobilized laterally. Once VA was identified we opened dura mater and began to remove the tumour. Conclusions In this paper, we present five cases of operated FMM, describe our approaches, the reason of each approach and propose some surgical remarks. PMID:25705335

2015-01-01

244

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

PubMed Central

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

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

2014-01-01

245

A case of cauda equina syndrome in early-onset chronic inflammatory demyelinating polyneuropathy clinically similar to charcot-marie-tooth disease type 1.  

PubMed

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

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

2014-06-01

246

Spinal cord sodium, potassium, calcium, and water concentration changes in rats after graded contusion injury.  

PubMed

Spinal cord Na, K, Ca, and H2O changes were measured 6 h after graded contusion injuries in 40 Sprague-Dawley rats. A 10 g weight was dropped 1.25 cm (n = 6), 2.5 cm (n = 7), 5.0 cm (n = 6), or 7.5 cm (n = 7) onto the thoracic spinal cord of 26 rats. An additional 10 rats served as laminectomy controls and 4 rats were unoperated controls. At 6 h after surgery or injury, the spinal cords were rapidly cut into 4 mm segments, weighed to obtain tissue wet weights (W), dried for 14-16 h at 97 degrees C in a vacuum oven (30 mmHg), and reweighed for tissue dry weights (D). Water concentrations ([H2O]d) were estimated from (W-D)/D in units of ml/g D. Ionic concentrations ([Na]d, [K]d, and [Ca]d) of the tissue samples were measured by atomic absorption spectroscopy with units of mumol/g D. Ionic shifts (delta [Na]d, delta [K]d, delta [Ca]d) were calculated by subtracting laminectomy control values from those measured in injured cords. Laminectomy alone significantly increased [Na]d and [H2O]d compared to unoperated controls. Mean +/- standard deviations of [H2O]d, [Na]d, [K]d, and [Ca]d were, respectively, 1.95 +/- 0.07, 182.6 +/- 5.9, 277.2 +/- 11.8, and 12.1 +/- 1.4 in unoperated controls; 2.12 +/- 0.08, 238.6 +/- 9.2, 277.8 +/- 9.2, and 11.7 +/- 1.1 in laminectomy controls. At the impact site, [K]d fell by 14-37% and [H2O]d rose by 14-24%, [Na]d by 13-64%, and [Ca]d by 65-137% of laminectomy control values. delta [Na]d, delta [K]d, and delta [Ca]d correlated linearly with impact velocities; [Ca]d increased by 1.0% per cm/sec (r = 0.995, p less than 0.005), [Na]d increased 0.67% per cm/sec (r = 0.950, p less than 0.01), and [K]d decreased 0.34% per cm/sec (r = 0.964, p less than 0.01). Neither delta [H2O] nor delta [Na]d + delta [K]d consistently predicted impact velocity. [Na]d + [K]d correlated with [H2O]d with a slope of 177.4 mumol/ml (r = 0.697, p less than 0.005). Since Na and K constitute greater than 95% of tissue inorganic ions, the slope approximates net ionic shift per ml of water entry or the ionic osmolarity of edema fluid. These results indicate that increasing contusions produce graded ionic shifts and that edema does not predict contusion severity. These data support our hypothesis that net ionic shifts cause edema in injured spinal cords. PMID:2754736

Kwo, S; Young, W; Decrescito, V

1989-01-01

247

Case Report Subacute delayed ascending myelopathy after low spine injury  

E-print Network

spinal cord injury, and to discuss evidence supporting a vascular mechanism. Setting: Health Science: After recent spinal cord injury, factors exacerbating spinal venous hypertension and/or arterial spinal cord injury. During the first few hours and days, neurological deterioration may result from edema

Manitoba, University of

248

Pathogenesis and treatment of HTLV-I associated myelopathy  

PubMed Central

That HTLV-I is not a latent infection is indicated by the detection of mRNA in the peripheral blood and CNS of patients with HTLV-I infection and by the persisting humoral and cellular immune responses. Indeed the frequency of anti-HTLV CTL is extremely high. The reduction in anti-TAX CTL frequency following reduction in proviral load suggests that removal of viral antigen may result in a reduced inflammatory response at least in peripheral blood and although the clinical data should be interpreted with caution, perhaps in the CNS. Patients with more advanced disease, and possibly fixed deficits may not benefit from either anti-inflammatory or antiretroviral treatment. The patients with most to gain are those with least deficit in whom early diagnosis and treatment will depend on raising awareness of HTLV-I beyond the neurological community. Many patients with HAM first present to a urologist or gynaecologist with bladder dysfunction or may have been seen in the genitourinary clinical with impotence or positive treponemal serology, which in the older patient is often the result of childhood infection with Treponema pallidum pertenue. Investigation of these patients should include HTLV-I serology and further investigation of HTLV-I positive patients should include proviral load measurements as well as markers of inflammation. Treatments whether antiviral or anti-inflammatory should be assessed for their effect on both as well as a clinical response. ??? PMID:10195025

Taylor, G. P.

1998-01-01

249

Lumbar Disk Herniation Surgery: Outcome and Predictors  

PubMed Central

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

Sedighi, Mahsa; Haghnegahdar, Ali

2014-01-01

250

Lumbar disk herniation surgery: outcome and predictors.  

PubMed

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

Sedighi, Mahsa; Haghnegahdar, Ali

2014-12-01

251

Klebsiella pneumoniae liver abscess associated with septic spinal epidural abscess.  

PubMed

A 56-year-old Japanese man with hypertension presented with a 10 days history of high fever, right and left upper quadrant tenderness. An abdominal ultrasonography and computerized tomographic scan revealed a large collection in the right lobe of the liver that was consistent with an abscess. A drainage catheter was placed and purulent fluid was drained. Cultures of the fluid and blood were positive for a strain of ampicillin-resistant Klebsiella pneumoniae. Six days after admission, paraplegia and urinary retention were found. On the neurological examination, deep tendon reflexes of the lower extremities were absent bilaterally. Magnetic resonance imaging scan detected thoracic spinal epidural abscess and paraspinal abscess. He received the emergent decompressive laminectomy. Culture of surgical specimen grew ampicillin-resistant K. pneumoniae. The patient was treated with biapenem intravenously. Thereafter, clinical symptoms improved gradually and he was removed to the professional hospital to continue rehabilitation for gait disturbance on hospital day 147. PMID:15652471

Kuramochi, Gen; Takei, Shin-Ichi; Sato, Munehiro; Isokawa, Osamu; Takemae, Takashi; Takahashi, Akira

2005-01-01

252

Stereotaxic Injection of a Viral Vector for Conditional Gene Manipulation in the Mouse Spinal Cord  

PubMed Central

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

Inquimbert, Perrine; Moll, Martin; Kohno, Tatsuro; Scholz, Joachim

2013-01-01

253

Sciatic neuropathy secondary to total hip arthroplasty wear debris.  

PubMed

Sciatic neuropathy after total hip arthroplasty can result from several causes. We present a case in which a large cystic mass developed around a failed total hip arthroplasty. The lesion extended through the greater sciatic notch and into the pelvis producing sciatic nerve compression. The diagnosis was delayed, and the patient underwent a laminectomy without relief of symptoms before an abdominopelvic computed tomography (CT) scan revealed the mass. After revision of the components and excision of the accessible portion of the lesion, the symptoms improved. Resolution of the intrapelvic portion of the mass was demonstrated on follow-up CT scan, suggesting that retroperitoneal resection of this type of lesion may not be required at the time of revision of the components. PMID:10512454

Fischer, S R; Christ, D J; Roehr, B A

1999-09-01

254

Ruptured Conus Medullaris Dermoid Cyst with Fat Droplets in the Central  

PubMed Central

Spinal dermoid tumors are rare, benign, slow growing tumors. These tumors may become acutely symptomatic after rupture or infection. Excision of the lesion with long term close follow-up studies is required for the management of these lesions. We present a very rare case of ruptured conus medullaris dermoid cyst in a 22-year-old male presented with urinary retention and low back pain. Magnetic resonance imaging scan with contrast reveals a lesion in the cauda equina inseparable from conus medullaris with fat droplets within the central spinal canal extending up to the medulla. Patient was operated with laminectomy and near complete excision of the lesion was done. Patient's low back pain was relieved following surgery. However patient had persistent urinary incontinence and on clean intermittent self-catheterization. Histopathology was suggestive of dermoid cyst. PMID:23508636

Mally, Rahul; Velho, Vernon

2013-01-01

255

Melanotic cyst of L5 spinal root: A case report and review of literature.  

PubMed

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

Chakravarthy, Hariprakash

2012-10-01

256

Epidermoid cyst inside anterior sacral meningocele in an adult patient of Currarino syndrome manifesting with meningitis.  

PubMed

The Currarino triad, also known as the "Currarino Syndrome", is a rare complex of congenital caudal anomalies including three main features; a sacral bony deformity, anorectal malformations, and a presacral mass. We present an extremely uncommon case of Currarino syndrome in adulthood presenting with repeated episodes of meningitis. Magnetic resonance imaging of spine was suggestive of caudal regression. Cord was low lying, conus ending at L3 level with evidence of tethering at that level. A large cyst was noted in the sacral canal extending forwards in the pelvis through the widened sacral foramina on right side. She was operated through a posterior approach, via sacral laminectomy. Dura was opened in the midline, large silvery white epidermoid tumor was found completely occupying the anterior sacral meningocele. The case and relevant literature is discussed. PMID:23015348

Kansal, Ritesh; Mahore, Amit; Dange, Nitin; Kukreja, Sanjay

2012-01-01

257

Successfull Management of a Life Threatening Cerebellar Haemorrhage Following Spine Surgery - A Case Report -  

PubMed Central

Cerebellar haemorrhages are rare life-threatening complications following spine surgery that present challenges for their diagnostic and their therapeutic management. Their patho-physiology remains unclear. We report a case of a life-threatening cerebellar haemorrhage secondary to an occult dural tear following a planned L5-S1 laminectomy. The patient was treated with emergent external ventriculostomy following by a posterior fossa decompressive craniectomy. Cerebellar haemorrhages have to be suspected systematically when unexpected neurological signs occur after spine surgery since their rapid management lead to favourable outcomes. The present imaging findings allow us proposing that cerebellar haemorrhages result primarily from superior cerebellar venous stretching and tearing, and that cerebellar infarction and swelling occur secondarily. PMID:20404944

Belaïd, Hayat; Aldea, Sorin

2009-01-01

258

Spinal giant cell tumor in tuberous sclerosis: Case report and review of the literature  

PubMed Central

Background Patients affected by tuberous sclerosis (TS) have a greater incidence of tumors than the healthy population. Spinal tumours in TS are reported very rarely and consist mainly of sacrococcygeal and cervical chordomas. Method Case report. Findings A 21-year-old man, affected by TS, presented a spinal dorsal T2 tumor that caused medullary compression. He underwent decompressive laminectomy and microsurgical excision of a giant cell tumor and an associated aneurysmal bone cyst. Postoperative hypofractionated radiotherapy was performed on the surgical field. At 2.4 years of follow-up the patient reported total recovery of neurological deficits and was free from tumor recurrence. Conclusion Considering this association, which is the first reported in the literature, spinal magnetic resonance imaging with gadolinium should be performed at the onset of spinal pain in patients affected by TS. PMID:23809532

Fraioli, Mario Francesco; Lecce, Mario; Fraioli, Chiara; Paolo, Curatolo

2013-01-01

259

Anterior Cervical Arachnoid Cyst  

PubMed Central

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

Sharifi, Give

2013-01-01

260

Traumatic Intradural Lumbar Disc Herniation without Bone Injury  

PubMed Central

Intradural lumbar disc herniation is a rare disease. According to the reports of intradural lumbar disc herniations, most cases have developed as a chronic degenerative disc diseases. Traumatic intradural lumbar disc herniations are even rarer. A 52-year-old man visited our emergency center with numbness in his left calf and ankle after falling accident. Initial impression by radiologic findings was a spinal subdural hematoma at the L1 level. A follow up image two weeks later, however, did not demonstrate any interval change. The patient was decided to have an operation. In operative findings, a ruptured disc particle penetrating the ventral and dorsal dura was indentified after laminectomy. It was assumed to be a traumatic outcome not a degenerative change. PMID:24757484

Lee, Hyun-Woo

2013-01-01

261

Unilateral Pedicle Stress Fracture in a Long-Term Hemodialysis Patient with Isthmic Spondylolisthesis  

PubMed Central

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

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

2015-01-01

262

Primary Lumbo-sacral Spinal Epidural Non-Hodgkin's Lymphoma: A Case Report and Review of Literature.  

PubMed

We present a case of 24-year-old male presented with low back pain radiating to the left lower limb, tingling numbness and weakness of 6 months duration. Magnetic resonance imaging scan with contrast reveals an extradural mass at lumbosacral region. Patient was operated with laminectomy and complete excision of the lesion was done. Patient's radicular pain relieved following the surgery and weakness also improved. Histopathology was suggestive of non-Hodgkin's lymphoma. Patient received chemotherapy which was followed by radiotherapy. Primary Non-Hodgkin's lymphoma of the lumbosacral spinal epidural tissue is an uncommon lesion. Lymphoma involves the central nervous system in 5-11% of cases either at presentation of the disease or during its course. The spinal epidural tissue is involved primarily in 0.1-3.3% of cases with spinal cord compression being the commonest presentation. Excision of the lesion followed by chemotherapy and radiotherapy is required to achieve cure. PMID:21892393

Mally, Rahul; Sharma, Mayur; Khan, Shadma; Velho, Vernon

2011-09-01

263

Occult spinal dysraphism.  

PubMed

When spina bifida is associated with skin abnormalities such as dimples, sinus tracts hypertrichosis, or capillary hemangiomas, there is a high incidence of an occult intraspinal lesion such as epidermoid and dermoid tumours, lipomas, diastematomyelia, dural bands and tethered spinal cord. The present study consists of 50 patients with occult spinal dysraphism treated with the diagnosis of lipomeningomyelocoele (20), lumbosacral lipoma (15) and diastematomyelia (15). The clinical presentation varied from lipoma in the lumbosacral region, dermal sinus, cutaneous hemangioma and hypertrichosis. The age range varied from 2 months to 7 years with an average of 2 years. 40% patients had neurological deficit at the time of presentation which varied from lower limb weakness to bladder & bowel involvement. All patients underwent laminectomy of the lumbar and lumbo-sacral spine with excision of intraspinal lipoma, excision of bony or cartilaginous spur in diastematomyelia and detethering of the conus medullaris & cauda equina. No patient developed late neurological deficit. PMID:11129883

Bajpai, M; Kataria, R; Gupta, D K; Agarwala, S

1997-01-01

264

Thoracic congenital dermal sinus associated with intramedullary spinal dermoid cyst  

PubMed Central

Dorsal dermal sinus is a rare, congenital lesion found most frequently in the lumbosacral followed by the occipital regions. It is rarely localized at the thoracic level. We report a rare case of thoracic congenital dermal sinus (CDS) associated with an intramedullary dermoid cyst in a 2-year-old male child, who presented with a 3 month history of motor weakness of both the lower extremities. Magnetic resonance imaging (MRI) of spine showed an intramedullary dermoid cyst extending from the lower border of T4 to upper border of T7, which was connected with the skin dimple along the sinus tract. Total excision of the dermoid cyst and the sinus tract with T5–7 laminectomy resulted in good functional recovery. PMID:24891899

Mishra, Sudhansu Sekhar; Panigrahi, Souvagya

2014-01-01

265

Intraspinal Lipomas Without Associated Spinal Dysraphism  

PubMed Central

Introduction: The aim of this study was to report surgical strategies and clinical outcomes for thoraco-lumbar intradural lipomas. Intraspinal lipomas are rare congenital histologically benign neoplasms, which account for less than 1% of all spinal cord tumors. These tumors are most frequently found in the lumbosacral area as components of a dysraphic state, however, intramedullary lipomas are not associated with spina bifida or cutaneous malformations and have only been described as isolated cases among spinal lipomas, where the thoracolumbar region is rarely affected. Case Presentation: Three patients with thoracolumbar intradural lipomas were admitted to our clinic at different points of time. Partial resections and debulking of the tumors were achieved with the guidance of an operating microscope. We performed laminectomies or laminoplasties, for tumor resections. Discussion: Postoperatively, the patients demonstrated significant clinical improvements. In this manuscript we presented our surgical experiences for intraspinal lipomas. PMID:25031846

Arslan, Erhan; Kuzeyli, Kayhan; Acar Arslan, Elif

2014-01-01

266

[Invasive pulmonary mucormycosis with invasion of the thoracic spine in a patient with myelodysplastic syndrome].  

PubMed

We report the case of a 67-year-old patient who presented with a myelodysplastic syndrome and who developed a pulmonary mucormycosis with a rare extension to the dorsal spine. A decompressive laminectomy was attempted after failure of broad-spectrum antifungal treatment (Cancidas, V-Fend). The diagnosis was obtained after surgical biopsy. The scheduled lobectomy could not be performed because of altered clinical condition. The patient eventually died despite adapted antifungal treatment (Abelcet, Posaconazole). Pulmonary mucormycosis is a rare cause of mycotic infection that reaches most of the time immunocompromised patients. The pathogenic agent is part of zygomyces that have angio-invasive ability. Perineural propagation was recently described. Immunodepression, late diagnosis and lack of response to new generation antifungal drugs (V-Fend, Cancidas) are responsible for therapeutic failure in this disease. This case emphasizes the risk inherent to empirical antifungal treatment and the need of early biopsy in cases that do not respond to treatment. PMID:19180827

De Pasqual, A; Deprez, M; Ghaye, B; Frère, P; Kaschten, B; Hayette, M P; Radermecker, M; Martin, D; Canivet, J L

2008-12-01

267

Pycnodysostosis with Multi-Segmental Spinal Canal Stenosis due to Ossification of the Yellow Ligament  

PubMed Central

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.

Kanaya, Koichi; Murata, Yasuaki; Kato, Yoshiharu

2015-01-01

268

Tarlov cyst: Case report and review of literature.  

PubMed

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

Prashad, Bhagwat; Jain, Anil K; Dhammi, Ish K

2007-10-01

269

Tarlov cyst: Case report and review of literature  

PubMed Central

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

Prashad, Bhagwat; Jain, Anil K; Dhammi, Ish K

2007-01-01

270

Symptomatic Tarlov cyst: report and review.  

PubMed

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

Chaiyabud, Pradit; Suwanpratheep, Kitti

2006-07-01

271

Lumbar spinal stenosis.  

PubMed Central

Lumbar spinal stenosis, the results of congenital and degenerative constriction of the neural canal and foramina leading to lumbosacral nerve root or cauda equina compression, is a common cause of disability in middle-aged and elderly patients. Advanced neuroradiologic imaging techniques have improved our ability to localize the site of nerve root entrapment in patients presenting with neurogenic claudication or painful radiculopathy. Although conservative medical management may be successful initially, surgical decompression by wide laminectomy or an intralaminar approach should be done in patients with serious or progressive pain or neurologic dysfunction. Because the early diagnosis and treatment of lumbar spinal stenosis may prevent intractable pain and the permanent neurologic sequelae of chronic nerve root entrapment, all physicians should be aware of the different neurologic presentations and the treatment options for patients with spinal stenosis. Images PMID:8434469

Ciricillo, S F; Weinstein, P R

1993-01-01

272

Noncommunicating Spinal Extradural Meningeal Cyst in Thoracolumbar Spine  

PubMed Central

Spinal extradural meningeal cyst has been rarely reported, whose etiologies are assumed to be the communication of cerebrospinal fluid (CSF) between intradural subarchnoid space and cyst due to the congenital defect in dura mater. Although the CSF communication due to this defect can be found, in most case, few cases in which there is a lack of the communication have also been reported. We report a case of the huge extradural meningeal cyst occurring in the thoracolumbar spine (from T10 to L2) where there was a lack of the communication between the intradural subarachnoid space and cyst in a 46-year-old man who presented with symptoms that were indicative of progressive paraparesis and leg pain. The patient underwent laminectomy and cyst excision. On intraoperative findings, the dura was intact and there was a lack of the communication with intradural subarachnoid space. Immediately after the surgery, weakness and leg pain disappeared shortly. PMID:21430982

Kim, Il Sup; Son, Byung Chul; Lee, Sang Won

2010-01-01

273

Intramedullary Solitary Fibrous Tumor of Cervicothoracic Spinal Cord  

PubMed Central

Solitary fibrous tumor is rare benign mesenchymal neoplasm. The spinal solitary fibrous tumor is extremely rare. The authors experienced a case of intramedullary solitary fibrous tumor of cervicothoracic spinal cord in a 48-year-old man with right lower extremity sensory disturbance. Spinal MRI showed intradural mass lesion in the level of C7-T1, the margin between the spinal cord and tumor was not clear on MRI. A Left unilateral laminectomy and mass removal was performed. Intra operative finding, the tumor boundary was unclear from spinal cord and it had intramedullary and extramedullary portion. After surgery, patient had good recovery and had uneventful prognosis. Follow up spinal MRI showed no recurrence of tumor. PMID:25368773

Hwang, Ui Seung; Kim, Sung Bum; Jo, Dae Jean

2014-01-01

274

[Spontaneous spinal epidural haematoma causing rapid flaccid paraplegia in a healthy 25-year-old patient].  

PubMed

Although clinical presentation of a spinal epidural compressive haematoma is well recognized, causing acute radicular pain shortly followed by cord compression syndrome, its aetiology may pose a quandary. Rare and most commonly seen after trauma, spinal surgery, epidural anaesthesia, anticoagulation therapy, vascular malformation or coagulopathy (haemophilia), spinal epidural haematoma (SHE) can be spontaneous. Surgical decompression remains the mainstay treatment especially when the prognosis depends on the interval to surgery and the severity of preoperative neurological deficit. We report the case of a healthy 25-year-old man who presented, three days after an acute back pain, a flaccid paraplegia with urinary retention. Magnetic resonance imaging of the spinal column identified a compressive SHE extending from T3 to T6, requiring an early laminectomy. After decompression, clinical outcome revealed a complete recovery excepted some mild sensibility trouble remains. PMID:17462853

Colsy, M; Argote, C; Raimbault, M; Touchard, P

2007-06-01

275

Whole Spontaneous Spinal Epidural Hematoma  

PubMed Central

A 26-year-old male who had no underlying disease, including coagulopathy, underwent thoracotomy and bleeding control due to hemothorax. On the fifth postoperative day, paralysis of both lower limbs occurred. Urgent spine magnetic resonance imaging showed a massive anterior spinal epidural hematoma from C2 to L1 level with different signal intensities, which was suspected to be staged hemorrhage. Hematoma evacuation with decompressive laminectomy was performed. The patient's neurologic deterioration was recovered immediately, and he was discharged without neurological deficits. A drug history of naftazone, which could induce a drug-induced platelet dysfunction, was revealed retrospectively. To our knowledge, this is the first report of whole spontaneous spinal epidural hematoma in a young patient, with a history of hemorrhoid medication. PMID:24967052

Yoon, Kyeong-Wook; Song, Jae Gyok; Ryu, Jae-Wook

2014-01-01

276

L5 – S1 Segmental Kinematics After Facet Arthroplasty  

PubMed Central

Background Facet arthroplasty is a motion restoring procedure. It is normally suggested as an alternative to rigid fixation after destabilizing decompression procedures in the posterior lumbar spine. While previous studies have reported successful results in reproducing normal spine kinematics after facet replacement at L4-5 and L3-4, there are no data on the viability of facet replacement at the lumbosacral joint. The anatomy of posterior elements and the resulting kinematics at L5-S1 are distinctly different from those at superior levels, making the task of facet replacement at the lumbosacral level challenging. This study evaluated the kinematics of facet replacement at L5-S1. Methods Six human cadaveric lumbar spines (L1-S1, 46.7 ± 13.0 years) were tested in the following sequence: (1) intact (L1-S1), (2) complete laminectomy and bilateral facetectomy at L5-S1, and (3) implantation of TFAS-LS (Lumbosacral Total Facet Arthroplasty System, Archus Orthopedics, Redmond, Washington) at L5-S1 using pedicle screws. Specimens were tested in flexion (8Nm), extension (6Nm), lateral bending (LB, ± 6Nm), and axial rotation (AR, ± 5Nm). The level of significance was ? = .017 after Bonferroni correction for three comparisons: (1) intact vs. destabilized, (2) destabilized vs. reconstructed, and (3) intact vs. reconstructed. Results Laminectomy-facetectomy at L5-S1 increased the L5-S1 angular range of motion (ROM) in all directions. Flexion-extension (F-E) ROM increased from 15.3 ± 2.9 to 18.7 ± 3.5 degrees (P < .017), LB from 8.2 ± 1.8 to 9.3 ± 1.6 degrees (P < .017), and AR from 3.7 ± 2.0 to 5.9 ± 1.8 degrees (P < .017). The facet arthroplasty system decreased ROM compared to the laminectomy-facetectomy condition in all tested directions (P < .017). The facet arthroplasty system restored the L5-S1 ROM to its intact levels in LB and AR (P > .017). F-E ROM after the facet arthroplasty system implantation was smaller than the intact value (10.1 ± 2.2 vs. 15.3 ± 2.9 degrees, P < .017). The load-displacement curves after the facet arthroplasty system implantation at L5-S1 were sigmoidal, and quality of motion measures were similar to intact, demonstrating graded resistance to angular motion in F-E, LB and AR. Conclusions The facet arthroplasty system was able to restore stability to the lumbosacral segment after complete laminectomy and bilateral facetectomy, while also allowing near-normal kinematics in all planes. While F-E ROM after the facet arthroplasty system implantation was smaller than the intact value, it was within the physiologic norms for L5-S1. These results are consistent with previous studies of facet arthroplasty at L3-L4 and L4-L5 and demonstrate that TFAS technology can be adapted to the lumbosacral joint with functionality comparable to its application in superior lumbar levels.

Voronov, Leonard I.; Havey, Robert M.; Rosler, David M.; Sjovold, Simon G.; Rogers, Susan L.; Carandang, Gerard; Ochoa, Jorge A.; Yuan, Hansen; Webb, Scott

2009-01-01

277

Subdural and cerebellar hematomas which developed after spinal surgery: a case report and review of the literature.  

PubMed

Cerebellar hemorrhage following a spinal surgery is extremely rare; however, considering the localization, it can cause major clinical manifestations. While it is considered that these types of bleedings occur secondary to a venous infarct, the pathogenesis is still unclear. A 57-year-old male patient who underwent a laminectomy by exposing T12-L5 and had pedicle screws placed for ankylosing spondylitis developed a CSF leak due to a 2?mm dural tear. A hemorrhage with parallel streaks on the left cerebellar hemisphere was seen in CT scan, and a thin subdural hematoma at right frontotemporal region was seen on cranial MRI, performed after the patient developed intense headache, nausea, vomiting, and stiff neck in the early postoperative period. In this paper, a case of cerebellar and subdural hematomas following a spinal surgery is discussed with its clinical and radiologic findings. PMID:23956894

Utku, Ufuk; Güler, Sibel; Yaln?z, Erol; Unlü, Ercüment

2013-01-01

278

Thoracic congenital dermal sinus associated with intramedullary spinal dermoid cyst.  

PubMed

Dorsal dermal sinus is a rare, congenital lesion found most frequently in the lumbosacral followed by the occipital regions. It is rarely localized at the thoracic level. We report a rare case of thoracic congenital dermal sinus (CDS) associated with an intramedullary dermoid cyst in a 2-year-old male child, who presented with a 3 month history of motor weakness of both the lower extremities. Magnetic resonance imaging (MRI) of spine showed an intramedullary dermoid cyst extending from the lower border of T4 to upper border of T7, which was connected with the skin dimple along the sinus tract. Total excision of the dermoid cyst and the sinus tract with T5-7 laminectomy resulted in good functional recovery. PMID:24891899

Mishra, Sudhansu Sekhar; Panigrahi, Souvagya

2014-01-01

279

Longitudinal in vivo coherent anti-Stokes Raman scattering imaging of demyelination and remyelination in injured spinal cord  

NASA Astrophysics Data System (ADS)

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.

Shi, Yunzhou; Zhang, Delong; Huff, Terry B.; Wang, Xiaofei; Shi, Riyi; Xu, Xiao-Ming; Cheng, Ji-Xin

2011-10-01

280

Degenerative lumbar spinal stenosis: evaluation and management.  

PubMed

Degenerative lumbar spinal stenosis is caused by mechanical factors and/or biochemical alterations within the intervertebral disk that lead to disk space collapse, facet joint hypertrophy, soft-tissue infolding, and osteophyte formation, which narrows the space available for the thecal sac and exiting nerve roots. The clinical consequence of this compression is neurogenic claudication and varying degrees of leg and back pain. Degenerative lumbar spinal stenosis is a major cause of pain and impaired quality of life in the elderly. The natural history of this condition varies; however, it has not been shown to worsen progressively. Nonsurgical management consists of nonsteroidal anti-inflammatory drugs, physical therapy, and epidural steroid injections. If nonsurgical management is unsuccessful and neurologic decline persists or progresses, surgical treatment, most commonly laminectomy, is indicated. Recent prospective randomized studies have demonstrated that surgery is superior to nonsurgical management in terms of controlling pain and improving function in patients with lumbar spinal stenosis. PMID:22855855

Issack, Paul S; Cunningham, Matthew E; Pumberger, Matthias; Hughes, Alexander P; Cammisa, Frank P

2012-08-01

281

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with hypertrophic spinal radiculopathy mimicking neurofibromatosis.  

PubMed

This report illustrates a case of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) masquerading as neurofibromatosis due to multifocal enlargements of spinal nerve roots. The patient initially complained of intermittent numbness of the hands and leg weakness at age 62. Nerve conduction velocities were reported to be abnormally slow, suggesting a diagnosis of demyelinating neuropathy. A complaint of progressive lower back pain 4 years later prompted a lumbar CT myelogram, which demonstrated bilateral nerve root enlargements. A biopsy of an enlarged lumbar root obtained during decompressive laminectomy was interpreted as consistent with a plexiform neurofibroma. He suffered recurrent paraparesis, at times with a sensory level indicating spinal cord compression, which responded to corticosteroid therapy. An autopsy 15 years after the onset of symptoms revealed hypertrophic radiculopathy and peripheral neuropathy due to CIDP with no evidence of neurofibromatosis. This case illustrates how the hypertrophic neuropathy accompanying CIDP can be mistaken for neurofibromatosis. PMID:12536230

Pytel, P; Rezania, K; Soliven, B; Frank, J; Wollmann, R

2003-02-01

282

Intravital Imaging of Axonal Interactions with Microglia and Macrophages in a Mouse Dorsal Column Crush Injury  

PubMed Central

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

Evans, Teresa A.; Barkauskas, Deborah S.; Myers, Jay T.; Huang, Alex Y.

2014-01-01

283

Whole spontaneous spinal epidural hematoma.  

PubMed

A 26-year-old male who had no underlying disease, including coagulopathy, underwent thoracotomy and bleeding control due to hemothorax. On the fifth postoperative day, paralysis of both lower limbs occurred. Urgent spine magnetic resonance imaging showed a massive anterior spinal epidural hematoma from C2 to L1 level with different signal intensities, which was suspected to be staged hemorrhage. Hematoma evacuation with decompressive laminectomy was performed. The patient's neurologic deterioration was recovered immediately, and he was discharged without neurological deficits. A drug history of naftazone, which could induce a drug-induced platelet dysfunction, was revealed retrospectively. To our knowledge, this is the first report of whole spontaneous spinal epidural hematoma in a young patient, with a history of hemorrhoid medication. PMID:24967052

Yoon, Kyeong-Wook; Song, Jae Gyok; Ryu, Jae-Wook; Kim, Young-Jin

2014-06-01

284

Surgical treatment of giant cell tumor of the cervicothoracic spine with combined anterior and posterior approaches  

PubMed Central

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

Habibou, M.L.; Boutarbouch, M.; Oudghiri, M.Y.; Mchome, L.; Louraoui, M.; Derraz, S.; El Ouahabi, A.

2015-01-01

285

Intravital imaging of axonal interactions with microglia and macrophages in a mouse dorsal column crush injury.  

PubMed

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

Evans, Teresa A; Barkauskas, Deborah S; Myers, Jay T; Huang, Alex Y

2014-01-01

286

[2 cases of vertebral hydatidosis treated by the association of surgery and mebendazole].  

PubMed

Two cases of vertebral hydatidosis were diagnosed only at the time of operation. The first one, a lumbar localisation treated as a tuberculosis, by posterior graft and chemotherapy went to a large vertebral destruction with paraplegia. An anterior approach revealed the hydatids. A large excision associated with graft and osteosynthesis gave only a temporary improvement, but the treatment by Mebendazol cured the neurological symptoms. The second case, with a large destruction of L5 and S1, was also treated as a tuberculosis even after a decompressive laminectomy and recognized at a second operation on the sacrum. A left paralysis, incompletely improved by a decompression, appeared as favourably influenced by Mebendazol. Epidemiologic conditions of hydatosis, difficulties of diagnosis of the rare bony localizations, are recalled. The great problem of treatment, especially in the most frequent vertebral lesions, where complete excision is impossible, appears as hopefully improved by Mebendazol. PMID:6222434

Cardona, J M; Giné, J; Flores, X; Algara, C; Ballester, J

1983-01-01

287

Surgical treatment of giant cell tumor of the cervicothoracic spine with combined anterior and posterior approaches.  

PubMed

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

Habibou, M L; Boutarbouch, M; Oudghiri, M Y; Mchome, L; Louraoui, M; Derraz, S; El Ouahabi, A

2015-01-01

288

Intraoperative Vertebral Artery Angiography to Guide C1-2 Transarticular Screw Fixation in a Patient with Athetoid Cerebral Palsy  

PubMed Central

We present a case of an athetoid cerebral palsy with quadriparesis caused by kyphotic deformity of the cervical spine, severe spinal stenosis at the cervicomedullary junction, and atlantoaxial instability. The patient improved after the first surgery, which included a C1 total laminectomy and C-arm guided righ side unilateral C1-2 transarticular screw fixation. C1-2 fixation was not performed on the other side because of an aberrant and dominant vertebral artery (VA). Eight months after the first operation, the patient required revision surgery for persistent neck pain and screw malposition. We used intraoperative VA angiography with simultaneous fluoroscopy for precise image guidance during bilateral C1-2 transarticular screw fixation. Intraoperative VA angiography allowed the accurate insertion of screws, and can therefore be used to avoid VA injury during C1-2 transarticular screw fixation in comorbid patients with atlantoaxial deformities. PMID:22639719

Chung, Jong Chul; Park, Ki Seok; Ha, Ho Gyun

2012-01-01

289

Regrowth of Cervical Intradural Lipoma without Spinal Dysraphism  

PubMed Central

A 49 years old male patient who suffered from deterioration of posterior neck pain, left hand numbness, left lower limb pain and gait disturbance for 3 years visited our outpatient department. He had been diagnosed as non-dysraphic cervical intradural lipoma and operated in August 1990. On the radiologic images, we found the regrowth of non-dysraphic cervical intradural lipoma from C2 to C7 level, which surrounds and compresses the cervical spinal cord. Previous subtotal laminectomy from C2 to C7 and severe cervical lordosis were also found. Appropriate debulking of lipoma mass without duroplasty was successfully done with intraoperative neurophysiological monitoring (IONM). We are following up the patient for 24 months via outpatient department, his neurologic symptoms such as hand numbness, gait disturbance, left lower limb pain and posterior neck pain have improved. We describe a rare case of regrowth of non-dysraphic cervical intradural lipoma. PMID:25328656

Son, Doo Kyung; Choi, Chang Hwa; Song, Geun Sung

2014-01-01

290

Intraspinal transplantation of mouse and human neural precursor cells  

PubMed Central

This unit describes the preparation and transplantation of human neural precursor cells (hNPCs) and mouse neural precursor cells (mNPCs) into the thoracic region of the mouse spinal cord. The techniques in this unit also describe how to prepare the mouse for surgery by performing a laminectomy to expose the spinal cord for transplantation. Here we show NPCs genetically labeled with eGFP transplanted into the spinal cord of a mouse following viralmediated demyelination can efficiently be detected via eGFP expression. Transplantation of these cells into the spinal cord is an efficacious way to determine their effects in neurological disorders such as multiple sclerosis, Alzheimer's disease, and spinal cord injury. PMID:24510791

Weinger, Jason G.; Chen, Lu; Coleman, Ronald; Leang, Ronika; Plaisted, Warren C.; Loring, Jeanne F.; Lane, Thomas E.

2013-01-01

291

Autologous mesenchymal stem cells in chronic spinal cord injury.  

PubMed

Spinal cord injury (SCI) occurs in the most productive part of life. Treatment options for treatment of chronic SCI are few and have limited impact on clinical outcome. Central nervous system (CNS) has limited intrinsic regeneration capability. The study included patients with chronic complete SCI. Previously harvested autologous mesenchymal stem cells were administered at the site of injury after a laminectomy. Follow-up was done by a neutral examiner not involved in the surgery every 3 months. One patient had improvement in motor power. Two patients had a patchy improvement in pin prick sensation below the level of injury. Three different, progressively increasing doses did not result in improvement in the clinical outcome. Though the administration of allogenic human mesenchymal stem cells is safe in patients with SCI, it may not be efficacious; especially in patients with chronic SCI. PMID:21749185

Bhanot, Yanish; Rao, Sujay; Ghosh, Debapriya; Balaraju, Sudheer; Radhika, C R; Satish Kumar, K V

2011-08-01

292

Langerhans' cell histiocytosis involving posterior elements of the dorsal spine: An unusual cause of extradural spinal mass in an adult.  

PubMed

Langerhans cell histiocytosis (LCH) is a clonal proliferation of Langerhans cells occurring as an isolated lesion or as part of a systemic proliferation. It is commoner in children younger than 10 years of age with sparing of the posterior elements in more than 95% of cases. We describe a case of LCH in an adult female presenting with paraplegia. MRI revealed a well-defined extradural contrast enhancing mass at D2-D4 vertebral level involving the posterior elements of spine. D2-5 laminectomy with excision of lesion was performed which lead to marked improvement of patients neurological status. Histopathology was suggestive of eosinophilic granuloma. We describe the case, discuss its uniqueness and review the literature on this rare tumor presentation. PMID:23125497

Tyagi, Devendra K; Balasubramaniam, Srikant; Savant, Hemant V

2011-07-01

293

Spinal lobular capillary hemangioma with an intramedullary component.  

PubMed

Capillary hemangiomas are benign vascular neoplasms rarely involving the spinal cord, where their usual location is extramedullary. A 59-year-old man presented with a 7-month history of progressive numbness which began in the left lower extremity and progressed across the lower back, right flank, trunk and into the right lower extremity with associated pressure and pain in his lower back. On magnetic resonance imaging, there was an avidly-enhancing thoracic intradural lesion that contained an extramedullary intradural component posteriorly, with an apparent intramedullary component anteriorly. Laminectomy of T7 - 8 was performed, and intradural exploration revealed a highly vascular-appearing tumor below the arachnoid, which was not completely dissected because it was densely adherent to the spinal cord. The pathological diagnosis was lobular capillary hemangioma with extra- and intramedullary components. We suggest this lesion should be considered in the differential diagnosis of spinal cord tumors with an intramedullary component. PMID:23924752

Gonzalez, Ricardo; Spears, Julian; Bharatha, Aditya; Munoz, David G

2014-01-01

294

Case study of a spinal epidural capillary hemangioma: a 4-year postoperative follow-up.  

PubMed

Study Design?Case study. Objectives?We report the case of a 58-year-old Caucasian man, who presented with a 4-month history of increasing low back pain and gait difficulty. Objective neurologic examination revealed a severe paraparetic symptomatology without any sphincter involvement. Methods?Spinal magnetic resonance imaging (MRI) showed an extradural mass formation situated dorsally at the level of thoracic vertebrae T2 to T4. Results?A laminectomy was performed with total removal of the mass; histology suggested a highly vascularized lesion with lobular architecture, which seems a very rare case, compatible with a capillary hemangioma. Conclusions?A careful follow-up for the next 4 years, including control MRIs every postoperative year, showed a very good neurologic condition of the patient and no recurrence on imaging findings. PMID:24494182

Seferi, Arsen; Alimehmeti, Ridvan; Vyshka, Gentian; Bushati, Teona; Petrela, Mentor

2014-02-01

295

Neuroprotective effects of sildenafil in experimental spinal cord injury in rabbits  

PubMed Central

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

Kara, Hasan; Degirmenci, Selim; Ak, Ahmet; Bayir, Aysegul; Kayis, Seyit Ali; Uyar, Mehmet; Akinci, Murat; Acar, Demet; Kocacan, Metin; Akyurek, Fikret

2015-01-01

296

Assessing forelimb function after unilateral cervical spinal cord injury: novel forelimb tasks predict lesion severity and recovery.  

PubMed

Cervical spinal cord injury (cSCI) can cause devastating neurological deficits, including impairment or loss of upper limb and hand function. Recently there has been increasing interest in cervical spinal cord injury models because the majority of spinal cord injuries are at cervical levels. Here we examined spontaneous functional recovery of adult rats with either laminectomy or lateral hemisection of the cervical spinal cord at C3-C4. Behavioral tests were carried out, including the forelimb locomotor scale (FLS), a postural instability test (PIT), a pasta-handling test that has been used to assess forepaw digit function and latency to eat, forelimb use during vertical-lateral wall exploration in a cylindrical enclosure, and vibrissae-elicited forelimb placing tests. In addition, a forelimb step-alternation test was developed to assess functional recovery at 12 weeks post-injury. All tests detected cSCI-induced deficits relative to laminectomy. Interestingly, the severity of deficits in the forelimb step-alternation test was associated with more extensive spinal damage, greater impairment, and less recovery in the FLS and other tests. For the pasta-handling test we found that rats with a milder cervical injury (alternators) were more likely to use both forepaws together compared to rats with a more severe injury (non-alternators). In addition, using the PIT, we detected enhanced function of the good limb, suggesting that neural plasticity on the unaffected side of the spinal cord may have occurred to compensate for deficits in the impaired forelimb. These outcome measures should be useful for investigating neural events associated with cSCI, and for developing novel treatment strategies. PMID:22022897

Khaing, Zin Z; Geissler, Sydney A; Jiang, Shan; Milman, Brian D; Aguilar, Sandra V; Schmidt, Christine E; Schallert, Timothy

2012-02-10

297

Enhancement of bilateral cortical somatosensory evoked potentials to intact forelimb stimulation following thoracic contusion spinal cord injury in rats.  

PubMed

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

Bazley, Faith A; Maybhate, Anil; Tan, Chuen Seng; Thakor, Nitish V; Kerr, Candace; All, Angelo H

2014-09-01

298

Unusual presentation of giant cell tumor originating from a facet joint of the thoracic spine in a child: a case report and review of the literature  

PubMed Central

Introduction Giant cell tumor of the synovium is a common benign lesion that frequently occurs at the tendon sheaths in the hand; it is usually found in adults over 30 years old. It is related to pigmented villonodular synovitis. Giant cell tumor of the synovium or pigmented villonodular synovitis has been described rarely in the axial skeleton especially in the thoracic vertebrae of a child. Case presentation A previously healthy 7-year-old Thai girl presented with back pain and progressive paraparesis and was unable to walk for 1 month. She had weakness and hyperreflexia of both lower extremities. Magnetic resonance imaging showed a well-defined homogeneously and intensely enhanced extradural mass with cord compression at T4 to T7 levels. The patient underwent laminectomy at T4 through to T7 and total tumor removal. Permanent histopathologic sections and immunostains revealed a giant cell tumor of the synovium. Postoperative neurological status recovered to grade V. Magnetic resonance imaging at the 1-year follow-up showed no recurrence and there was no clinical recurrence at the 2-year follow-up. Conclusion We report an extremely rare case of giant cell tumor in the epidural space that extended from a thoracic facet joint. The tumor was removed successfully through laminectomies. Although giant cell tumor of a facet joint of the thoracic spine is very rare, it must be considered in the differential diagnosis for masses occurring in the epidural space in a child. Total tumor removal is the best treatment. Careful monitoring of recurrence can achieve a good clinical outcome. PMID:23830026

2013-01-01

299

Management of Thoracal and Lumbar Schwannomas Using a Unilateral Approach without Instability: An Analysis of 15 Cases  

PubMed Central

Study Design Retrospective case series. Purpose The objectives of this study were to determine and discuss the surgical planning of patients who underwent operations following diagnoses of thoracal and lumbar spinal schwannomas. We also aimed to discuss the application of unilateral hemilaminectomy for the microsurgery of schwannomas. Overview of Literature Schwannomas are located in different regions and sites. These differences require several surgical approaches. Unilateral laminectomy without stabilization of the spine provides a more minimally invasive removal of the tumor. Methods In this retrospective study, 15 patients with spinal schwannomas were evaluated with regards to age, sex, onset history, neurological findings, tumor locations, McCormick scale, surgical procedure, and operational results. The lateral approach provides exposure of intradural structures and posterior paraspinal regions. Extensions of tumors cause problem for the surgeon in terms of approach, resectability of the tumor, and stability of the spine. Gross total resection was achieved in all cases, and none of the patients necessary required a fusion procedure. Results Five patients were males and 10 were females. The age interval was 29-65 years. The tumor was located in the lumbar region in 9 patients, in the thoracic region in 2 patients, and in the thoracolumbar junction in 4 patients. The intradural lesions were removed by laminectomy and the extradural lesions were resected with hemilaminectomy. The paramedian route was used to explore the extraspinal part of the tumor. Costotransversectomy was for the thoracic region. Subtotal resection was performed in 1 patient. Patient symptoms recovered gradually in the postoperative period. Conclusions Resection of giant schwannomas is challenging and usually requires a different approach. We describe the complete resection of complex dumbbell or paraspinal schwannomas of the thoracic and lumbar spine by unilateral hemilaminectomy. PMID:22439087

Canbay, Suat; Basmaci, Mehmet; Erten, Fuat; Harman, Ferhat

2012-01-01

300

Four-year follow-up results of transforaminal lumbar interbody fusion as revision surgery for recurrent lumbar disc herniation after conventional discectomy.  

PubMed

This study investigated the safety, effectiveness, and clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) for recurrent lumbar disc herniation (rLDH) following previous lumbar spine surgery. Seventy-three consecutive patients treated for rLDH between June 2005 and May 2012 were included in the study. The previous surgical procedures included percutaneous discectomy, discectomy with laminotomy, discectomy with unilateral laminectomy, and discectomy with bilateral laminectomy. The level of rLDH was L4-L5 in 51 patients, L5-S1 in 19 patients, and L3-L4 in three patients. All patients underwent reoperation using the TLIF technique. Outcomes were evaluated using the Oswestry disability index (ODI), visual analogue scale (VAS) scores for low back pain and leg pain, and the Japanese Orthopaedic Association (JOA) score, based on the results of physical examinations and questionnaires. The range of motion and disc height index of the operative segment were compared between preoperative and postoperative radiographs. The mean follow-up period was 4.1 years. The VAS scores for low back pain and leg pain, ODI, and JOA score improved significantly between the preoperative and final follow-up evaluations. The mean recovery rate of the JOA score was 89.0%. The disc space height and stability at the fused level were significantly improved after surgery. The fusion rate at the final follow-up was 93.2%. There were no major complications. These results indicate that TLIF can be considered an effective, reliable, and safe alternative procedure for the treatment of rLDH. PMID:25443080

Li, Zhonghai; Tang, Jiaguang; Hou, Shuxun; Ren, Dongfeng; Li, Li; Lu, Xiang; Hou, Tiesheng

2015-02-01

301

AUTOIMMUNE STIFF PERSON SYNDROME AND RELATED MYELOPATHIES: UNDERSTANDING OF ELECTROPHYSIOLOGICAL AND IMMUNOLOGICAL PROCESSES  

PubMed Central

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

Rakocevic, Goran; Floeter, Mary Kay

2011-01-01

302

Motor conduction velocity in the human spinal cord: slowed conduction in multiple sclerosis and radiation myelopathy  

Microsoft Academic Search

Transcutaneous electrical stimulation of the central nervous system was used to measure motor conduction velocity in the human spinal cord in 21 subjects aged 22 to 75 years (mean 55 years), none of whom had neurological disease. The motor conduction velocity between the sixth cervical (C6) and first lumbar (L1) vertebral levels was 67.4 +\\/- 9.1 m\\/s. This probably represents

S J Snooks; M Swash

1985-01-01

303

Granulocytic Sarcoma with Compressive Myelopathy: A Rare Presentation of Chronic Myelogenous Leukemia  

PubMed Central

Granulocytic sarcoma occurs most commonly in acute myelogenous leukemia. The appearance of granulocytic sarcoma in chronic myelogenous leukemia signals accelerated phase/ blast transformation. This is a rare case of undiagnosed chronic myelogenous leukemia with granulocytic sarcoma causing cord compression, which went into tumour lysis syndrome requiring dialysis after starting of steroids and radiotherapy. A 43-year-old male presented in emergency department with acute onset of flaccid paralysis. On clinical examination, there was hepatosplenomegaly and lower motor neuron paralysis in the lower limbs. The peripheral smear was consistent with chronic myelogenous leukemia in chronic phase. The MRI spine revealed para-spinal and epidural masses causing cord compression and the biopsy from the paraspinal mass was consistent with granulocytic sarcoma. PMID:25177619

Viswabandya, Auro; Jasper, Anita; Patel, Palak; Kokil, Gautami

2014-01-01

304

Granulocytic sarcoma with compressive myelopathy: a rare presentation of chronic myelogenous leukemia.  

PubMed

Granulocytic sarcoma occurs most commonly in acute myelogenous leukemia. The appearance of granulocytic sarcoma in chronic myelogenous leukemia signals accelerated phase/ blast transformation. This is a rare case of undiagnosed chronic myelogenous leukemia with granulocytic sarcoma causing cord compression, which went into tumour lysis syndrome requiring dialysis after starting of steroids and radiotherapy. A 43-year-old male presented in emergency department with acute onset of flaccid paralysis. On clinical examination, there was hepatosplenomegaly and lower motor neuron paralysis in the lower limbs. The peripheral smear was consistent with chronic myelogenous leukemia in chronic phase. The MRI spine revealed para-spinal and epidural masses causing cord compression and the biopsy from the paraspinal mass was consistent with granulocytic sarcoma. PMID:25177619

Ganapule, Abhijeet P; Viswabandya, Auro; Jasper, Anita; Patel, Palak; Kokil, Gautami

2014-07-01

305

Severe kyphoscoliosis after primary Echinococcus granulosus infection of the spine  

PubMed Central

A primary Echinococcus granulosus infection of the spine involving the vertebrae T8 and T9 of a 6-year-old child was treated elsewhere by thoracotomy, partial corporectomy, multiple laminectomies and uninstrumented fusion. Owing to inappropriate stabilization, severe deformity developed secondary to these surgeries. X-rays, CT and MRI scans of the spine revealed a severe thoracic kyphoscoliosis of more than 100° (Fig. 1) and recurrence of Echinococcus granulosus infection. The intraspinal cyst formation was located between the stretched dural sac and the vertebral bodies of the kyphotic apex causing significant compression of the cord (Figs. 2, 3, 4). A progressive neurologic deficit was reported by the patient. At the time of referral, the patient was wheelchair bound and unable to walk by herself (Frankel Grade C). Standard antiinfectious therapy of Echinococcus granulosus requires a minimum treatment period of 3 months. This should be done before any surgical intervention because in case of a rupture of an active cyst, the delivered lipoprotein antigens of the parasite may cause a potentially lethal anaphylactic shock. Owing to the critical neurological status, we decided to perform surgery without full length preoperative antiinfectious therapy. Surgical treatment consisted in posterior vertebral column resection technique with an extensive bilateral costotransversectomy over three levels, re-decompression with cyst excision around the apex and multilevel corporectomy of the apex of the deformity. Stabilisation and correction of the spinal deformity were done by insertion of a vertebral body replacement cage anteriorly and posterior shortening by compression and by a multisegmental pedicle screw construct. After the surgery, antihelminthic therapy was continued. The patients neurological deficits resolved quickly: 4 weeks after surgery, the patient had Frankel Grade D and was ambulatory without any assistance. After an 18-month follow-up, the patient is free of recurrence of infection and free of neurologically deficits (Frankel E). This case demonstrates that inappropriate treatment—partial resection of the cyst, inappropriate anterior stabilization and posterior multilevel laminectomies without posterior stabilization—may lead to severe progressive kyphoscoliotic deformity and recurrence of infection, both leading to significant neurological injury presenting as a very difficult to treat pathology.Fig. 1X-rays of the patient showing a kyhoscoliotic deformity. a ap view, b lateral viewFig. 2CT reconstruction of the whole spine showing the apex of the deformity is located in the area of the previous surgeriesFig. 3Sagittal CT-cut showing the bone bloc at the apex with a translation deformityFig. 4Sagittal T2-weighted MRI image showing the cystic formation at the apex PMID:20514501

Gabl, M.; Lechner, R.; Gstöttner, M.; Bach, C. M.

2010-01-01

306

Co- transplantation of Bone Marrow Stromal Cells with Schwann Cells Evokes Mechanical Allodynia in the Contusion Model of Spinal Cord Injury in Rats  

PubMed Central

Objective: Several studies have shown that, although transplantation of neural stem cells into the contusion model of spinal cord injury (SCI) promotes locomotor function and improves functional recovery, it induces a painful response, Allodynia. Different studies indicate that bone marrow stromal cells (BMSCs) and Schwann cells (SCs) can improve locomotor recovery when transplanted into the injured rat spinal cord. Since these cells are commonly used in cell therapy, we investigated whether co-transplantation of these cells leads to the development of Allodynia. Materials and Methods: In this experimental research, the contusion model of SCI was induced by laminectomy at the T8-T9 level of the spinal cord in adult female wistar rats (n=40) weighting (250-300g) using the New York University Device. BMSCs and SCs were cultured and prelabeled with 5-bromo-2-deoxyuridine (BrdU) and 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) respectively. The rats were divided into five groups of 8 including: a control group (laminectomy only), three experimental groups (BMSC, SC and Co-transplant) and a sham group. The experimental groups received BMSCs, SCs, and BMSCs and SCs respectively by intraspinal injection 7 days after injury and the sham group received serum only. Locomotion was assessed using Basso, Beattie and Bresnahan (BBB) test and Allodynia by the withdrawal threshold test using Von Frey Filaments at 1, 7, 14, 21, 28, 35, 42, 49 and 56 days after SCI. The statistical comparisons between groups were carried out by using repeated measures analysis of variances (ANOVA). Results: Significant differences were observed in BBB scores in the Co- transplant group compared to the BMSC and SC groups (p< 0.05). There were also significant differences in the withdrawal threshold means between animals in the sham group and the BMSC, SC and the Co-transplant groups (p<0.05).BBB scores and withdrawal threshold means showed that co-transplation improved functioning but greater Allodynia compared to the other experimental groups. Conclusion: The present study has shown that, although transplantation of BMSCs, SCs and a combination of these cells into the injured rat spinal cord can improve functional recovery, it leads to the development of mechanical Allodynia. This finding indicates that strategies to reduce Allodynia in cell transplantation studies are required. PMID:23508042

Pourheydar, Bagher; Joghataei, Mohammad Taghi; Bakhtiari, Mehrdad; Mehdizadeh, Mehdi; Yekta, Zahra; Najafzadeh, Norooz

2012-01-01

307

Microdiskectomy and translaminar approach: minimal invasiveness and flavum ligament preservation.  

PubMed

Study Design?Retrospective study. Objective?The interlaminar approach represents the standard procedure for the surgical treatment of lumbar disk herniation (LDH). In the case of disk herniations in the "hidden zone," it could be necessary to perform laminotomies or laminectomies and partial or total facetectomies to remove the herniated fragment, thus leading to iatrogenic instability. The objective of the study is to evaluate the translaminar approach, in terms of the results, safety, and efficacy compared with the standard approach. Methods?Since February 2010, 38 patients (26 men and 12 women; mean age 50.9 years, range 31 to 78 years) with LDH and migration into the hidden zone underwent a microdiskectomy by the translaminar approach. Using a micro-diamond dust-coated burr, a translaminar hole (8?±?2 mm) was made, with subsequent exposure of the involved root and removal of the fragment. A clinical follow-up was performed at months 1, 3, 6, and 12 using the visual analog scale and the Oswestry Disability Index. All patients were evaluated according to the Spangfort score. Postoperative radiographic evaluations were done at 1, 6, and 12 months (dynamic radiographic studies done at 6 and 12 months). Results?In over 60% of cases, L4-L5 was the involved disk. The visualization of the roots was successfully achieved through a translaminar approach. No laminotomies, laminectomies, or partial or total facetectomies were performed. The flavum ligament was always spared. A severe intraoperative bleeding episode occurred in 5% of the cases, due to involvement of the epidural veins, but it did not result in prolonged operative time (mean duration 60?±?10 minutes). The patients showed a gradual resolution of the back pain and a progressive resolution of the radicular pain and the neurologic deficits. No sign of radiographic instability was documented during the follow-up. No infections, dural tears, or spinal cord injuries occurred. No revision surgery was performed. Conclusion?The translaminar approach is the only tissue-sparing technique viable in case of cranially migrated LDH encroaching on the exiting nerve root in the preforaminal zones, for the levels above L2-L3, and in the preforaminal and foraminal zones, for the levels below L3-L4 (L5-S1 included, if a total microdiskectomy is not necessary). The possibility to spare the flavum ligament is one of the main advantages of this technique. According to our experience, the translaminar approach is an effective and safe alternative minimally invasive surgical option. PMID:25844280

Vanni, Daniele; Sirabella, Francesco S; Guelfi, Matteo; Pantalone, Andrea; Galzio, Renato; Salini, Vincenzo; Magliani, Vincenzo

2015-04-01

308

Microdiskectomy and Translaminar Approach: Minimal Invasiveness and Flavum Ligament Preservation  

PubMed Central

Study Design?Retrospective study. Objective?The interlaminar approach represents the standard procedure for the surgical treatment of lumbar disk herniation (LDH). In the case of disk herniations in the “hidden zone,” it could be necessary to perform laminotomies or laminectomies and partial or total facetectomies to remove the herniated fragment, thus leading to iatrogenic instability. The objective of the study is to evaluate the translaminar approach, in terms of the results, safety, and efficacy compared with the standard approach. Methods?Since February 2010, 38 patients (26 men and 12 women; mean age 50.9 years, range 31 to 78 years) with LDH and migration into the hidden zone underwent a microdiskectomy by the translaminar approach. Using a micro-diamond dust-coated burr, a translaminar hole (8?±?2 mm) was made, with subsequent exposure of the involved root and removal of the fragment. A clinical follow-up was performed at months 1, 3, 6, and 12 using the visual analog scale and the Oswestry Disability Index. All patients were evaluated according to the Spangfort score. Postoperative radiographic evaluations were done at 1, 6, and 12 months (dynamic radiographic studies done at 6 and 12 months). Results?In over 60% of cases, L4–L5 was the involved disk. The visualization of the roots was successfully achieved through a translaminar approach. No laminotomies, laminectomies, or partial or total facetectomies were performed. The flavum ligament was always spared. A severe intraoperative bleeding episode occurred in 5% of the cases, due to involvement of the epidural veins, but it did not result in prolonged operative time (mean duration 60?±?10 minutes). The patients showed a gradual resolution of the back pain and a progressive resolution of the radicular pain and the neurologic deficits. No sign of radiographic instability was documented during the follow-up. No infections, dural tears, or spinal cord injuries occurred. No revision surgery was performed. Conclusion?The translaminar approach is the only tissue-sparing technique viable in case of cranially migrated LDH encroaching on the exiting nerve root in the preforaminal zones, for the levels above L2–L3, and in the preforaminal and foraminal zones, for the levels below L3–L4 (L5–S1 included, if a total microdiskectomy is not necessary). The possibility to spare the flavum ligament is one of the main advantages of this technique. According to our experience, the translaminar approach is an effective and safe alternative minimally invasive surgical option.

Vanni, Daniele; Sirabella, Francesco S.; Guelfi, Matteo; Pantalone, Andrea; Galzio, Renato; Salini, Vincenzo; Magliani, Vincenzo

2014-01-01

309

Primary liposarcoma of the thoracic spine: case report.  

PubMed

Liposarcoma is a malignant tumor of soft tissue. The thoracic spine is an unusual location, even for metastasis, and to our knowledge, no case of primary pleomorphic liposarcoma of the vertebral body has been reported until now. A female patient presented with paraplegia. She had a previous medical history of mental depression, and complained of dorsal pain for three months following a road accident. Magnetic Resonance Imaging (MRI) revealed a collapse of T7-T8, and the diagnosis of plasmocytoma was made. She was treated with decompressive laminectomy and posterior instrumentation. Histological examination revealed a pleomorphic liposarcoma. She received a course of radiotherapy. At 13 months follow-up she developed pulmonary metastases and rib involvement. The spine is an unusual location for pleomorphic liposarcoma, even as metastasis. The differential diagnoses of this rare entity are discussed, as well as the criteria for diagnosing primary spinal liposarcoma. Although rare, our case demonstrates that liposarcoma should be considered in the differential diagnosis of spinal tumors. PMID:15864668

Hamlat, Abderrahmane; Saikali, Stephan; Gueye, Edouard-Marcel; Le Strat, Anne; Carsin-Nicol, Beatrice; Brassier, Gilles

2005-08-01

310

Intradural cement leakage: a rare complication of percutaneous vertebroplasty.  

PubMed

Percutaneous vertebroplasty (PV) is one of the alternative treatments for vertebral fractures. Reported significant complications include pain, radiculopathy, spinal cord compression, pulmonary embolism, infection and rib fractures. In this report, we highlight intradural cement leakage which is a rare complication of the procedure. A 49 year old man with a T12 compression fracture due to multiple myeloma was referred to the neurosurgery department from the orthopaedics and traumatology clinic after developing a right lower limb weakness following percutaneous vertebroplasty with polymethylmethacrylate. An urgent thoraco-lumbar magnetic resonance imaging was performed. The T1 and T2-weighted images demonstrated intradural extramedullary and epidural cement leakages which were hypointense on both sequences. Total laminectomy was performed at T12 and L1 and two epidural cement collections were excised on the right. Then, a dural incision from T12 to the body of L1 was done and cement material seen in front of the rootlets excised without any nerve injury. The patient was discharged after a week and referred to the haematology clinic for additional therapy of multiple myeloma. Although the cement leakage was extensive, the right leg weakness improved significantly and he began to walk with assistance 3 months later. Good quality image monitoring and clear visualisation of cement are essential requirements for PV using polymethylmethacrylate to prevent this complication from the treatment. PMID:18509588

Sabuncuo?lu, H; Dinçer, D; Güçlü, B; Erdo?an, E; Hatipo?lu, H G; Ozdo?an, S; Timurkaynak, E

2008-08-01

311

Severe thoracic spinal fracture-dislocation without neurological symptoms and costal fractures: a case report and review of the literature  

PubMed Central

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

2014-01-01

312

A case report of 3-level degenerative spondylolisthesis with spinal canal stenosis  

PubMed Central

Introduction Lumbar degenerative spondylolisthesis is a major cause of impaired quality of life and diminished functional capacity in the elderly. Degenerative spondylolisthesis often involves only one or two level and tend to present with one or two level spinal canal stenosis. Case report The authors describe an unusual case of degenerative spondylolisthesis involving 3 levels of the lumbar spine from L2 to L5. The patient was a 58-year-old woman who suffered chronic back pain and neurogenic claudication. Plain radiography revealed grade I degenerative spondylolisthesis at L2–L3, L3–L4 and L4–L5. Elevated pedicle-facet joint angles and W-type facet joints at the lumbar spine was observed. Magnetic resonance imaging showed L2–S1 spinal cord compression at the lumbar spine. Patient underwent L2–S1 decompression laminectomy and posterior lateral fusion of L2–S1 with posterior instrumentation and bone grafting. Symptoms improved significantly at 4 months follow-up. Conclusion Thorough evaluation for multilevel segmental involvement in degenerative spondylolisthesis is important because of the frequency of severe symptomatic spinal stenosis or foraminal encroachment. Good surgical outcome can be expected from decompression and stabilisation. The pathogenesis of multi-level lumbar degenerative spondylolisthesis can be complex and heterogeneous. PMID:25666306

Moo, Ing How; Tan, See Wei; Kasat, Niraj; Thng, Leong Keng

2014-01-01

313

Management of traumatic c6-7 spondyloptosis with cord compression.  

PubMed

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

Choi, Man-Kyu; Jo, Dae-Jean; Kim, Min-Ki; Kim, Tae-Sung

2014-05-01

314

Thoracic meningioma masquerading as chronic abdominal pain.  

PubMed

Chronic abdominal pain without a structural or metabolic gastroenterological etiology can be extremely challenging to diagnose. Patients presenting with an associated radicular pattern of pain may alert the clinician to a possible structural neurological cause of the symptoms. We present the case of a 70-year-old woman who presented to our institution with an 18-month history of right upper quadrant abdominal pain. She had no associated symptoms or provoking factors. She underwent an extensive gastroenterology evaluation, including colonoscopy that was unrevealing. Ultrasound demonstrated gallstones and she was evaluated for cholecystectomy. She subsequently developed right costal margin pain. Her symptoms remained stable over the course of the next year. Follow-up general surgical evaluation was still unconvincing that the gallstones were the etiology of her symptoms. A thoracic spinal MR demonstrated a large intradural extramedullary mass at T8. The patient's neurological exam was normal. She underwent a thoracic laminectomy and resection of meningioma with intraoperative electrophysiological monitoring. Her abdominal pain resolved. Patients can present with months to years of elusive abdominal symptoms only to be eventually found to be harboring an undiagnosed spinal tumor. We discuss the case and review the literature reports of spinal tumors masquerading as chronic abdominal pain. PMID:22665009

Lyons, Mark; Windgassen, Elizabeth; Kinney, Carolyn; Johnson, Daniel; Birch, Barry; Boucher, Orland

2012-01-01

315

Synchrotron FTIR Microspectroscopic Analysis of the Effects of Anti-inflammatory Therapeutics on Would Healing in Laminectomized Rats  

SciTech Connect

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.

Weins,R.; Rak, M.; Cox, N.; Abraham, S.; Juurlink, B.; Kulyk, W.; Gough, K.

2007-01-01

316

Side-Cutting Aspiration Device for Endoscopic and Microscopic Tumor Removal*  

PubMed Central

The authors present a unique side-cutting instrument (NICO Myriad, Indianapolis, IN) with variable aspiration designed specifically for tumor resection. The study included retrospective review of data collected from 10/2009 to 01/2011. We detail the use of the Myriad in 31 patients with the following pathologies: meningioma (n=16), chordoma (n?=?3), schwannoma (n?=?3), pituitary adenoma (n?=?2), metastasis (n?=?3), hemangioblastoma (n?=?1), craniopharyngioma (n?=?1), and nasopharyngeal tumors (n?=?2). Surgical approaches included expanded endonasal approach (n?=?19), endoscopic brain port (n?=?3), supraorbital “eyebrow” craniotomy (n?=?3), retrosigmoid suboccipital craniotomy (n?=?3), pterional craniotomy (n?=?1), extreme far lateral (n?=?1), and laminectomy (n?=?1). Successful tumor resection was achieved in 30 cases. Instrument failure was noted in only one extremely fibrous meningioma. The design of this instrument facilitated maneuvering through narrow corridors while providing direct visualization of the suction aperture during tumor resection. These features allowed for tumor removal without injury to adjacent neurovascular structures. The side-cutting aspiration device allows safe and effective tumor removal. Its low profile, variable aspiration, and lack of thermal heat energy are particularly useful in tumor resection through narrow corridors, such as endonasal, port, and keyhole approaches. The multifunctional nature of the instrument (suction, scissors, and dissectors) minimizes multiple exchanges, facilitating tumor resection through these minimal access corridors. PMID:23372990

McLaughlin, Nancy; Filho, Leo F.S. Ditzel; Prevedello, Daniel M.; Kelly, Daniel F.; Carrau, Ricardo L.; Kassam, Amin B.

2012-01-01

317

Skeletal sequelae of radiation therapy for malignant childhood tumors  

SciTech Connect

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.

Butler, M.S.; Robertson, W.W. Jr.; Rate, W.; D'Angio, G.J.; Drummond, D.S. (UMDNJ Robert Wood Johnson Medical School, New Brunswick (USA))

1990-02-01

318

A sacral hydatid cyst mimicking an anterior sacral meningocele.  

PubMed

Hydatid disease is a zoonosis caused by Echinococcus granulosus. It is a progressive disease with serious morbidity risks. Sacral hydatid disease is very uncommon, accounting for < 11% of spinal hydatidosis cases. The diagnosis of a sacral hydatid cyst is sometimes difficult because hydatidosis can simulate other cystic pathologies. The authors report on 9-year-old boy admitted to their service with a paraparesis that allowed walking without aid. The boy presented with a 2-year history of an evolving incomplete cauda equina syndrome as well as a soft cystic mass in the abdomen extending from the pelvis. Radiological examination revealed an anterior meningocele. A posterior approach with laminectomy from L-5 to S-3 was performed. Three lesions with classic features of a hydatid cyst were observed and removed. The diagnosis of hydatid cyst was confirmed histopathologically. Antihelmintic treatment with albendazole (15 mg/kg/day) was included in the postoperative treatment. The patient's condition improved after surgery, and he recovered normal mobility. The unusual site and presentation of hydatid disease in this patient clearly supports the consideration of spinal hydatid disease in the differential diagnosis for any mass in the body, especially in endemic areas. PMID:22044380

Hemama, Mustapha; Lasseini, Ali; Rifi, Loubna; Boutarbouch, Mahjouba; Derraz, Said; Ouahabi, Abdessamad El; Khamlichi, Abdeslam El

2011-11-01

319

What is the true location of Jacoby's line?  

PubMed

We investigated 60 cadavers to examine the accurate location of conus medullaris, lower end of dura mater, and intercrestal line (Jacoby's line). Jacoby's line was established using the method described by Jacoby GW (1899). Then the intersection of this line and vertical line through the spinous processes was marked by a fine nail. After a laminectomy was performed to expose the spinal cord, spinal level of the conus medullaris, the lower end of dura mater, and Jacoby's line were examined, and marked and recorded these locations of nailing. In 2 of 48 cases (2.1%), Jacoby's line passed through the level superior to 3rd lumber vertebra (L3). The Conus medullaris was at the level beneath L3 in 2 of 57 cases (3.5%). And lower end of dura mater was located beneath the superior margin of S3 in 1 of 28 cases (3.6%). When Jacoby's line is used as a guide-point, the site for subarachnoid puncture is established in the L3-4 interspinous space. But when we consider the risk of spinal cord injury cannot be completely excluded, in case that conus medullaris is located inferior to L3 in 3.5% of cases. Conseqently, it should be important to avoid performing subarachnoid puncture at L2-3 or higher lumbar vertebral level especially in the elderly. PMID:16526569

Shiraishi, Naoki; Matsumura, George

2006-02-01

320

Epidural needle with embedded optical fibers for spectroscopic differentiation of tissue: ex vivo feasibility study  

PubMed Central

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

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

321

Iatrogenic intradural lumbosacral cyst following epiduroscopy.  

PubMed

We report a rare complication of iatrogenic spinal intradural following minimally invasive extradural endoscopic procedues in the lumbo-sacral spines. To our knowledge, intradural cyst following epiduroscopy has not been reported in the literature. A 65-year-old woman with back pain related with previous lumbar disc surgery underwent endoscopic epidural neuroplasty and nerve block, but her back pain much aggravated after this procedure. Postoperative magnetic resonance imaging revealed a large intradural cyst from S1-2 to L2-3 displacing the nerve roots anteriorly. On T1 and T2-weighted image, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent partial laminectomy of L5 and intradural exploration, and fenestration of the cystic wall was accomplished. During operation, the communication between the cyst and subarachnoid space was not identified, and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the pain attenuated immediately. Incidental durotomy which occurred during advancing the endoscope through epidural space may be the cause of formation of the intradural cyst. Intrdural cyst should be considered, if a patient complains of new symptoms such as aggravation of back pain after epiduroscopy. Surgical treatment, simple fenestration of the cyst may lead to improved outcome. All the procedures using epiduroscopy should be performed with caution. PMID:23323173

Ryu, Kyeong-Sik; Rathi, Nitesh Kumar; Kim, Geol; Park, Chun-Kun

2012-11-01

322

Iatrogenic Intradural Lumbosacral Cyst Following Epiduroscopy  

PubMed Central

We report a rare complication of iatrogenic spinal intradural following minimally invasive extradural endoscopic procedues in the lumbo-sacral spines. To our knowledge, intradural cyst following epiduroscopy has not been reported in the literature. A 65-year-old woman with back pain related with previous lumbar disc surgery underwent endoscopic epidural neuroplasty and nerve block, but her back pain much aggravated after this procedure. Postoperative magnetic resonance imaging revealed a large intradural cyst from S1-2 to L2-3 displacing the nerve roots anteriorly. On T1 and T2-weighted image, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent partial laminectomy of L5 and intradural exploration, and fenestration of the cystic wall was accomplished. During operation, the communication between the cyst and subarachnoid space was not identified, and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the pain attenuated immediately. Incidental durotomy which occurred during advancing the endoscope through epidural space may be the cause of formation of the intradural cyst. Intrdural cyst should be considered, if a patient complains of new symptoms such as aggravation of back pain after epiduroscopy. Surgical treatment, simple fenestration of the cyst may lead to improved outcome. All the procedures using epiduroscopy should be performed with caution. PMID:23323173

Ryu, Kyeong-Sik; Rathi, Nitesh Kumar; Kim, Geol

2012-01-01

323

Spinal dural attachments to the vertebral column: An anatomic report and review of the literature  

PubMed Central

Background: The spinal dura is anchored within the vertebral canal by connective tissue in the epidural space as well as the spinal roots. Inadvertent disruption of these dural attachments may lead to durotomy and cerebrospinal fluid (CSF) leaks. We observed well-developed connective tissue ligaments connecting the lumbar dura to the spinal column and examined these tissues microscopically. Methods: Intraoperative images were obtained during lumbar laminectomy procedures. They demonstrated connective tissue attachments, linking the lumbar dura to the spinal column in the dorsal midline and dorsolaterally. Tissue samples were obtained and examined microscopically. We then conducted a search of the literature to find references to dural attachments to the spinal column. Results: Histological examination of the samples showed minimal cellular fibrous tissue. To date no references to these attachments have been made in neurosurgical literature. Previous studies, including live, cadaveric, and radiographic examinations, have demonstrated a dorsomedian fold of dura attached to the junction of the ligamentum flavum, and dorsolateral ligaments that divide the dorsal epidural space into an anterior and posterior compartment. Conclusions: Epidural fibrous connections or ligaments between the dura and the lumbar spinal column may be of clinical importance to the neurosurgeon. Care should be taken during lumbar procedures not to disrupt or tear these ligaments as this may cause dural tears and CSF leaks. Identifying these ligaments and cutting them sharply may prevent inadvertent durotomies. PMID:21811703

Kimmell, Kristopher T.; Dayoub, Hayan; Shakir, Hakeem; Sincoff, Eric H.

2011-01-01

324

Acute tension pneumocephalus secondary to whole spine pneumorrhachis as an unusual presentation of a colon cancer complicated by a transsacral cerebrospinal fluid leak.  

PubMed

A 52-year-old woman who was having chemotherapy for treatment of an adenocarcinoma of the colon, was admitted to the emergency department because of a moderate neurological impairment. Head CT scan showed bifrontal pneumocephalus without fractures or discontinuities of the skull base. A few hours later, following the patient's neurologic deterioration, a new CT scan showed tension pneumocephalus with air diffusion throughout the posterior cranial fossa and cervical spine. Because of air bubbles into the cervical spine, an MRI of the entire spinal canal was done. This exam revealed a whole spine pneumorrhachis along with a transforaminal air passage through the first right sacral foramen and a pyogenic collection anterior to sacral bone. An abdomen CT scan showed a massive relapse of the colon cancer and confirmed a hypodense collection contiguous to the anterior sacral surface, causing erosion of the sacral bone and dural layer with air penetration into the spinal canal. Neurosurgical treatment by a lumbosacral laminectomy and duraplasty was followed by tumour removal and omental covering of the pelvis. Her neurological symptoms were resolved completely. One month later, the patient began adjuvant chemotherapy. PMID:23164825

Iacoangeli, M; Di Rienzo, A; Fianchini, A; Marmorale, C; Alvaro, L; Nocchi, N; Scerrati, M

2013-03-01

325

Decompression, correction, and interbody fusion for lumbar burst fractures using a single posterior approach.  

PubMed

Burst fractures of the lumbar spine with instability or severe kyphosis are best served by surgical treatment. The question as to how these fractures should be approached and stabilized (anteriorly, posteriorly, or combined anteroposteriorly) is controversial. We performed decompression, correction, and interbody fusion using a single posterior approach for Denis type B or C lumbar burst fractures with severe kyphosis. The operative technique is as follows: after partial laminectomy, the bone fragment, which had migrated into the spinal canal, is impacted into the posterior wall of the vertebral body. After curetting the injured disk, bone chips and adapted lamina are inserted into the disk space for anterior support. Five Denis type B or C burst fractures demanding >20 degrees kyphosis correction were treated by this procedure. Mean follow-up was 41 months. We evaluated neurologic assessment and localized kyphotic angle. The neurologic function of all 5 patients improved by at least 1 grade, as measured by the Frankel grading scale. Mean values of localized kyphosis improved from a mean 23.0. before surgery to -3.0 degrees after surgery. At follow-up examination, average regional kyphosis was -2.4 degrees . No implant failure was observed at follow-up. Bony fusion was achieved in all patients. The advantages of this operative procedure are it is safe for the neural structures and complete spinal canal decompression and kyphosis correction are achieved, while providing anterior support and posterior stabilization. PMID:19824611

Sasagawa, Takeshi; Kawahara, Norio; Murakami, Hideki; Demura, Satoru; Tomita, Katsuro

2009-10-01

326

Fibromyxoma of the axis.  

PubMed

Fibromyxoma of bone is a rare benign tumor of fibrous tissue origin. The typical location is the jaws. Sporadic extragnathic cases have been reported, but fibromyxoma of the spine has not been reported. The histological appearance of fibromyxoma is benign and includes abundant extracellular fibrous and myxoid stroma with varying amounts of calcification and ossification. Myxoid changes are usually extensive. Extragnathic fibromyxoma of bone should be distinguished from benign cartilage-forming bone tumors, such as chondromyxoid and myxoid chondrosarcoma and myxoma of bone. It has also been suggested that fibromyxoma is a variant of myxoid fibrous dysplasia, whereas other authors reported extragnathic fibromyxoma resulting from myxoid degeneration of bone tumors, such as chondrosarcoma or fibrosarcoma. The overtreatment of patients with fibromyxoma of bone due to an aggressive imaging appearance should be avoided; the prognosis is excellent compared with the jaw variant and depends on the location and extent of the tumor. This article describes a case of a 21-year-old woman with fibromyxoma of bone originating from the spinous process of the axis. Clinical examination showed a tender mass in the midline of the posterior aspect the neck and slight limitation of neck range of motion; neurologic examination was normal. Diagnosis was obtained with a preoperative biopsy. Marginal excision of the lesion with posterior laminectomy of the axis was performed. The facets were preserved, and no fusion was performed. At last follow-up 2 years after diagnosis and treatment, the patient was asymptomatic with no evidence of local recurrence. PMID:22784917

Mavrogenis, Andreas F; Casadei, Roberto; Gambarotti, Marco; Ruggieri, Pietro

2012-07-01

327

Extraskeletal Myxoid Chondrosarcoma Presenting as an Intradural Spinal Mass: Report of a Rare Clinical Presentation With an Emphasis on Differential Diagnostic Considerations  

PubMed Central

Extraskeletal myxoid chondrosarcoma is a rare soft tissue neoplasm that occurs predominantly in the soft tissues of the lower extremities. Herein we present a case of a 29 year old male who presented with bilateral femoral numbness believed to be the result of prior injury to his back. A magnetic resonance imaging revealed a mass in the T4-T5 epidural space compressing the spinal cord. Laminectomy was performed and the lesion removed piecemeal. The pathology specimen consisted of multiple fragments of dura involved by a myxoid neoplasm with a nodular growth pattern. The tumor cells were arranged in anastomosing cords and strands. Individual tumor cells were small, of uniform size and shape, with small hyperchromatic nuclei and scant eosinophilic cytoplasm. Immunohistochemical stains were performed which showed the tumor cells were diffusely positive for vimentin and focally positive for EMA, S-100 protein and cytokeratin, whereas they were negative for CD34 and CD99. Fluorescence in situ hybridization (FISH) studies showed a clonal population of cells with re-arrangement of the EWSR1 locus, confirming the histologic impression of extraskeletal myxoid chondrosarcoma. This is the first report of a case of an extraskeletal myxoid chondrosarcoma arising from the dura, confirmed to have rearrangement of the EWSR1 gene by FISH. There have only been two other cases of dural based extraskeletal myxoid chondrosarcoma reported prior to our case. We also briefly review the published literature and discuss differential diagnostic considerations for this rare tumor. PMID:25568751

Rao, Priya; Colen, Rivka R.; Bruner, Janet M.; Meis, Jeanne M.

2014-01-01

328

Spinal Autofluorescent Flavoprotein Imaging in a Rat Model of Nerve Injury-Induced Pain and the Effect of Spinal Cord Stimulation  

PubMed Central

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

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

329

Fibromyalgia and arachnoiditis presented as an acute spinal disorder  

PubMed Central

Background: Adhesive arachnoiditis is a chronic, insidious condition that causes debilitating intractable pain and a range of other neurological problems. Its pathophysiology is not well understood. This manuscript discusses its presentations, which can mimic an acute spinal disorder, its hypothetical pathophysiology, treatment, and its relationship with fibromyalgia. Case Description: The authors present a case of a 47-year-old female who presented with clinical features mimicking an acute spinal disorder but later found to have an adhesive arachnoiditis. She was admitted following a trauma with complaints of back pain and paraplegia. On examination, there was marked tenderness over thoracolumbar spine with lower limbs upper motor neuron weakness. An urgent magnetic resonance imaging (MRI) of the spine revealed multiple lesions at her thoracic and lumbar spinal canals, which did not compress the spinal cord. Therefore, conservative management was initiated. Despite on regular therapies, her back and body pain worsened and little improvement in her limbs power was noted. Laminectomy was pursued and found to have spinal cord arachnoiditis. Subsequently, she was operated by other team members for multiple pelvic masses, which later proved to be benign. After gathering all the clinical information obtained at surgery and after taking detailed history inclusive of cognitive functions, diagnosis of an adhesive arachnoiditis syndrome was made. Currently, she is managed by neuropsychologist and pain specialist. Conclusion: This case report highlights the importance of knowing an adhesive arachnoiditis syndrome – a rarely discussed pathology by the neurosurgeon, which discloses a significant relationship between immune and nervous systems. PMID:25396073

Idris, Zamzuri; Ghazali, Faizul H.; Abdullah, Jafri M.

2014-01-01

330

[Necessary or unnecessary? a critical glance on spine surgery].  

PubMed

Patients with complaints and symptoms caused by spinal degenerative diseases demonstrate a high rate of spontaneous improvement. Except of severe neurological symptoms such as high grade motor deficits, medically intractable pain and vegetative symptoms (cauda syndrome) operations require 1) symptoms, 2) a mechanical cause visible on imaging that sufficiently explains the symptoms, 3) a completed conservative treatment protocol performed over a 4) 6-12 week period. According to the evidence found in the literature, patients with lumbar disk herniation significantly benefit from surgery by a faster relieve of pain and return to social and professional activity, however, the results are converging after a period of 1-2 years. Surgery of lumbar spinal stenosis is considered a gold standard and superior to conservative care when symptoms are severe and leg pain is present. Bilateral microsurgical decompression using a bilateral or a unilateral approach with over-the-top decompression of the contralateral nerve root are superior to laminectomy as the decompression procedure. Lumbar fusion is only indicated in patients with spinal stenosis when a major or mobile spondylolisthesis is diagnosed. There is no indication of prophylactic surgery to avoid a "dangerous" deficit that might develop in the future. PMID:25447083

Raabe, Andreas; Beck, Jürgen; Ulrich, Christian

2014-12-01

331

Near-infrared reflectance spectroscopy as a novel method to detect demyelination in rat sciatic nerve in vivo  

NASA Astrophysics Data System (ADS)

This study was done to use near infrared (NIR) spectroscopy to bring out differences in the anatomical substructures in the rat spinal cord and further to differentiate scattering between demyelinated and normal sciatic nerves in rat models, thereby exploring a new methodology to localize MS (multiple Sclerosis) lesions in vivo for animal studies. The experimental setup consisted of a tungsten light source, CCD array spectrometer, and bifurcated optical fibers for light delivery and detection of back scattered light from tissue. The measurement system was calibrated with reflectance standard. The spinal cord of 14 rats was exposed by laminectomy, and the measurements were taken on 8 points at intervals of 1 mm on the right and left lumbar-sacral regions and the central blood vessel. For measurements on the sciatic nerve, the spinal nerves of 84 rats were ligated according to the Chung Model. Measurements were taken on five points on both the ligated and the control nerve side after 1, 4, 7 and 14 days. The reduced scattering coefficient, ?s', was found to be higher in the lumbar-sacral regions (34.17 +/- 2.05 cm-1) than that near the central blood vessel (19.9 +/- 3.8 cm-1). Statistically, there was significant difference in scattering between the control side and the ligated side on postoperative days 4, 7, and 14. This study shows a promising diagnostic value in the future for monitoring of demyelinated CNS (central nervous system) diseases, like Multiple Sclerosis.

Radhakrishnan, Harsha; Senapati, Arun; Peng, Yuan Bo; Kashyap, Dheerendra; Liu, Hanli

2005-04-01

332

Intradural Solitary Fibrous Tumor of the Lumbar Spine: A Distinctive Case Report  

PubMed Central

Background. Solitary fibrous tumors are ubiquitous mesenchymal neoplasms of putative fibroblastic origin. They were originally described in the pleura but subsequently have been reported in many extraserosal sites. Solitary fibrous tumors may also occur in the meninges, central nervous system parenchyma, and spinal cord. Case. A 67-year-old male patient with progressive lower extremity weakness, urinary urgency, and sexual dysfunction has been admitted to our hospital. On his lumbar MRI, we detected an intradural lesion posterior to the L3 vertebral corpus. We resected the lesion by L3 total laminectomy. Immunohistological findings revealed strong and diffuse immunopositivity with vimentin, CD34, and bcl-2. Ki-67 proliferation index was 5–8%. We did not detect any recurrence 12 months after his operation. Conclusion. SFT is mostly seen in young and middle-aged patients and should be considered among differential diagnosis in cases suffering from pain, hypoesthesia, and urinary dysfunction. Gross total resection should be primary treatment. Tumors that have high Ki-67 labeling should be followed up for potential recurrences. PMID:25648160

Kaksi, Mustafa; Onoz, Mustafa; Sav, Aydin

2015-01-01

333

Intradural solitary fibrous tumor of the lumbar spine: a distinctive case report.  

PubMed

Background. Solitary fibrous tumors are ubiquitous mesenchymal neoplasms of putative fibroblastic origin. They were originally described in the pleura but subsequently have been reported in many extraserosal sites. Solitary fibrous tumors may also occur in the meninges, central nervous system parenchyma, and spinal cord. Case. A 67-year-old male patient with progressive lower extremity weakness, urinary urgency, and sexual dysfunction has been admitted to our hospital. On his lumbar MRI, we detected an intradural lesion posterior to the L3 vertebral corpus. We resected the lesion by L3 total laminectomy. Immunohistological findings revealed strong and diffuse immunopositivity with vimentin, CD34, and bcl-2. Ki-67 proliferation index was 5-8%. We did not detect any recurrence 12 months after his operation. Conclusion. SFT is mostly seen in young and middle-aged patients and should be considered among differential diagnosis in cases suffering from pain, hypoesthesia, and urinary dysfunction. Gross total resection should be primary treatment. Tumors that have high Ki-67 labeling should be followed up for potential recurrences. PMID:25648160

Basaran, Recep; Kaksi, Mustafa; Onoz, Mustafa; Balkuv, Ece; Sav, Aydin

2015-01-01

334

Lumbar Intradural Neurocysticercosis: A Case Report  

PubMed Central

Cysticercosis is the most common parasitic disease affecting the central nervous system. Spinal involvement is rare in neurocysticercosis, and isolated spinal involvement without evidence of cranial involvement is even rarer. We report an unusual case of neurocysticercosis with isolated spinal involvement. A 59 year-old male presented with radiating pain in the left leg. He complained of aggravating weakness and numbness in the left leg since his previous visit one month ago. Magnetic resonance imaging (MRI) revealed multiple peripheral wall-enhanced intradural cystic masses from L1 to L5. The patient underwent a total laminectomy of L4. Dissection revealed abnormal cystic masses compressing the nerve roots. The cyst was punctured, spilling clear mucoid fluid into the surgical field. The exposed cysticerci, white and mucoid, was easily removed. Patient received course of steroids and oral albendazole. The patient experienced symptomatic improvement without further neurologic deficits except for mild sensory impairment. Clinicians should include spinal neurocysticercosis in differential diagnosis of radiculopathies. Although isolated spinal neurocysticercosis is rare, it can be satisfactorily managed with surgery and medication. PMID:25346771

Han, Sang-Beom; Kwon, Hyon-Jo; Choi, Seung-Won; Koh, Hyeon-Song; Kim, Seon-Hwan; Song, Shi-Hun

2014-01-01

335

Intramedullary cervical tuberculoma: a case report with note on surgical management.  

PubMed

This study aims to report a relatively rare entity-intramedullary tuberculum of cervical spine-and describe its management and some key learning points. Intramedullary tuberculomas are rare entities. Intramedullary tuberculoma is most commonly found in the thoracic cord of a patient and is rarely seen in the cervical cord. We present an intramedullary cervical tuberculoma in a 21-year-old patient with finding of spinal cord compression. All 4 limbs were spastic, with grade 1 power on the right side and grade 3 power on the left side. Sensory deficit was found below the C6 level. Magnetic resonance imaging showed an intramedullary lesion at the C5 to C6 levels. Intramedullary tuberculoma was diagnosed based on clinical symptoms, physical examination, previous history, and magnetic resonance imaging. A C5 to C7 laminectomy was performed. Intramedullary tuberculoma was resected by microsurgery. One year after the surgery, strength returned to normal grade 5. Excellent clinical outcome was obtained with a combination of both medical and surgical treatments. Intramedullary cervical tuberculoma should be removed without delay to eliminate any mass effect on the neurons as soon as possible. PMID:25594653

Ju, Hong-Bin; Guo, Dong-Ming; Chen, Fan-Fan

2015-01-01

336

Extra-intradural Spinal Meningioma: A Case Report  

PubMed Central

Extradural spinal meningiomas are uncommon, and their pathophysiology is not entirely understood. Here, we present the case of a 49-year-old woman with low back and left leg pain of 5 years duration. Magnetic resonance imaging revealed a mass, 1.8-cm in size, with rim enhancement in the spinal canal at the T12 level and extending into the left T12-L1 foramen. In the surgical field, the mass presented with the characteristics of an extra-intradural spinal meningioma. The patient underwent a T12 total laminectomy. A linear durotomy was performed at the midline, and the intradural portion was removed. The extradural portion was not separable from the adjacent dura and the left T12 root, and it was removed by dural excision. Pathological examination confirmed the diagnosis of psammomatous meningioma. We also conducted a literature review of similar cases. Based on our experience with this case, we believe that it is important to clearly distinguish extradural meningiomas from other types of tumors as misdiagnosis can change the operative plan. The long term prognosis of extradural meningiomas is not clear but total excision is thought to be essential. PMID:25346770

Jeong, Seong Kyun; Seong, Han Yu

2014-01-01

337

A simple technique for localizing consecutive fields for disector pairs in light microscopy: application to neuron counting in rabbit spinal cord following spinal cord injury.  

PubMed

Locating the same microscopic fields in consecutive sections is important in stereological analysis. The tools for achieving this requirement have limited number in practice. This paper presents a simple and inexpensive technique for localizing the same fields on disector pairs in conventional light microscopes equipped with widely available dial indicators. It is partly a modification of equipment previously described. The presented procedure requires two light microscopes equipped with dial indicators and modified slide clips. An application of the present system was shown in a model of spinal cord injury (SCI). A midthoracic laminectomy was performed leaving the dura intact. A contusion was done at the level of midthoracic spinal cord segments (T7-T8) by dropping a 10-g mass from a height of 30 cm. The subjects were randomly divided into three groups (10 animals in each): hypothermia group, methylprednisolone group, and traumatic spinal cord injury alone group. Present results show that treatment with hypothermia after spinal cord trauma has a neuroprotective effect on cell damage but not in the methylprednisolone treatment group. PMID:15922043

Kaplan, Süleyman; Gökyar, Ahmet; Unal, Bünyami; Tunç, Ayten Türkkani; Bahadir, Ay?e; Aslan, Hüseyin

2005-06-30

338

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)

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

Yin, Zhenchun; Dong, Yinghai; Zhu, Jing

2005-07-01

339

Case 216: hypertrophic spinal pachymeningitis.  

PubMed

History A 58-year-old woman presented for evaluation of gradually progressive lower extremity pain and paresthesia. She initially experienced interscapular pain that developed while gardening. After 1 month, she started to feel numbness in her feet. This numbness ascended over the next few days to involve her lower breast margin. There were no exacerbating or alleviating factors. She had no history of trauma, and she denied having fevers, weight change, or night sweats. Her past medical history was noncontributory. On examination, there was hyperreflexia and clonus of her lower extremities, with no clear sensory level to pinprick testing. Otherwise, her general physical examination results were normal. She underwent magnetic resonance (MR) and computed tomographic (CT) imaging of her spine. Surgery was considered at this time; however, given the preservation of strength and sensation in her legs, it was deemed to be of limited benefit. Five months passed, and her numbness and pain persisted. In the interim, her left foot had begun to drag, requiring her to use a cane. She also had developed delayed bladder emptying. She underwent a second spine MR imaging examination, which was followed by a posterior decompressive laminectomy. Her symptoms resolved after surgery. One year later, her symptoms returned and repeat MR imaging was performed at that time. PMID:25799338

van der Pol, Christian B; Chakraborty, Santanu; Côté, Ian; Humphrey-Murto, Susan; Michaud, Jean

2015-04-01

340

Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture  

PubMed Central

A case of bilateral pedicle stress fracture of L4 in a patient with osteoporotic compression fracture of L5 and without a history of major trauma or surgery is reported, and the literature is reviewed. Bilateral pedicle fracture is a rare entity and few cases have been reported in the literature. All reported cases had some underlying causative factors like previous spine surgery or stress related activities. To the best of the authors’ knowledge, only one case of bilateral pedicle stress fracture without a history of trauma, previous spine surgery, or stress-related activities has been reported. A 77-year-old woman presented with severe low back pain and radiating pain in the right leg that was exacerbated after standing and walking. Plain radiograph showed pathological fracture at L5 level. Magnetic resonance imaging (MRI) revealed the compression of dural sac at L5 level. CT scan taken 3 months after admission revealed bilateral pedicle fractures through L4. The patient was treated with decompressive laminectomies of L4, followed by posterior spinal fusion with rigid pedicle screw fixation and autogenous bone graft mixed with hydroxyapatite. The patient achieved pain relief and returned to normal activity. Stress fracture of the pedicle within the proximal vertebra of an osteoporotic compression fracture of lumbar spine is an uncommon entity. It may, however, be an additional source of symptoms in patients with osteoporosis who present with further back pain. Surgeons caring for this group of patients should be aware of this condition. PMID:19005693

Ando, Yoshihiro; Hirata, Soichiro; Ishikawa, Hitoshi; Kurosaka, Masahiro

2008-01-01

341

Hydrocephalus due to Membranous Obstruction of Magendie's Foramen.  

PubMed

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

Kasapas, Konstantinos; Varthalitis, Dimitrios; Georgakoulias, Nikolaos; Orphanidis, Georgios

2015-01-01

342

[Surgery of lumbar disk hernia: historical perspective].  

PubMed

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

Brunori, A; De Caro, G M; Giuffrè, R

1998-01-01

343

Pneumomediastinum, Subcutaneous Emphysema, and Tracheal Tear in the Early Postoperative Period of Spinal Surgery in a Paraplegic Achondroplastic Dwarf  

PubMed Central

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

Kahraman, Sinan; Enercan, Meriç; Demirhan, Özkan; ?engül, Türker; Hamzao?lu, Azmi

2013-01-01

344

Malignant peripheral nerve sheath tumor of the cauda equina with craniospinal metastasis.  

PubMed

Intradural spinal malignant peripheral nerve sheath tumors (MPNST) are extremely rare, with only 20 adult patients reported to our knowledge, and only four primary tumors arising from the cauda equina. A 49-year-old man presented with back pain, constipation, and lower extremity weakness and was found to have a large intradural lesion involving the cauda equina. Imaging of the rest of his neuraxis revealed additional small left temporal lobe, cervical, and thoracic lesions. The patient underwent laminectomy for tumor debulking and biopsy, as gross total resection was not possible due to envelopment of the cauda equina. Histopathology revealed a MPNST with high cellularity, elevated proliferative indices, and nerve fascicle invasion. After the debulking, the patient reported improvement in his symptoms. However, 6 weeks later, the patient began having severe headaches, and his left temporal lobe lesion was found to have increased significantly in size, requiring craniotomy for palliative resection. The authors report the first adult patient with sporadic spinal MPNST with craniospinal metastasis to our knowledge. Imaging of the entire neuraxis is recommended for initial workup of these lesions, which are capable of intradural spread. The best treatment approach is unclear, but total surgical resection should be attempted, barring infiltration and engulfment of the nerve roots or widespread dissemination. PMID:24986157

Thomas, Jonathan G; Lincoln, Christie; Goodman, J Clay; Gopinath, Shankar P

2014-12-01

345

Syncope caused by congenital anomaly at the craniovertebral junction: a case report  

PubMed Central

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

2014-01-01

346

The Mechanisms of Medial Pedicle Wall Violation: Insertion Method Is as Important as Correct Cannulation of the Pedicle  

PubMed Central

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

Isik, Cengiz; Kose, Kamil Cagri; Inanmaz, Mustafa Erkan; Tagil, Suleyman Murat; Sarman, Hakan

2014-01-01

347

Economic impact of minimally invasive lumbar surgery  

PubMed Central

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.

Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

2015-01-01

348

Intraspinal leiomyoma: A case report and literature review.  

PubMed

Leiomyomas are benign tumors which are predominantly found in the genitourinary and gastrointestinal tracts. Leiomyomas in the spine are extremely rare. The current study presents a case of a 35-year-old female with intraspinal leiomyoma who presented with low back pain and weakness in the left leg of two months. Computerized tomography and magnetic resonance imaging revealed an epidural mass at the T11-12 levels. The patient underwent a T11-12 laminectomy through posterior approach, achieving total removal of the tumor with a well-demarcated dissection plane. Pathological examination demonstrated a leiomyoma. Postoperatively, the patient showed a significant improvement in neurological function. Although intraspinal leiomyoma is extremely rare, it should be considered in the differential diagnosis of spinal lesions in females. The diagnosis is predominantly dependent on a pathological examination. Gross total resection is recommended for its treatment, however the prognosis remains poor. Post-operative hormonal therapy may be useful in controlling tumor recurrence. PMID:25120728

Yang, Tao; Wu, Liang; Deng, Xiaofeng; Yang, Chenlong; Zhao, Lei; Xu, Yulun

2014-09-01

349

[An adult case of intradural lumbo-sacral lipoma].  

PubMed

A rare case of lumbo-sacral lipoma in an adult case is reported. A 55-year-old male was admitted to the Department of Neurosurgery, Mazda Hospital, after a history of one year of urinary incontinence. Neurologically, no motor or sensory disturbance of the lower extremities was found in this patient. MRI showed a mass with high signal intensity on T2-weighted image, located between L3 to S2 vertebral segments. Metrizamide-CT scan demonstrated the outline of this hypodense mass at the same location as shown on MRI image. A L3 through L5 laminectomy was performed and the tumor was subtotally removed. Microscopic examination revealed that the tumor mass was made up of mature lipoma cells. Postoperative course of the patient was uneventful. The urinary incontinence was improved slightly. No motor or sensory deficit was found. We thought that MRI was useful for the correct diagnosis of lumbosacral lipoma. And it is best managed by operative removal of the tumor as early as possible after it is diagnosed. PMID:1407342

Hatayama, T; Sakoda, K; Tokuda, Y; Uozumi, T

1992-10-01

350

Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery  

PubMed Central

The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection. PMID:16835734

Keel, Marius; Trentz, Otmar; Heinzelmann, Michael

2006-01-01

351

Primary intraosseous malignant peripheral nerve sheath tumor of spine with a giant paraspinal and retrospinal subcutaneous extension  

PubMed Central

Background: According to World Health Organization (WHO) classification of tumors, malignant peripheral nerve sheath tumors (MPNST) encompass the tumors, which were previously termed as malignant schwannoma, neurogenic sarcoma, and neurofibrosarcoma. These are rare tumors constituting only 5% of all malignant soft tissue tumors. As per their name, they arise from the malignant proliferation of cells forming sheath of a nerve root. They cause spinal cord compression, secondary changes in the surrounding bone with variable amount of tumor tissue going into the paraspinal space. However, purely intraosseous origin of the MPNST with no visible connection with a nerve root or dura is rare and few cases have been described in the literature. Case Description: We present a primary intraosseous MPNST arising from the body of a thoracic spine with a minimal intraspinal component. However, there was a huge tumor part occupying the paraspinal and retrospinal region. The latter component was so large that it extended to lie just beneath the skin. The intraspinal component was confined to only one level. The giant extraspinal part was spanning multiple corresponding spinal level. We could not find such presentation in the literature. Conclusion: Gross total removal (GTR) followed by adjuvant chemo-radiotherapy is the optimal treatment for MPNST of spine. In case of multiple laminectomy or gross spinal instability, spinal instrumentation makes the treatment protocol complete. PMID:23372973

Patnaik, Ashis; Mishra, Sudhansu Sekhar; Senapati, Satya Bhushan; Patra, Sunil Kalpalata; Tripathy, Kalpalata; Burma, Subrat

2012-01-01

352

Could an osteoinductor result in degeneration of a neurofibroma in NF1?  

PubMed

We report a case of fatal evolution of neurofibromatosis in a young boy. A laminectomy was performed when he was 9 years old. A secondary hyperkyphosis led to many surgeries resulting in recurrent malunions. When he was 23 years old, a breakage of his rods was treated by a new instrumentation and a T12-L1 interbody cage fitted with rh-BMP. Five months later, he developed a huge posterior tumour on his back. The biopsy diagnosed a neurofibrosarcoma. The growth of the tumour was extremely rapid. He died after several months from a septic shock. NF1 is characterised by neurofibromas that have a possibility of malign degeneration and conversion to a sarcoma. However, the chronology, rapidity of evolution and the exceptional volume of the tumour made us wonder whether the BMP had a part of responsibility as osteoinductor in the malignant degeneration, in this particular case, of neurofibromatosis. It seemed important to point out this case to the medical community. PMID:20449613

Steib, Jean-Paul; Jean-Paul, Steib; Bouchaïb, Julia; Julia, Bouchaïb; Walter, Axel; Axel, Walter; Schuller, Sébastien; Sébastien, Schuller; Charles, Yann Philippe; Philippe, Charles

2010-07-01

353

Diastematomyelia Presenting With no Pain in a 53-Year-Old Man: A Case Report  

PubMed Central

Initial presentation of diastematomyelia is rarely seen in adults. The purpose of this case report is to present a case of clinically silent diastematomyelia unrecognized into adulthood and review of the literature. A 53-year-old Persian man was admitted to our hospital with gait disturbance, weakness of the right lower extremity, sensory loss of the left and right lower extremity of two weeks’ duration, with no pain or sphincter dysfunction. The patient underwent radiological examinations, and diastematomyelia was diagnosed. The deteriorating condition of our patient led to the decision to perform a surgery. A laminectomy was performed from L-3 to L-5 with resection of the soft-tissue mass and excision of the bony spur, and the patient was followed for 6 months. Postoperatively, the patient did not show new neurologic deficit and he returned to work 4 months after surgery. Our case was unique because of the absence of any pain, neurologic signs, and precipitating acute event leading to diagnosis, until 53 years of age. Surgical decompression of bony spur provided relative improvement of his symptoms. PMID:24349753

Azimi, Parisa; Mohammadi, Hassan Reza

2013-01-01

354

Coexistence of multiple cavernous angiomas in the spinal cord and skin: a unique case of Cobb syndrome.  

PubMed

Cobb syndrome is a rare, noninherited, neurocutaneous disease characterized by vascular abnormality of the spinal cord and is associated with vascular lesions in the skin at the same metamere. The majority of spinal vascular lesions are arteriovenous malformations, and skin lesions are mostly port-wine angiomas. The authors report the first case of multiple intramedullary cavernous angiomas (CAs) accompanied by skin CAs within the same metamere. A 42-year-old man presented with an acute onset of gait disturbance, low-back pain, and urinary incontinence. Magnetic resonance imaging of the thoracolumbar spine showed homogeneously enhanced lesions on a contrast-enhanced T1-weighted image and a hypointense area on a T2*-weighted image surrounding this enhanced lesion, between the T-12 and S-1 levels. Purple protruding skin lesions were detected on the left side of his gluteal region. The patient received a laminectomy followed by evacuation of a hematoma and partial removal of the tumor, which completely resolved his neurological symptoms. Pathological examinations showed that the spinal and skin lesions were CAs, suggesting that these vascular lesions developed congenitally. Cavernous angiomas associated with Cobb syndrome present with multiple lesions spanning more than 3 vertebral levels, making it difficult to completely resect these tumors. Although Cobb syndrome is an uncommon disease entity, it should be considered if a patient manifesting with neurological deficits has skin vascular lesions, including CAs. PMID:24358995

Matsui, Yuya; Mineharu, Yohei; Satow, Takeshi; Takebe, Noriyoshi; Takeuchi, Eiji; Saiki, Masaaki

2014-02-01

355

The Retrospective Analysis of Posterior Short-Segment Pedicle Instrumentation without Fusion for Thoracolumbar Burst Fracture with Neurological Deficit  

PubMed Central

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

Zou, Hui; Ping, Ansong; Wang, Yongzhi; Ai, Qiyong

2014-01-01

356

Pelvic pain from a giant presacral Tarlov cyst successfully obliterated using aneurysm clips in a patient with Marfan syndrome.  

PubMed

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

Wang, Bonnie; Moon, Seong-Jin; Olivero, William C; Wang, Huan

2014-11-01

357

Midline synovial and ganglion cysts causing neurogenic claudication  

PubMed Central

Typically situated posterolateral in the spinal canal, intraspinal facet cysts often cause radicular symptoms. Rarely, the midline location of these synovial or ganglion cysts may cause thecal sac compression leading to neurogenic claudication or cauda equina syndrome. This article summarizes the clinical presentation, radiographic appearance, and management of three intraspinal, midline facet cysts. Three patients with symptomatic midline intraspinal facet cysts were retrospectively reviewed. Documented clinical visits, operative notes, histopathology reports, and imaging findings were investigated for each patient. One patient presented with neurogenic claudication while two patients developed partial, subacute cauda equina syndrome. All 3 patients initially responded favorably to lumbar decompression and midline cyst resection; however, one patient required surgical stabilization 8 mo later. Following the three case presentations, we performed a thorough literature search in order to identify articles describing intraspinal cystic lesions in lateral or midline locations. Midline intraspinal facet cysts represent an uncommon cause of lumbar stenosis and thecal sac compression. Such entities should enter the differential diagnosis of midline posterior cystic lesions. Midline cysts causing thecal sac compression respond favorably to lumbar surgical decompression and cyst resection. Though laminectomy is a commonly performed operation, stabilization may be required in cases of spondylolisthesis or instability. PMID:24364023

Pindrik, Jonathan; Macki, Mohamed; Bydon, Mohamad; Maleki, Zahra; Bydon, Ali

2013-01-01

358

[A case of spinal epidural abscess in a renal transplant recipient].  

PubMed

A 44-year-old male underwent a cadaveric renal transplantation at the university hospital of Tsukuba on March 3, 1979. On June 11, 1979, he was discharged this hospital. Immunosuppressive therapy with azathioprine and methylprednisolone was done. On November 1, 1979, he developed back pain associated with fever. On November 3, 1979, he was admitted to the university hospital of Tsukuba. Laboratory study revealed leucocytosis. CRP inserum was positive. But pneumonia, urinary tract infection and infectious skin lesion were ruled out by physical, radiological and laboratory examination. On November 16, 1979, he became paraparetic. On the next day, he consulted the neurosurgical unit. Neurological findings were as follows: paraplegia, and hypesthesia and hypalgesia below the level of T4, and bilateral hyperrefrexia of P.T.R. and A.T.R. Lumbar myelogram revealed a complete block at the level T7. On November 17, 1979, a laminectomy from T4 through T7 was performed. The epidural abscess containing yellow pus was found and totally removed. Gram-positive rods were isolated on bacteriologic culture. On the 7th postoperative day, the sensory level dropped to L4 bilaterally and the muscle strength in the lower extremity became fair. About 3 years after operation, he became to be able to walk without cane. Discussion was made about this case together with previously reported cases. PMID:6379492

Egashira, T; Nose, T; Maki, Y

1984-05-01

359

Primary osseous hemangiopericytoma in the thoracic spine.  

PubMed

Hemangiopericytoma (HPC) is a rare tumor of the central nervous system, most commonly found in the cranial cavity. HPCs in the spine are rare, and very few of them are primary osseous HPC. The aims of this study were to describe a rare case of primary osseous HPC in the thoracic spine and review the literature. A 54-year-old man presented with a 3-month history of back pain. Aneuro logical examination revealed no motor or sensory deficits. Magnetic resonance imaging (MRI) and computed tomography (CT) scan showed a tumor originating from the bone structure of the T10 vertebra with paravertebral extension, and chest CT revealed pulmonary metastases. A laminectomy, face-totomy,and subtotal resection of the tumor was performed with posterior pedicle screw system fixation followed by radiotherapy. The post-operative course was uneventful. His back pain was resolved completely after surgery. The patient survived with tumor during the 18-month follow-up period. Histopathology and immunohistologic findings were consistent with HPC. On immunohistochemistry, the tumor was positive for vimentin and CD34, partially positive for S-100, but negative for EMA, desmin, CD117, and CD1a. A literature review identified eight such cases reported between 1942 and 2013. As a conclusion, clinical manifestations of primary osseous spinal HPCs are different from intraspinal meningeal HPCs. Although showing certain variability, histopathology and immunohistochemical examinations are essential to establish the diagnosis. Surgical resection and radiotherapy are the treatment of choice. *These authors contributed equally to this work. PMID:24887400

Ren, Ke; Zhou, Xing; Wu, SuJia; Sun, Xiaoliang

2014-01-01

360

Image-guided facet joint injection  

PubMed Central

Chronic spine pain poses a peculiar diagnostic and therapeutic challenge due to multiple pain sources, overlapping clinical features and nonspecific radiological findings. Facet joint injection is an interventional pain management tool for facet-related spinal pain that can be effectively administered by a radiologist. This technique is the gold standard for identifying facet joints as the source of spinal pain. The major indications for facet injections include strong clinical suspicion of the facet syndrome, focal tenderness over the facet joints, low back pain with normal radiological findings, post-laminectomy syndrome with no evidence of arachnoiditis or recurrent disc disease, and persistent low back pain after spinal fusion. The contraindications are more ancillary, with none being absolute. Like any synovial joint degeneration, inflammation and injury can lead to pain on motion, initiating a vicious cycle of physical deconditioning, irritation of facet innervations and muscle spasm. Image-guided injection of local anesthetic and steroid into or around the facet joint aims to break this vicious cycle and thereby provide pain relief. This outpatient procedure has high diagnostic accuracy, safety and reproducibility but the therapeutic outcome is variable. PMID:21655113

Peh, WCG

2011-01-01

361

Digital multimedia books produced using iBooks Author for pre-operative surgical patient information.  

PubMed

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

Briggs, Matthew; Wilkinson, Caroline; Golash, Aprajay

2014-10-01

362

Does the Removal of Spinal Implants Reduce Back Pain?  

PubMed Central

Background The importance of the removal of spinal implants is known in the presence of infection. However, the benefits and/or risks of the removal of spinal implant for the management of back pain are not clear. Methods In this retrospective study, we aimed to evaluate the beneficial effects of the removal of spinal implants for back pain. Study included 25 patients with thoracolumbar instrumentation. Results Seventeen (68%) of them were male. Indications for spinal instrumentation were vertebra fracture (n = 9), iatrogenic instability due to multiple segment laminectomy (n = 12), and instrumentation after recurrent disk herniations (n = 4). Mean visual analog score (VAS) before the removal was 8.08. Mean VAS was 3.36 after the removal. Spinal instruments were removed after the observance of the presence of fusion. All patients were prescribed analgesics and muscle relaxants for 3 weeks before removal. Back pain did not decrease in five (20%) patients in total. Four of them had been instrumented due to recurrent lumbar disk herniation. None of the patients reported the complete relief of pain. Conclusion In conclusion, patients should be cautioned that their back pain might not decrease after a successful removal of their instruments.

Ak, Hakan; Gulsen, Ismail; Atalay, Tugay; Gencer, Muzaffer

2015-01-01

363

Biomechanical changes of spinous process osteotomy with different amounts of facetectomy using finite element model  

NASA Astrophysics Data System (ADS)

The aim of this study is to evaluate the biomechanical changes after Spinous Process Osteotomy (SPO) with different amounts of facetectomy of the lumbar spine and to compare the models with SPO and intact models using finite element models. Intact spine models and one decompression models (L3-4) with SPO were developed. SPO models included three different amounts of facetectomy (25%, 50%, and 75%). After validation of the models, finite element analyses were performed to investigate the ranges of motion and disc stresses at each corresponding level among three SPO models and intact lumbar spine models. The ranges of motion in the SPO models were increased more than the intact models. According to increase of amounts of facetectomy, ranges of motion were also increased. Similar to range of motion, the von Mises stress of disc in the SPO models was higher than that of intact models. Moreover, with the increase of amount of facetectomy, the disc stress increased at each segments under various moments. The decompression procedures using spinous process osteotomy has been reported to provide better postoperative stability compared to the conventional laminectomy. However, facetectomy over 50 % is likely to attenuate this advantage.

Kang, K.-T.; Kim, K.-Y.; Jung, H.-J.; Lee, H.-Y.; Chun, H.-J.; Lee, H.-M.; Moon, S.-H.; Kim, H.-J.

2010-03-01

364

Biomechanical changes of spinous process osteotomy with different amounts of facetectomy using finite element model  

NASA Astrophysics Data System (ADS)

The aim of this study is to evaluate the biomechanical changes after Spinous Process Osteotomy (SPO) with different amounts of facetectomy of the lumbar spine and to compare the models with SPO and intact models using finite element models. Intact spine models and one decompression models (L3-4) with SPO were developed. SPO models included three different amounts of facetectomy (25%, 50%, and 75%). After validation of the models, finite element analyses were performed to investigate the ranges of motion and disc stresses at each corresponding level among three SPO models and intact lumbar spine models. The ranges of motion in the SPO models were increased more than the intact models. According to increase of amounts of facetectomy, ranges of motion were also increased. Similar to range of motion, the von Mises stress of disc in the SPO models was higher than that of intact models. Moreover, with the increase of amount of facetectomy, the disc stress increased at each segments under various moments. The decompression procedures using spinous process osteotomy has been reported to provide better postoperative stability compared to the conventional laminectomy. However, facetectomy over 50 % is likely to attenuate this advantage.

Kang, K.-T.; Kim, K.-Y.; Jung, H.-J.; Lee, H.-Y.; Chun, H.-J.; Lee, H.-M.; Moon, S.-H.; Kim, H.-J.

2009-12-01

365

Isolated unilateral vertebral pedicle fracture caused by a back massage in an elderly patient: a case report and literature review.  

PubMed

The vertebral pedicle injuries are clinically common. However, the isolated vertebral pedicle fracture with intact vertebral bodies is a rare lesion. We reported a case of a 66-year-old man who experienced a pedicle fracture after a back massage. The patient sustained osteoporosis, long-existing low back pain and nerve compression symptoms without antecedent major trauma. Imaging findings demonstrated an isolated unilateral L5 vertebral pedicle fracture with intact vertebral bodies, spinal canal stenosis at the L4-5 levels, bulging annulus fibrosus at the L4-S1 levels, bilateral spondylolysis and an L5/S1 spondylolisthesis. The patient underwent L4-S1 decompressive laminectomy, L5/S1 discectomy and neurolysis, and reduction and fixation of the L5 vertebral pedicle fracture and L5/S1 spondylolisthesis using the pedicle nail system. At follow-ups, the patient showed good recovery without pain or numbness in the low back and bilateral lower extremities. This study raises the awareness of a complication of alternative medicine and the possibility of a pedicle fracture caused by a low-energy trauma. PMID:23412164

Guo, Zhiping; Chen, Wei; Su, Yanling; Yuan, Junhui; Zhang, Yingze

2013-11-01

366

Intramedullary spinal cord abscess as complication of lumbar puncture: a case-based update.  

PubMed

INTRODUCTION: Although lumbar puncture (LP) is a relatively straightforward procedure and is usually associated with low morbidity, rare and significant neurological complications can occur. Intramedullary spinal cord abscess (ISCA) after lumbar puncture is one of these serious complications; however, this complication has not yet been reported in children. CASE REPORT: After 27 days in another medical facility, a 1-year-old girl was admitted to our hospital with a diagnosis of fever of unknown origin. Prior to the second admission, she had undergone multiple traumatic LP attempts. The patient was referred to our institution with progressive and ascending weakness. Three days later, this weakness involved all of the patient's four limbs. A LP was performed and showed purulent cerebrospinal fluid (CSF). An emergent spinal magnetic resonance imaging was performed and revealed an intramedullary lesion extending from the T2 to L3 level. Broad-spectrum antibiotics and steroids were administered to the patient, and a T2-L3 laminectomy was performed. The postoperative course was uneventful, but a neurologic deficit, including lower limb paralysis, remained. CONCLUSION: The index of suspicion for a pyogenic infection of the intramedullary space should be higher if progressive flaccid paralysis develops within a few days after a lumbar procedure. Nevertheless, the diagnosis may be challenging due to the rarity of this condition. Any misdiagnosis or delay of adequate treatment may lead to unfavorable outcomes. PMID:23559394

da Silva, Paulo Sergio Lucas; de Souza Loduca, Rafael Duarte

2013-04-01

367

Minimally Invasive Resection of an Extradural Far Lateral Lumbar Schwannoma with Zygapophyseal Joint Sparing: Surgical Nuances and Literature Review  

PubMed Central

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

Gonçalves, Vítor M.; Santiago, Bruno; Ferreira, Vítor C.; Cunha e Sá, Manuel

2014-01-01

368

Postinjury treatment with magnesium sulfate attenuates neuropathic pains following spinal cord injury in male rats.  

PubMed

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

Farsi, Leila; Afshari, Khashayar; Keshavarz, Mansoor; NaghibZadeh, Maryam; Memari, Fereidoon; Norouzi-Javidan, Abbas

2015-04-01

369

Cortical screw trajectory for instrumentation and fusion in the setting of osteopathic compression fracture allows for percutaneous kyphoplasty for adjacent level compression fractures.  

PubMed

Spinal fixation in the osteoporotic patient can be challenging due to the poor trabecular bone quality of the vertebral body. Patients with osteoporotic vertebral body compression fractures are at risk for future compression fractures at adjacent levels, especially after cement augmentation. The purpose of this technical report is to describe the utilization of a cortical screw trajectory along with kyphoplasty for a patient with an osteoporotic compression fracture as well as degenerative spinal disease. This trajectory allows for the possibility of percutaneous pedicle access in the event of future compression fractures. Our patient underwent a decompressive laminectomy and kyphoplasty at the level of an osteoporotic compression fracture. The fracture was stabilized with cortical screw instrumentation and fusion at a level above and a level below the fracture. Subsequently the patient developed an adjacent level fracture within the fusion construct. Due to the utilization of a cortical screw trajectory for the initial fusion, the traditional pedicle trajectory was still accessible. As a result, the new fracture was treated with a percutaneous kyphoplasty through a standard pedicle trajectory. In conclusion, the use of a cortical screw trajectory for stabilization of osteoporotic compression fractures provides for a stronger bone screw interface and avoids osteoporotic trabecular vertebral body bone. At the same time this trajectory allows for future percutaneous pedicular access in the event that the patient suffers future compression fractures. PMID:25724313

Pacione, Donato; Kim, Irene; Wilson, Taylor A; Frempong-Boadu, Anthony

2015-05-01

370

Canine intraneural perineurioma.  

PubMed

A 6-year-old castrated German Shepherd Dog was presented with a 6-month history of progressive, nonpainful, left pelvic limb paresis. Magnetic resonance imaging revealed atrophy of left-sided epaxial and hypaxial muscles from L5-L7 and an enlarged L5 spinal nerve. Exploratory hemi-laminectomy revealed focally and cylindrically thickened L5 and L6 nerve roots. Histologic evaluation of a surgical biopsy specimen from the L6 dorsal nerve root, and the L5 nerve roots after later amputation revealed distended hypercellular fascicles. This distension was due to widely separated axons surrounded by concentric lamellations formed by neoplastic perineurial cells and their processes. These pseudo-onion bulbs were separated from each other by a basophilic myxoid stroma. The perineurioma cell processes were immunonegative for S-100 (alpha and beta chains) and collagen IV, but were immunoreactive for laminin. The central axons were also immunoreactive for NF-200 and S-100. The proliferative index of the perineurioma cells, as determined by MIB-1 immunoreactivity, was about 3%. Ultrastructurally, the widely separated, interdigitating perineurioma cell processes were connected by desmosomal-like junctional complexes to form continuous circles. Their processes were covered by a discontinuous basal lamina. Each centrally placed axon was normally, thinly, or completely unmyelinated and was surrounded by a normal Schwann cell. These morphologic and immunologic features distinguish this lesion from hypertrophic neuropathy and were consistent with intraneural perineurioma. PMID:16407486

Higgins, R J; Dickinson, P J; Jimenez, D F; Bollen, A W; Lecouteur, R A

2006-01-01

371

In situ forming hydrogel composed of hyaluronate and polygalacturonic acid for prevention of peridural fibrosis.  

PubMed

Hyaluronic acid-based hydrogels can reduce postoperative adhesion. However, the long-term application of hyaluronic acid is limited by tissue mediated enzymatic degradation. To overcome this limitation, we developed a polygalacturonic acid and hyaluronate composite hydrogel by Schiff's base crosslinking reaction. The polygalacturonic acid and hyaluronate composite hydrogels had short gelation time (less than 15 s) and degraded by less than 50 % in the presence of hyaluronidase for 7 days. Cell adhesion and migration assays showed polygalacturonic acid and hyaluronate composite hydrogels prevented fibroblasts from adhesion and infiltration into the hydrogels. Compared to hyaluronate hydrogels and commercial Medishield™ gels, polygalacturonic acid and hyaluronate composite hydrogel was not totally degraded in vivo after 4 weeks. In the rat laminectomy model, polygalacturonic acid and hyaluronate composite hydrogel also had better adhesion grade and smaller mean area of fibrous tissue formation over the saline control and hyaluronate hydrogel groups. Polygalacturonic acid and hyaluronate composite hydrogel is a system that can be easy to use due to its in situ cross-linkable property and potentially promising for adhesion prevention in spine surgeries. PMID:25791456

Lin, Cheng-Yi; Peng, Hsiu-Hui; Chen, Mei-Hsiu; Sun, Jui-Sheng; Liu, Tse-Ying; Chen, Ming-Hong

2015-04-01

372

A Spinal Arteriovenous Fistula in a 3-Year Old Boy  

PubMed Central

We present a case of a 3-year-old boy with neurodegeneration. Family history reveals Rendu-Osler-Weber disease. Magnetic resonance imaging (MRI) of the spinal cord and spinal angiography showed a spinal arteriovenous fistula with venous aneurysm, causing compression of the lumbar spinal cord. Embolisation of the fistula was executed, resulting in clinical improvement. A week after discharge he was readmitted with neurologic regression. A second MRI scan revealed an intraspinal epidural haematoma and increase in size of the aneurysm with several new arterial feeders leading to it. Coiling of the aneurysm and fistulas was performed. Postoperative, the spinal oedema increased despite corticoids, causing more extensive paraplegia of the lower limbs and a deterioration of his mental state. A laminectomy was performed and the aneurysm was surgically removed. Subsequently, the boy recovered gradually. A new MRI scan after two months showed less oedema and a split, partly affected spinal chord. This case shows the importance of excluding possible arteriovenous malformations in a child presenting with progressive neurodegeneration. In particular when there is a family history for Rendu-Osler-Weber disease, scans should be performed instantly to rule out this possibility. The case also highlights the possibility of good recovery of paraplegia in paediatric Rendu-Osler-Weber patients. PMID:24707424

Crijnen, Thomas E. M.; Voormolen, Maurits H. J.; Robert, Dominique; Jorens, Philippe G.; Ramet, Jose

2014-01-01

373

Chiari malformation, cervical spine anomalies, and neurologic deficits in velocardiofacial syndrome.  

PubMed

The purpose of this investigation was to evaluate the prevalence of Chiari malformation, cervical spine anomalies, and neurologic deficits in patients with velocardio-facial syndrome. This study was a prospective evaluation of 41 consecutive patients with velocardiofacial syndrome, documented by fluorescence in situ hybridization, between March of 1994 and September of 1998. The 23 girls and 18 boys ranged in age from 0.5 to 15.2 years, with a mean age of 6.7 years. Nineteen patients were assessed with magnetic resonance imaging, 39 underwent lateral cephalometric radiography, and all patients were examined for neurologic deficits. Eight of 19 patients (42 percent) had anomalies of the craniovertebral junction, including Chiari type I malformations (n = 4), occipitalization of the atlas (n = 3), and narrowing of the foramen magnum (n = 1). One patient with Chiari malformation required suboccipital craniectomy with laminectomy and decompression. Fourteen of 41 patients (34 percent) had demonstrated neurologic deficits; 10 patients (24 percent) had velar paresis (6 unilateral and 4 bilateral). Chiari malformations, cervical spine anomalies, and neurologic deficits are common in velocardiofacial syndrome. Because these findings may influence the outcome of surgical intervention, routine assessment of patients with velocardiofacial syndrome should include careful orofacial examination, lateral cephalometric radiography, and magnetic resonance imaging of the craniovertebral junction. PMID:10883607

Hultman, C S; Riski, J E; Cohen, S R; Burstein, F D; Boydston, W R; Hudgins, R J; Grattan-Smith, D; Uhas, K; Simms, C

2000-07-01

374

Midline lumbar fusion with cortical bone trajectory screw.  

PubMed

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 midline 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

Mizuno, Masaki; Kuraishi, Keita; Umeda, Yasuyuki; Sano, Takanori; Tsuji, Masanori; Suzuki, Hidenori

2014-01-01

375

Cauda Equina Syndrome Associated with Dural Ectasia in Chronic Anlylosing Spondylitis  

PubMed Central

Cauda equina syndrome (CES) associated with dural ectasia is a rare neurologic complication in patients with longstanding ankylosing spondylitis (AS). We report a 68-year-old male with a 30-year history of AS who presented a typical symptom and signs of progressive CES, urinary incontinence and neuropathic pain of the lumbosacral radiculopathy. Computed tomography (CT) and magnetic resonance imaging (MRI) findings showed the unique appearances of dural ectasia, multiple dural diverticula, erosion of posterior element of the lumbar spine, tethering of the conus medullaris and adhesion of the lumbosacral nerve roots to the posterior aspect of the dural ectasia. Considering the progressive worsening of the clinical signs, detethering of the conus medullaris through resection of the filum terminale was performed through a limited laminectomy. However, the urinary incontinence did not improve and there was a partial relief of the neuropathic leg pain only. The possible pathogenetic mechanism of CES-AS and the dural ectasia in this patient with longstanding AS are discussed with a literature review. PMID:25628815

Ha, Sang-woo

2014-01-01

376

Spinal Cord Ependymoma Associated with Neurofibromatosis 1 : Case Report and Review of the Literature  

PubMed Central

Patients with neurofibromatosis 1 (NF1) are predisposed to develop central nervous system tumors, due to the loss of neurofibromin, an inactivator of proto-oncogene Ras. However, to our knowledge, only three cases of ependymomas with NF1 have been reported in the literature. The authors present a case of NF1 patient with a spinal cord ependymoma. She was referred for about half a year history of increasing numbness that progressed from her fingers to her entire body above the bellybutton. Magnetic resonance imaging revealed a relative-demarcated, heterogeneously enhanced mass lesion accompanied by perifocal edema in C5-7 level, a left-sided T11 spinous process heterogeneously enhanced mass in soft tissue, intervertebral disk hernia in L2-5 level, and widespread punctum enhancing lesion in her scalp and in T11-L5 level. The patient underwent C5-7 laminectomies and total excision of the tumor under operative microscope, and intraoperative ultrasonography and physiological monitoring were used during the surgery. Histopathologically, her tumor was found to be a ependymoma without malignant features (grade II in the World Health Organization classification). Therefore, no adjuvant therapy was applied. Following the operation, the patient showed an uneventful clinical recovery with no evidence of tumor recurrence after one year of follow-up. PMID:24570818

Shan, Ming; Feng, Chunguo; Wang, Xiaojie

2014-01-01

377

Time-related effects of general functional training in spinal cord-injured rats  

PubMed Central

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

Miranda, Taisa Amoroso Bortolato; Vicente, Juliana Mendes Yule; Marcon, Raphael Martus; Cristante, Alexandre Fogaça; Morya, Edgard; do Valle, Angela Cristina

2012-01-01

378

Neuroprotective effect of epidural hypothermia after spinal cord lesion in rats  

PubMed Central

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

Barbosa, Marcello Oliveira; Cristante, Alexandre Fogaça; dos Santos, Gustavo Bispo; Ferreira, Ricardo; Marcon, Raphael Martus; de Barros Filho, Tarcisio Eloy Pessoa

2014-01-01

379

Lateral retroperitoneal transpsoas interbody fusion in a patient with achondroplastic dwarfism.  

PubMed

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

Staub, Blake N; Holman, Paul J

2015-02-01

380

Failure of reconstruction surgery using anterior fibular strut grafting to correct postlaminectomy kyphosis.  

PubMed

A patient with postlaminectomy kyphosis with a neurological deficit which developed following the initial surgical treatment is reported. A 49-year-old man, complaining of neck pain, sought treatment in 1995. An extramedullary cervical spinal tumor was diagnosed and C2-C4 laminectomy and resection of the tumor were performed. Recurrence of the tumor was seen 1 year later and a second tumor resection and radiation therapy were performed. One year after the second resection of the tumor, X-rays of the cervical spine revealed kyphosis. Anterior spinal fusion without instrumentation was performed followed by immobilization using a halo vest for 4 months. However, pseudoarthrosis and progression of the kyphosis occurred postoperatively. Iliac bone grafting at the pseudoarthrosis site and posterior internal fixation with lateral mass plates was performed. Bony fusion between the graft and C6 vertebra was obtained after these procedures, but the neurological deficits were not completely resolved. Clinicians who treat spinal cord tumors may learn from this treatment failure. PMID:17240145

Nagano, Akihito; Miyamoto, Kei; Fushimi, Kazunari; Hosoe, Hideo; Shimizu, Katsuji

2007-04-01

381

Chiropractic management of postoperative spine pain: a report of 3 cases  

PubMed Central

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

Coulis, Christopher M.; Lisi, Anthony J.

2013-01-01

382

Therapy of Acute and Delayed Spinal Infections after Spinal Surgery Treated with Negative Pressure Wound Therapy in Adult Patients  

PubMed Central

We present the results of the treatment of infected primary or delayed spine wounds after spinal surgery using negative pressure wound therapy. In our institution (University Hospital Zurich, Switzerland) nine patients (three women and six men; mean age 68.6, range 43-87 years) were treated in the period between January to December 2011 for non-healing spinal wounds. The treatment consisted of repeated debridements, irrigation and temporary closure with negative pressure wound therapy system. Three patients were admitted with a spinal epidural abscess; two with osteoporotic lumbar fracture; two with pathologic vertebra fracture and spinal cord compression, and two with vertebra fracture after trauma. All nine patients have been treated with antibiotic therapy. In one case the hardware has been removed, in three patients laminectomy was performed without instrumentation, in five patients there was no need to remove the hardware. The average hospital stay was 16.6 days (range 11-30). The average follow-up was 3.8, range 0.5-14 months. The average number of negative pressure wound therapy procedures was three, with the range 1-11. Our retrospective study focuses on the clinical problems faced by the spinal surgeon, clinical outcomes after spinal surgery followed by wound infection, and negative pressure wound therapy. Moreover, we would like to emphasize the importance for the patients and their relatives to be fully informed about the increased complications of surgery and about the limitations of treatment of these wounds with negative pressure wound therapy. PMID:24416474

Zwolak, Pawel; König, Matthias Alexander; Osterhoff, Georg; Wilzeck, Verena; Simmen, Hans-Peter; Jukema, Gerrolt Nico

2013-01-01

383

Hydrocephalus due to Membranous Obstruction of Magendie's Foramen  

PubMed Central

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

Varthalitis, Dimitrios; Georgakoulias, Nikolaos; Orphanidis, Georgios

2015-01-01

384

Neuroprotection and enhanced recovery with hypericum perforatum extract after experimental spinal cord injury in mice.  

PubMed

Oxidative stress results from an oxidant/antioxidant imbalance, an excess of oxidants, and/or a depletion of antioxidants. A considerable body of recent evidence suggests that oxidative stress and exaggerated production of reactive oxygen species play a major role in several aspects of inflammation. Hypericum perforatum is a medicinal plant species containing many polyphenolic compounds, namely, flavonoids and phenolic acids. Because polyphenolic compounds have high antioxidant potential, in this study, we evaluated the effect of H. perforatum (given at 30 mg . kg (-1)) in an experimental animal model of spinal cord injury, which was induced by the application of vascular clips to the dura via a four-level T5 through T8 laminectomy. The degree of (a) spinal cord inflammation and tissue injury (histological score), (b) nitrotyrosine, (c) poly(adenosine diphosphate-ribose), (d) neutrophils infiltration, and (e) the activation of signal transducer and activator transcription 3 was markedly reduced in spinal cord tissue obtained from H. perforatum extract-treated mice. We have also demonstrated that H. perforatum extract significantly ameliorated the recovery of limb function. PMID:16721269

Genovese, Tiziana; Mazzon, Emanuela; Menegazzi, Marta; Di Paola, Rosanna; Muià, Carmelo; Crisafulli, Concetta; Bramanti, Placido; Suzuki, Hisanori; Cuzzocrea, Salvatore

2006-06-01

385

Zoonotic Onchocerca lupi Infection in a 22-Month-Old Child in Arizona: First Report in the United States and a Review of the Literature  

PubMed Central

A 22-month-old girl presented with neck pain and stiffness and magnetic resonance imaging showed an extradural mass extending from C2 through the C4 level with moderate to severe compression of the cord. A left unilateral C2–C4 laminectomy was performed revealing an extradural rubbery tumor; a small biopsy was obtained. Examination of stained tissue revealed the presence of a parasitic worm that was identified as a gravid female Onchocerca lupi. A magnetic resonance imaging at 7 weeks follow-up showed a significantly decreased size of the enhancing lesion and the patient's symptoms gradually resolved. This is the first report of zoonotic O. lupi in the United States. The parasite has been reported in dogs and cats in the western United States, and from people in four cases reported from Europe. A great deal more needs to be learned, including full host range and geographic distribution, before we fully understand O. lupi infections in animals and man. PMID:23382171

Eberhard, Mark L.; Ostovar, Gholamabbas Amin; Chundu, Kote; Hobohm, Dan; Feiz-Erfan, Iman; Mathison, Blaine A.; Bishop, Henry S.; Cantey, Paul T.

2013-01-01

386

Mesenchymal Stem Cells as an Alternative for Schwann Cells in Rat Spinal Cord Injury  

PubMed Central

Background: Spinal cord has a limited capacity to repair; therefore, medical interventions are necessary for treatment of injuries. Transplantation of Schwann cells has shown a great promising result for spinal cord injury (SCI). However, harvesting Schwann cell has been limited due to donor morbidity and limited expansion capacity. Furthermore, accessible sources such as bone marrow stem cells have drawn attentions to themselves. Therefore, this study was designed to evaluate the effect of bone marrow-derived Schwann cell on functional recovery in adult rats after injury. Methods: Mesenchymal stem cells were cultured from adult rats’ bone marrow and induced into Schwann cells in vitro. Differentiation was confirmed by immunocytochemistry and RT-PCR. Next, Schwann cells were seeded into collagen scaffolds and engrafted in 3 mm lateral hemisection defects. For 8 weeks, motor and sensory improvements were assessed by open field locomotor scale, narrow beam, and tail flick tests. Afterwards, lesioned spinal cord was evaluated by conventional histology and immunohistochemistry. Results: In vitro observations showed that differentiated cells had Schwann cell morphology and markers. In this study, we had four groups (n = 10 each): laminectomy, control, scaffold and scaffold + Schwann cells. Locomotor and sensory scores of cell grafted group were significantly better than control and scaffold groups. In histology, axonal regeneration and remyelination were better than control and scaffold groups. Conclusion: This study demonstrates that bone marrow-derived Schwann cells can be considered as a cell source for Schwann cells in SCI treatment. PMID:23748888

Zaminy, Arash; Shokrgozar, Mohammad Ali; Sadeghi, Yousef; Noroozian, Mohsen; Heidari, Mohammad Hassan; Piryaei, Abbas

2013-01-01

387

Desmoid Tumor Formation following Posterior Spinal Instrumentation Placement.  

PubMed

Study Design?Case report. Objective?The objective of the article is to illustrate a case of desmoid tumor (DT) formation after posterior instrumentation of the thoracic spine. Methods?A 57-year-old woman presented with lower extremity clumsiness, balance, and ambulation difficulty resulting from spinal cord compression due to an upper thoracic atypical vertebral hemangioma. Ten months after undergoing embolization, resection, and placement of instrumentation for this lesion, the patient developed a growing mass at the rostral end of the incision. Biopsy revealed desmoid fibromatosis. The mass was removed via an en bloc resection. Histology revealed an infiltrative DT above the laminectomy site abutting the instrumentation. Results?At 2-year follow-up, there was no evidence of recurrence of the tumor. Conclusion?Paraspinal DTs have been reported in the literature to develop after surgical procedures of the spine. Often times, patients attribute swelling or fullness at the site of their surgery to scar tissue formation or instrumentation. One must consider the possibility of a DT in the setting of reported surgical site fullness or mass after spine surgery. It is thought that postoperative inflammation present in the surgical bed may promote formation of DTs. Instrumentation may also contribute to inflammation and increase the likelihood of developing a DT. Generous margins must be taken to prevent recurrence. PMID:24436712

Puvanesarajah, Varun; Lina, Ioan A; Liauw, Jason A; Hsu, Wesley; Burger, Peter C; Witham, Timothy F

2013-10-01

388

Pregnancy related symptomatic vertebral hemangioma.  

PubMed

Vertebral hemangiomas are benign vascular tumors of the spine that remain asymptomatic in most cases and incidentally encountered on imaging. Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of 23-year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging (MRI) revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit. Repeat MRI of dorsal spine performed at 3 months postoperatively showed reduced posterior and anterior epidural components of vertebral hemangioma. PMID:24753678

Gupta, Meena; Nayak, Rajeev; Singh, Hukum; Khwaja, Geeta; Chowdhury, Debashish

2014-01-01

389

Surgical management of symptomatic T8 vertebral hemangioma: case report and review of the literature.  

PubMed

Vertebral hemangiomas are benign vascular lesions of the vertebral column; only 0.9-1.2% of all vertebral hemangiomas cause spinal cord compression. We report a 34-year-old female who was admitted to the neurosurgery clinic with a history of back pain, poor quality of life and easy fatigability for 1.5 years. Her medical history revealed a fall from a height of 2 meters 1.5 years ago. Neurology examination revealed bilateral hypoesthesia below the T8 level and hyperactive deep tendon reflexes in her left leg. Computed tomography scan of the thoracic spine showed T8 vertebral hemangioma, and magnetic resonance imaging showed a T8 hemangioma compressing the spinal cord. Surgical intervention was planned and T8 total laminectomy was performed. The tumor extending into the anterior spinal cord was resected, and T8 vertebroplasty with short segment posterior stabilization and fusion was performed. We aimed to present a new treatment approach for symptomatic vertebral hemangiomas and reviewed the relevant literature. PMID:24101319

Tucer, Bulent; Ekici, Mehmet Ali; Menku, Ahmet; Koc, Rahmi Kemal; Guclu, Bulent

2013-01-01

390

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

Microsoft Academic Search

Summary  Hurler–Scheie syndrome is caused by alpha-l-iduronidase deficiency. Enzyme replacement therapy (ERT) can improve physical\\u000a capacity and reduces organomegaly. However, the effect on bradytrophic connective tissue is limited. As intravenously administered\\u000a enzyme cannot cross the blood–brain barrier, the therapy of choice for the more severe Hurler syndrome is haematopoietic stem\\u000a cell transplantation (HCT). In the more attenuated Scheie syndrome, neurological impairment

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

391

A novel vertebral stabilization method for producing contusive spinal cord injury.  

PubMed

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

Walker, Melissa J; Walker, Chandler L; Zhang, Y Ping; Shields, Lisa B E; Shields, Christopher B; Xu, Xiao-Ming

2015-01-01

392

Improvement of gait patterns in step-trained, complete spinal cord-transected rats treated with a peripheral nerve graft and acidic fibroblast growth factor  

PubMed Central

The effects of peripheral nerve grafts (PNG) and acidic fibroblast growth factor (?FGF) combined with step training on the locomotor performance of complete spinal cord-transected (ST, T8) adult rats were studied. Rats were assigned randomly to five groups (N = 10 per group): sham control (laminectomy only), ST only, ST–step-trained, repaired (ST with PNG and ?FGF treatment), or repaired–step-trained. Step-trained rats were stepped bipedally on a treadmill 20 min/day, 5 days/week for 6 months. Bipolar intramuscular EMG electrodes were implanted in the soleus and tibialis anterior (TA) muscles of ST–step-trained (n = 3) and repaired–step-trained (n = 2) rats. Gait analysis was conducted at 3 and 6 months after surgery. Stepping analysis was completed on the best continuous 10-s period of stepping performed in a 2-min trial. Significantly better stepping (number of steps, stance duration, swing duration, maximum step length, and maximum step height) was observed in the repaired and repaired–step-trained than in the ST and ST–step-trained rats. Mean EMG amplitudes in both the soleus and TA were significantly higher and the patterns of activation of flexors and extensors more reciprocal in the repaired–step-trained than ST–step-trained rats. 5-HT fibers were present in the lumbar area of repaired but not ST rats. Thus, PNG plus ?FGF treatment resulted in a clear improvement in locomotor performance with or without step training. Furthermore, the number of 5-HT fibers observed below the lesion was related directly to stepping performance. These observations indicate that the improved stepping performance in Repaired rats may be due to newly formed supraspinal control via regeneration. PMID:20488178

Lee, Yu-Shang; Zdunowski, Sharon; Edgerton, V. Reggie; Roy, Roland R.; Zhong, Hui; Hsiao, Ian; Lin, Vernon W.

2011-01-01

393

Correlation between disability and MRI findings in lumbar spinal stenosis  

PubMed Central

Background and purpose MRI is the modality of choice when diagnosing spinal stenosis but it also shows that stenosis is prevalent in asymptomatic subjects over 60. The relationship between preoperative health-related quality of life, functional status, leg and back pain, and the objectively measured dural sac area in single and multilevel stenosis is unknown. We assessed this relationship in a prospective study. Patients and methods The cohort included 109 consecutive patients with central spinal stenosis operated on with decompressive laminectomy or laminotomy. Preoperatively, all patients completed the questionnaires for EQ-5D, SF-36, Oswestry disability index (ODI), estimated walking distance and leg and back pain (VAS). The cross-sectional area of the dural sac was measured at relevant disc levels in mm2, and spondylolisthesis was measured in mm. For comparison, the area of the most narrow level, the number of levels with dural sac area < 70 mm2, and spondylolisthesis were studied. Results Before surgery, patients with central spinal stenosis had low HRLQoL and functional status, and high pain levels. Patients with multilevel stenosis had better general health (p = 0.04) and less leg and back pain despite having smaller dural sac area than patients with single-level stenosis. There was a poor correlation between walking distance, ODI, the SF-36, EQ-5D, and leg and back pain levels on the one hand and dural sac area on the other. Women more often had multilevel spinal stenosis (p = 0.05) and spondylolisthesis (p < 0.001). Spondylolisthetic patients more often had small dural sac area (p = 0.04) and multilevel stenosis (p = 0.06). Interpretation Our findings indicate that HRQoL, function, and pain measured preoperatively correlate with morphological changes on MRI to a limited extent. PMID:21434811

2011-01-01

394

Central Decompressive Laminoplasty for Treatment of Lumbar Spinal Stenosis : Technique and Early Surgical Results  

PubMed Central

Objective Lumbar spinal stenosis is a common degenerative spine disease that requires surgical intervention. Currently, there is interest in minimally invasive surgery and various technical modifications of decompressive lumbar laminectomy without fusion. The purpose of this study was to present the author's surgical technique and results for decompression of spinal stenosis. Methods The author performed surgery in 57 patients with lumbar spinal stenosis between 2006 and 2010. Data were gathered retrospectively via outpatient interviews and telephone questionnaires. The operation used in this study was named central decompressive laminoplasty (CDL), which allows thorough decompression of the lumbar spinal canal and proximal two foraminal nerve roots by undercutting the lamina and facet joint. Kyphotic prone positioning on elevated curvature of the frame or occasional use of an interlaminar spreader enables sufficient interlaminar working space. Pain was measured with a visual analogue scale (VAS). Surgical outcome was analyzed with the Oswestry Disability Index (ODI). Data were analyzed preoperatively and six months postoperatively. Results The interlaminar window provided by this technique allowed for unhindered access to the central canal, lateral recess, and upper/lower foraminal zone, with near-total sparing of the facet joint. The VAS scores and ODI were significantly improved at six-month follow-up compared to preoperative levels (p<0.001, respectively). Excellent pain relief (>75% of initial VAS score) of back/buttock and leg was observed in 75.0% and 76.2% of patients, respectively. Conclusion CDL is easily applied, allows good field visualization and decompression, maintains stability by sparing ligament and bony structures, and shows excellent early surgical results. PMID:25368762

2014-01-01

395

What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review  

PubMed Central

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

Epstein, Nancy E.

2014-01-01

396

Spinal intradural, extramedullary anaplastic ependymoma with an extradural component: Case report and review of the literature  

PubMed Central

Background: There have been 18 reported cases of primary spinal intradural, extramedullary ependymomas reported in the literature. One of the 18 cases had an extradural component and was benign. Our case is the second spinal intradural, extramedullary ependymoma with an extradural component and the first with its initial presentation as an anaplastic ependymoma. Case Description: A 50-year-old male presented with bilateral upper thigh weakness and thoracic numbness. His exam showed the pin-prick level at T5. Magnetic resonance imaging (MRI) of the thoracic spine showed an enhancing lesion at T5–6 with severe compression of the spinal cord with a dumbbell shape extension of the tumor through the right T5–6 neural foramen. The patient had a laminectomy at T4–T6 with the resection of the tumor. Postoperatively, the patient regained full strength in his lower extremities. Intraoperatively, the tumor was found to be intradural, extramedullary with an extradural component. The tumor was found to be an anaplastic ependymoma. Conclusions: Even though spinal intradural extramedullary ependymomas are very rare, surgeons must be aware that on MRI, they can be mistaken for meningiomas or nerve sheath tumors especially if there is an extradural component. Our case report is the first intradural, extramedullary ependymoma that is anaplastic and has an extradural component. A review of the literature provides little information on the treatment and prognosis for these tumors especially if they are anaplastic. We propose that the treatment, as done in our case, should be complete resection of the tumor with spinal radiotherapy to the tumor level. PMID:21918734

Guppy, Kern H.; Hou, Lewis; Moes, Greg S.; Sahrakar, Kamran

2011-01-01

397

Effects of combining methylprednisolone with magnesium sulfate on neuropathic pain and functional recovery following spinal cord injury in male rats.  

PubMed

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

Farsi, Leila; Naghib Zadeh, Maryam; Afshari, Khashayar; Norouzi-Javidan, Abbas; Ghajarzadeh, Mahsa; Naghshband, Zeinab; Keshavarz, Mansoor

2015-03-01

398

Role of gap junctions in spontaneous activity of the rat bladder  

PubMed Central

Increased gap junction expression in lamina propria myofibroblasts and urothelial cells may be involved in detrusor overactivity, leading to incontinence. Immunohistochemistry was used to compare connexin (Cx) 26, 43, and 45 expression in the bladders of neonatal, adult, and spinal cord-transected rats, while optical imaging was used to map the spread of spontaneous activity and the effects of gap junction blockade. Female adult Sprague-Dawley rats were deeply anesthetized, a laminectomy was performed, and the spinal cord was transected (T8/T9). After 14 days, their bladders and those of age-matched adults (4 mo old) and neonates (7-21 day old) were excised and studied immunohistochemically using frozen sections or optically using whole bladders stained with voltage- and Ca2+-sensitive dyes. The expression of Cx26 was localized to the urothelium, Cx43 to the lamina propria myofibro-blasts, and Cx45 to the detrusor smooth muscle. While the expression of Cx45 was comparable in all bladders, the expression of Cx43 and Cx26 was increased in neonate and transected animals. In the bladders of adults, spontaneous activity was initiated at multiple sites, resulting in a lack of coordination. Alternatively, in neonate and transected animals spontaneous activity was initiated at a focal site near the dome and spread in a coordinated fashion throughout the bladder. Gap junction blockade (18?-glycyrrhetinic acid, 1 ?M) abolished this coordinated activity but had no effect on the uncoordinated activity in adult bladders. These data suggest that coordinated spontaneous activity requires gap junction upregulation in urothelial cells and lamina propria myofibroblasts. PMID:17581924

Ikeda, Y.; Fry, C.; Hayashi, F.; Stolz, D.; Griffiths, D.; Kanai, A.

2011-01-01

399

Surgery Followed by Radiotherapy Versus Radiotherapy Alone for Metastatic Spinal Cord Compression From Unfavorable Tumors  

SciTech Connect

Purpose: Despite a previously published randomized trial, controversy exists regarding the benefit of adding surgery to radiotherapy for metastatic spinal cord compression (MSCC). It is thought that patients with MSCC from relatively radioresistant tumors or tumors associated with poor functional outcome after radiotherapy alone may benefit from surgery. This study focuses on these tumors. Methods and Materials: Data from 67 patients receiving surgery plus radiotherapy (S+RT) were matched to 134 patients (1:2) receiving radiotherapy alone (RT). Groups were matched for 10 factors and compared for motor function, ambulatory status, local control, and survival. Additional separate matched-pair analyses were performed for patients receiving direct decompressive surgery plus stabilization of involved vertebrae (DDSS) and patients receiving laminectomy (LE). Results: Improvement of motor function occurred in 22% of patients after S+RT and 16% after RT (p = 0.25). Posttreatment ambulatory rates were 67% and 61%, respectively (p = 0.68). Of nonambulatory patients, 29% and 19% (p = 0.53) regained ambulatory status. One-year local control rates were 85% and 89% (p = 0.87). One-year survival rates were 38% and 24% (p = 0.20). The matched-pair analysis of patients receiving LE showed no significant differences between both therapies. In the matched-pair analysis of patients receiving DDSS, improvement of motor function occurred more often after DDSS+RT than RT (28% vs. 19%, p = 0.024). Posttreatment ambulatory rates were 86% and 67% (p = 0.30); 45% and 18% of patients regained ambulatory status (p = 0.29). Conclusions: Patients with MSCC from an unfavorable primary tumor appeared to benefit from DDSS but not LE when added to radiotherapy in terms of improved functional outcome.

Rades, Dirk, E-mail: Rades.Dirk@gmx.net [Department of Radiation Oncology, University of Lubeck (Germany); Huttenlocher, Stefan [Department of Radiation Oncology, University of Lubeck (Germany); Bajrovic, Amira [Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf (Germany); Karstens, Johann H. [Department of Radiation Oncology, Medical University Hannover (Germany); Adamietz, Irenaeus A. [Department of Radiation Oncology, Ruhr University Bochum (Germany); Kazic, N