1/127. Spinal subdural hematoma: a rare complication of lumbar puncture. Case report and review of the literature.Spinal subdural hematoma, though rare, is an established complication of lumbar puncture. A young man with persistent back and neck pain after a traumatic lumbar puncture for the diagnosis of lymphocytic meningitis is presented. A diagnosis of spinal subdural hematoma at T2 to T8 levels without significant spinal cord compression was confirmed by magnetic resonance imaging. Symptoms resolved after one month of analgesics and muscle relaxants.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/127. Childhood leukemia presenting with back pain and vertebral compression fractures.Vertebral body collapse and back pain are an unusual presentation for childhood leukemia. This report is intended to promote greater awareness that acute lymphocytic leukemia can cause significant back pain in children without other systemic symptoms. We describe four cases in which patients with acute lymphocytic leukemia presented with back pain and vertebral compression fractures. All of the patients were initially misdiagnosed. No patient had neurologic compromise, despite extensive vertebral body collapse. The back pain was relieved after chemotherapy.- - - - - - - - - - ranking = 9.6494858271893keywords = compression, fracture (Clic here for more details about this article) |
3/127. iliac artery pseudoaneurysm following renal transplantation presenting as lumbosacral plexopathy.A renal transplant patient developed chronic and progressive back and lower extremity pain followed by foot weakness. The correct diagnosis of lumbosacral plexopathy was made after electromyography and nerve conduction studies and the etiology of radiculopathy due to nerve root compression was excluded. This prompted further investigations that led to the discovery of a large internal iliac artery pseudoaneurysm. We emphasize the use of electrodiagnostic studies to investigate patients with back and limb pain for correctly localizing responsible pathology. In this case a potentially lethal situation was correctly identified in a transplant patient.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
4/127. Symptomatic ossification of the posterior longitudinal ligament of the lumbar spine. Case report.The authors report a case of focal ossification of the posterior longitudinal ligament (OPLL) behind the L-3 vertebral body. This is relatively rare among previously reported cases in the literature. Magnetic resonance (MR) imaging revealed that the ossifying portion of the PLL was impinging on the left L-3 nerve root. Contrast enhancing hypertrophic PLL was also demonstrated around the ossification and along the lumbosacral PLL. Via a laminectomy and wide excision of the PLL the lesion was removed. Pathological examination revealed a nodule composed of fibrous cartilage, lamina bone, and mature fat marrow. Enchondral ossification could be identified under a microscope. The authors believe that preoperative MR imaging evaluation is important for the detection of the relationship between an OPLL and the neural structure. Excision of the symptomatic OPLL should be performed when needed to obtain adequate nerve root decompression.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
5/127. Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging.We reviewed the records of all patients who had received an epidural catheter for management of chronic cancer pain in a 3-year period (1993-1996). patients with nervous system infections were identified, and pertinent clinical, radiological (magnetic resonance imaging), and bacteriological data were analyzed. We identified 11 patients who developed spinal epidural abscess (SEA). All of these had back pain; radicular signs occurred in seven patients and spinal cord compression in two patients. magnetic resonance imaging revealed SEA in all 11 patients. SEA was iso- to hypointense on T1-weighted images and hyperintense on T2-weighted images relative to spinal cord. After gadolinium administration seven lesions showed characteristic rim enhancement while three showed minimal enhancement. No signs of diskitis or osteomyelitis were present, and the abscess was always localized to the posterior epidural space. Cultures were positive in all cases and revealed staphylococcus epidermidis in eight and S. aureus in three. All patients were treated with intravenous antibiotics, and four had an additional decompressive laminectomy. Two patients died within 1 week of diagnosis from overwhelming septicemia despite apparently adequate antibiotic treatment. Within 4 weeks after diagnosis of SEA two patients died from widely metastatic disease, although infection may have contributed. One patient developed septicemia while receiving appropriate antibiotics and underwent emergency laminectomy. The neurological deficits recovered in all patients who survived the acute infectious episode. We conclude that patients with chronic epidural catheters for cancer pain require prompt neurological evaluation and magnetic resonance imaging when SEA is suspected. Early evaluation and treatment may lead to full recovery.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
6/127. Lumbar disc herniation in a 27-month-old child. Case report.The occurrence of disc herniation is rare in children. A 27-month-old child fell from his cradle and developed, in the following 2 weeks, irritability, low-back pain, and difficulty in walking. On physical examination a compensatory gait, paravertebral muscle spasm, and a restricted right straight-leg raising test were demonstrated. Plain x-ray films revealed a narrowed L4-5 intervertebral space. magnetic resonance imaging of the lumbosacral spine demonstrated decreased signal in the L4-5 disc, with posterior disc protrusion. At surgery, blood infiltrating the subperiosteal plane was observed. Via a left hemilaminectomy and under microscopic magnification, the left L-5 nerve root was found to be intact, and on the right side significant nerve root compression was identified. During dissection an accidental dural tear occurred. A right L-4 hemilaminectomy was performed, and the disc fragments were removed until a complete nerve root decompression was obtained and the dura was repaired. The child recovered uneventfully and was asymptomatic 7 years postsurgery. This child is one of the youngest patients with a herniated disc reported in the world literature. The authors discuss the diagnostic difficulties and management of this entity in children.- - - - - - - - - - ranking = 2keywords = compression (Clic here for more details about this article) |
7/127. Persistent or severe back pain and stiffness are ominous symptoms requiring prompt attention.BACKGROUND: Children with severe or persistent back pain and stiffness often have an underlying organic cause but there is a large differential diagnosis, examination may be difficult and the problem is relatively rare in general paediatric practice. These difficulties appeared to lead to delays in diagnosis and management of children with this problem. OBJECTIVES: To provide an approach to the diagnosis and management children with severe or persistent back pain or stiffness based on our clinical experience and the literature. METHODOLOGY: The case histories of 10 children with severe back pain seen by the authors over a 5-year period were reviewed. They were chosen as illustrative examples of the diagnostic and management problems and did not represent a systematic review of all cases seen by the authors over that time. RESULTS: Underlying causes included infection, inflammation, neoplasm, trauma and vascular malformation. Four of the children had spinal cord compression which required urgent decompression. There was one child with a conversion disorder but three children with organic disease were initially felt to have a conversion disorder. Investigations generally proceeded relatively slowly and the problem was not regarded as a semi-urgent situation carrying the risk of permanent paraplegia. magnetic resonance imaging (MRI) scan of the spine was the investigation of choice. CONCLUSION: Children with severe or persistent back pain and stiffness have a wide variety of underlying causes. The possibility of underlying spinal cord compression should always be considered in children with this presentation. If the diagnosis is not obvious, MRI scan of the spine should be arranged without delay.- - - - - - - - - - ranking = 3keywords = compression (Clic here for more details about this article) |
8/127. A viable residual spinal hydatid cyst cured with albendazole. Case report.Spinal hydatid disease is a rare entity that frequently yields to severe, acute-onset neurological deficits. Although the gold standard treatment is total surgical removal of the cysts without inducing any spillage, it may not be possible to perform this in patients with multiple and fragile cysts. In such cases, the neural structures should be adequately decompressed and albendazole should be administered promptly. The authors describe the case of a 13-year-old girl who was admitted with a history of back pain and acute-onset lower-extremity weakness. magnetic resonance imaging scans demonstrated severe spinal cord compression caused by multiple cysts involving T-4 and the mediastinum. The patient underwent surgery, and the cysts were removed, except for one cyst that was hardly exposed. Following histopathological confirmation of spinal hydatid disease, she was treated with albendazole for 1 year. One year postoperatively, the residual cyst had gradually shrunk and had almost disappeared. Although a single case is not sufficiently promising, we believe that administration of albendazole is efficient to prevent recurrences in cases in which it is not possible to obtain total removal of the cysts without inducing spillage.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
9/127. Stress fracture of the hip and pubic rami after fusion to the sacrum in an adult with scoliosis: a case report.Correction of adult scoliosis frequently involves long segmental fusions, but controversy still exists whether these fusions should include the sacrum. It has been suggested that forces associated with activities of daily living transfer the stresses to the remaining levels of the spine and to the pelvis. The case described here was a 43-year-old woman with scoliosis and chronic back pain refractory to non-surgical modalities. Radiographically, the patient had a 110 degree lumbar curve. An anterior and posterior fusion with Luque-Galveston instrumentation was performed. Six months postoperatively the patient returned with a 2-week history of right hip pain with no history of trauma. There was radiographic evidence of a displaced femoral neck fracture and pubic rami fractures. The femoral neck fracture was treated with a total hip replacement. Further surgeries were required to correct a lumbar pseudoarthrosis and hardware failure. We believe that this case provides evidence that fusion into the lumbosacral junction may distribute forces through the pelvic bones and hip resulting in stress and potential hardware complications, especially in patients at risk due to osteopenic conditions.- - - - - - - - - - ranking = 6.509280158065keywords = fracture (Clic here for more details about this article) |
10/127. osteoporosis and men. Don't forget the blokes.BACKGROUND: There is a clear analogy between osteoporosis and hypertension. After all, the fractures associated with osteoporosis can be as disastrous as a cardiovascular event associated with hypertension and both fractures and cardiovascular events, can be greatly reduced by modern treatment. However, osteoporosis is still relatively underdiagnosed, especially in men where it may not be considered an important aspect of men's health. OBJECTIVE: This case study may trigger readers to look for osteoporosis in men at risk and to use the available medications and interventions to preserve bone and avoid falls in such men, thus reducing fractures and associated disability and pain. DISCUSSION: The risk factors for osteoporosis and fracture are known and easily identified and measurement of bone mineral density quantifies bone loss and fracture risk. There are well established strategies to protect bone, to prevent fractures and to maintain comfort. osteoporosis is already a major public health problem in australia and will become more important as the proportion of old and the 'old old' increase over the next two decades. osteoporosis is recognised as an important component of the health of older women and should not be forgotten in older men.- - - - - - - - - - ranking = 5.5793829926271keywords = fracture (Clic here for more details about this article) |
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