1/16. A case of peroneal neuropathy-induced footdrop. Correlated and compensatory lower-extremity function.This article reports on the case of a man with peroneal neuropathy-induced footdrop who was seen at the authors' institution 3 years after open reduction and internal fixation of a proximal fibular fracture and a distal, spiral, oblique tibial fracture of the right leg. A comprehensive gait analysis was conducted. A significant footdrop in gait resulted in a "reverse check mark" center-of-pressure pattern, an increased transverse-plane rotation of the foot, and excessive knee and hip flexion in the sagittal plane. These objective findings documented significant dysfunction within the involved lower extremity; in addition, aberrant biomechanics were observed in structures other than the site of initial injury within both limbs.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/16. Cervical posterior fusion with wave-shaped rod under local anesthesia for cervical spondylotic myelopathy: review of 12 patients.STUDY DESIGN: Clinical evaluation of cervical interspinous fusion under local anesthesia in elderly patients with cervical spondylotic myelopathy. OBJECTIVES: To evaluate the effectiveness of cervical posterior fusion with wave-shaped rods inserted under local anesthesia for elderly high-risk patients with cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: A substantial number of patients cannot undergo surgical interventions under general anesthesia because of their general medical complications. Although such patients would become unable to walk, which might induce a worsening of their general condition, conservative treatments had been adopted as the only treatment for these patients. The authors have obtained satisfactory results by means of posterior interspinous fusion under local anesthesia even in the high-risk patients with severe cervical spondylotic myelopathy. The aims of this surgical technique were to adjust cervical alignment and to stabilize the motion segment(s) without decompression. patients AND methods: Between May 1989 and August 1998, 12 elderly patients (3 men and 9 women) with cervical spondylotic myelopathy were treated with posterior interspinous fusion using wave-shaped rods inserted under local anesthesia. The average age at the surgery was 76.9 years. The average follow-up period was 5 years 6 months. All patients were unable to walk without any assistance because of their advanced myelopathy. It was felt that all of them would be unable to accept general anesthesia because of their generally poor medical conditions. Preoperative severity of the clinical symptoms and postoperative recovery were evaluated by a scoring system proposed by the Japanese Orthopaedic association, which had 17 points at full mark. RESULTS: The average duration of the surgical procedure was 122.8 minutes. The average total blood loss was 118.6 g. No instrument failures were denoted. Neither neural deterioration nor major complication was observed relating to the surgery. Radiographic bony union of the grafted bone was achieved in all patients. Progression of myelopathy was arrested in all 12 patients, and clinical symptoms were improved in 10 patients. The mean Japanese Orthopaedic association scores had increased from 5.0 to 10.2 points. CONCLUSIONS: Twelve high-risk patients with cervical spondylotic myelopathy were treated with posterior interspinous fusion using wave-shaped rods inserted under local anesthesia. This method was evaluated as an effective surgical salvage without any mortal complications even in the elderly high-risk patients.- - - - - - - - - - ranking = 2.9102820958316keywords = compression (Clic here for more details about this article) |
3/16. Treatment of craniocervical spine lesion with osteogenesis imperfecta: a case report.STUDY DESIGN: A case report of craniocervical spine lesions including basilar impression, atlantoaxial dislocation, and syringomyelia, with osteogenesis imperfecta is presented, and the literature is reviewed. OBJECTIVE: To discuss the problems involved in the surgical management of craniocervical spine lesion with osteogenesis imperfecta. SUMMARY OF BACKGROUND DATA: osteogenesis imperfecta is known to have various spine lesions as complications. However, few reports have described craniocervical lesions associated with osteogenesis imperfecta. methods: A 14-year-old girl with osteogenesis imperfecta, Silence classification IVB, experienced difficulty walking, with marked motor disturbance and muscle weakness in the extremities. Deep tendon reflexes were exaggerated bilaterally in the upper and lower extremities, and positive Babinski reflex and ankle clonus were observed bilaterally. Basilar impression, atlantoaxial dislocation, and syringomyelia were shown by plain radiography, tomography, three-dimensional computed tomography, and magnetic resonance imaging. RESULTS: In the reported patient, posterior fossa decompression and atlantoaxial posterior fusion could not be performed because the foramen magnum and upper cervical spine invaginated to the base of the skull. Therefore, occipitocervical spine fusion using titanium loop and wires was performed at the reduced position of the atlantoaxial dislocation, resulting in improvement of neurologic deficits. CONCLUSIONS: For patients with atlantoaxial dislocation, syringomyelia, and basilar impression without clinical symptoms or signs of brain stem compression, occipitocervical spine fusion alone at the reduction of the atlantoaxial dislocation may be indicated because these procedures improve neurologic deficits and prevent postoperative development of basilar impression and enlargement of syringomyelia.- - - - - - - - - - ranking = 5.8205641916633keywords = compression (Clic here for more details about this article) |
4/16. Retroperitoneal lipoma. Unusual presentation with detrusor instability.Retroperitoneal lipomas are a heterogeneous group of mesenchymal tumors. They are usually large and occur most frequently in the retroperitoneal, perineal and pelvic regions. Lipomas grow slowly surrounding the retroperitoneal and pelvic organs, with a displacement of bowel and vascular axis. A case of a 61-year-old male patient which referred urinary frequency, urgency and nocturia is presented. urodynamics evidenced a detrusor instability in a low capacity bladder. CT scan demonstrated a bladder dome compression due to a huge retroperitoneal mass extending from the right hepatic lobe to the hypogastric region and the right thigh. Surgical complete resection was performed: histology demonstrated a lipoma with areas of well differentiated myxoid degeneration. After surgery the irritative urinary symptoms disappeared. This is the first case described in literature of detrusor instability due to bladder compression by retroperitoneal lipoma.- - - - - - - - - - ranking = 5.8205641916633keywords = compression (Clic here for more details about this article) |
5/16. Multimodality management of a giant cell tumor arising in the proximal sacrum: case report.STUDY DESIGN: Descriptive. OBJECTIVE: To outline a novel multimodality approach for a difficult surgical resection of a giant cell tumor in the cephalad portion of the sacrum. SUMMARY OF BACKGROUND DATA: giant cell tumors of the sacrum are rare primary bone tumors. Recent reports have demonstrated diminished giant cell tumor recurrence with cryosurgery by using a "direct pour" technique with liquid nitrogen. Although successful in decreasing tumor recurrence, this technique is accompanied by a 4%-8% rate of skin necrosis and high rates of pathologic fracture. The authors describe resection and a novel, controlled method of argon-based cryotherapy (followed by a unique pelvic reconstruction) for a large, difficult giant cell tumor of the sacrum. methods: A 29-year-old woman presented with complaints of right foot drop and decreased sensation of the right buttock, posterior thigh, posterior calf, and lateral aspect of the right foot. Radiographic evaluation revealed a mass in the right sacrum; histologic examination of CT-guided biopsy revealed a giant cell tumor. A combined anterior abdominal and posterior sacral approach was performed, the tumor was resected, and the margin of the cavity was treated with controlled argon-based cryotherapy. The combination of thermocouples, electromyographic monitoring, and rapid freeze-thaw cycles allowed a controlled ablation of the tumor margin while ensuring that surrounding structures, such as the rectal wall, sacral nerves, and gluteal muscles, were not damaged. Posterior spinal fusion L4 to sacrum, posterior spinal instrumentation L4 to pelvis, and allograft reconstruction of the right sacrum were performed. RESULTS: The patient recovered well without skin necrosis or pathologic fracture. Urinary and fecal continence were preserved. At the 20-month follow-up the patient has no evidence of local tumor recurrence and is fully ambulatory without a brace or narcotic medication. CONCLUSION: A novel multimodality approach, consisting of resection, controlled cryosurgery, and a unique lumbopelvic reconstruction, was safe and successful in managing a challenging proximal sacral giant cell tumor. Twenty months after surgery the patient has excellent bowel and bladder control, no tumor recurrence, and functional ambulation without a brace or pain.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
6/16. Exertional myelopathy in type 2 congenital kyphosis.STUDY DESIGN: A case of lower-extremity myelopathy induced by physical exertion in a patient with Type 2 (failure of segmentation) congenital kyphosis is reported. OBJECTIVE: To describe the uncommon presentation of neurologic sequelae in a patient with Type 2 congenital kyphosis. SUMMARY OF BACKGROUND DATA: Various reports have described neurologic sequelae in patients with Type 1 (failure of formation) congenital kyphosis. To the authors' knowledge, no case of Type 2 congenital kyphosis leading to neurologic symptoms has been reported. methods: A 17-year-old boy presented with a 3-year history of progressively worsening midthoracic back pain. During exertion, numbness developed along the posterior aspects of his legs, and he experienced a wobbly sensation in his lower extremities that prevented his participation in athletic activities. His static and dynamic neurologic examination was unremarkable. However, he developed a wide-based clumsy myelopathic gait when he was asked to run in the halls of the clinic. magnetic resonance imaging demonstrated that the spinal cord was draped over the posterior vertebral body of T10. Anterior thoracic spinal cord decompression and fusion were performed through a seventh rib thoracotomy using a structural rib graft to fill the defect. The anterior 1 cm of bone was left intact so as not to cause any additional instability. RESULTS: The patient tolerated the procedure well and had complete resolution of his exertionally dependent myelopathic symptoms. At this writing, 3 years after surgery, he is involved in the Navy ROTC program. CONCLUSIONS: Although Type 2 congenital kyphosis is a rare entity, it should be followed carefully and corrected surgically when appropriate. A history of exertional myelopathy may be an early sign of spinal cord impingement and is an indication for surgical decompression.- - - - - - - - - - ranking = 5.8205641916633keywords = compression (Clic here for more details about this article) |
7/16. Congenital spondylolysis of the axis with associated myelopathy. Case report.Cervical spondylolysis is a rare clinical entity and occurs predominantly at the C-6 level. The authors describe a patient with congenital spondylolysis of the axis that caused myelopathy. The patient was a 57-year-old woman with long-standing gait disturbance. Plain cervical radiography revealed a radiolucent defect across the pedicle of the axis. magnetic resonance imaging of the cervical spine in the neutral, flexion, and extension neck positions as well as a computerized tomography myelography in the neutral neck position failed to demonstrate any spinal cord compression. When she rotated her neck, however, the spinal cord was caught between the hypertrophic anterior arch of the atlas and posterior part of the slipped pedicle of the axis on the contralateral side. The spinal cord was transformed into a pear shape. Mechanical injury to the spinal cord seemed to explain her neurological presentation. This is, to the authors' knowledge, the 15th case of axial spondylolysis and the sixth case of spinal cord involvement of the cervical spondylolysis. No cases involving myelopathy secondary to such a unique mechanism have been reported previously in the literature.- - - - - - - - - - ranking = 2.9102820958316keywords = compression (Clic here for more details about this article) |
8/16. Intraspinal synovial cyst at the craniocervical junction.A cystic lesion adjacent to the dens with compression of the lower portion of the medulla oblongata was found on MRI in a 75-year-old male patient with a 2-month history of occipital pain and gait disturbance. Clinically, the patient showed mild tetraparesis, signs of spinal ataxia and symmetrical hyperreflexia. Following subtotal removal of the cyst via left-sided suboccipital craniotomy and left-sided hemilaminectomy of C1 the lesion was classified as synovial cyst on histopathological examination. Postoperatively, the quadriparesis almost completely subsided and the patient is currently doing well, 33 months after surgery. Synovial or ganglion cysts adjacent to the atlantoaxial articulation with ventral compression of the cervicomedullar cord represent rare surgical or radiological entities. Atlantoaxial synovial cysts have no typical radiographic appearance or specific neurological symptoms so that they are frequently misdiagnosed as intraspinal- or skull base tumour, rheumatoid lesion or ectatic vertebral artery. Since no ensuing complications or recurrences have been encountered in cases of incompletely removed cysts the less invasive operative approaches should be used to avoid destabilisation and subsequent additional surgical procedures.- - - - - - - - - - ranking = 5.8205641916633keywords = compression (Clic here for more details about this article) |
9/16. gait control in spinal palsy.Developmental motor impairment with lower limb spasticity most commonly corresponds to cerebral palsy of the spastic diplegia type. Here we describe a 4-year-old girl whose locomotor phenotype reflects early cortico-spinal lesion at the spinal level. This child has developmental spastic paraparesis secondary to D4-D8 cord compression. We analysed her gait using the ELITE optoelectronic system and compared it to that of six normal age-matched controls and six age-matched children with leucomalacic spastic diplegia. gait characteristics of the patient included preservation of head orientation and arm swing similar to findings in normal controls and contrasting with children with spastic diplegia. She also had truncal instability and displayed lack of selectivity in lower limb movement as in spastic diplegia and in contrast with normal controls. This may reflect differences in locomotor control between developmental spasticity of cerebral and spinal origin. The latter might correspond to spinal palsy defined as abnormal movement and posture secondary to non-progressive pathological processes affecting the immature spinal cord.- - - - - - - - - - ranking = 2.9102820958316keywords = compression (Clic here for more details about this article) |
10/16. Intraosseous malignant peripheral nerve sheath tumor (MPNST) of the thoracic spine: a rare cause of spinal cord compression.OBJECTIVE: To describe the management of a patient presenting with intraosseous MPNST of the thoracic spine causing cord compression. SUMMARY OF BACKGROUND DATA: Malignant peripheral nerve sheath tumors (MPNST) are uncommon tumors of cells of peripheral nerve sheath origin. MPNST typically present as an enlarging mass originating from a peripheral nerve root in the trunk, extremities, and head and neck region. methods.: A 59-year-old woman presented with midthoracic back pain, paraparesis, and a T4 sensory level. Magnetic resonance image scan revealed a large enhancing and destructive lesion at the T3 level with cord compression. RESULTS: Decompressive laminectomies, tumor debulking, and instrumentation was performed from a posterior approach. At surgery, the lesion was noted to originate from the T3 vertebral body, and separate from the dura and spinal nerve roots. Surgical excision was incomplete and the spine was stabilized with a Ti frame. MPNST was confirmed histologically. Despite adjuvant radiotherapy, she developed metastatic deposits in the spine and femur. CONCLUSIONS: Intraosseous MPNST causing spinal cord compression has not been described as yet and should be added to the differential diagnosis of primary bone tumors causing cord compression. prognosis with MPNST can be poor, especially in patients with large tumors, undergoing subtotal surgical resection and in association with neurofibromatosis.- - - - - - - - - - ranking = 23.282256766653keywords = compression (Clic here for more details about this article) |
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