1/64. Complete reduction of retro-odontoid soft tissue mass in os odontoideum following the posterior C1-C2 tranarticular screw fixation.STUDY DESIGN: A case report of os odontoideum with retro-odontoid soft tissue hypertrophy treated by the transarticular screw fixation. OBJECTIVES: To present a case of os odontoideum that showed complete reduction of retro-odontoid soft tissue mass caused by atlantoaxial subluxation after the C1-C2 transarticular screw fixation. SUMMARY OF BACKGROUND DATA: hypertrophy of the periodontoid soft tissue has been reported to be associated with chronic atlantoaxial subluxation and progressive myelopathy. While the rheumatoid pannus has been reported to become reduced of disappear after fixation of the unstable segment, the reduction of the hypertrophied soft tissue mass has never been reported in atlantoaxial subluxation of nonrheumatoid origin, especially in the case of os odontoideum. methods: Posterior C1-C2 transarticular screw fixation was performed in a patient with os odontoideum, who showed signs of progressive myelopathy by the compression of retro-odontoid soft tissue mass and atlantoaxial subluxation. RESULTS: The fixation of atlantoaxial subluxation achieved not only the complete reduction of the retro-odontoid soft tissue mass, but also clinical improvement of the myelopathy. CONCLUSIONS: Posterior atlantoaxial fixation is worth trying in slow progressing myelopathy by the compression of hypertrophy of the soft tissue even in nonrheumatoid atlantoaxial subluxation, thereby obviating the need for direct removal of the mass via the transoral route.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/64. Transcatheter renal arterial embolization therapy on a patient with polycystic kidney disease on hemodialysis.We report a patient with autosomal dominant polycystic kidney disease (ADPKD) undergoing long-term hemodialysis who underwent transcatheter arterial embolization (TAE) of the renal arteries to shrink enlarged kidneys. In 1983, the patient started hemodialysis because of chronic renal failure secondary to ADPKD. However, renal size continued to increase. In January 1997, he was admitted to our hospital with abdominal distension and anorexia, in addition to progression of anemia. Upper gastroendoscopy showed an esophageal ulcer and severe external compression of the stomach. Renal angiography using the Seldinger technique showed stretched and deformed segmental renal arteries with massive enlargement of the kidneys. TAE with stainless steel coils was performed on both renal arteries. With a rapid and progressive decrease in kidney size, anorexia and anemia were improved, and the gastrointestinal compression was eliminated. In some patients with ADPKD, renal size continues to increase even after the initiation of dialysis. In about 10 years, patients develop gastrointestinal complications, such as dysphagia, ileus, severe constipation, and intestinal perforation. Surgical procedures such as nephrectomy are not satisfactory. This report shows that TAE is a safe and effective therapy for patients with ADPKD with massively enlarged kidneys.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
3/64. Idiopathic hypertrophic cranial pachymeningitis: clinicoradiological spectrum and therapeutic options.OBJECTIVE: Idiopathic hypertrophic cranial pachymeningitis is a rare disease, of undetermined pathogenesis, that is characterized by inflammation and fibrosis of the dura mater. methods: We encountered six patients with idiopathic hypertrophic cranial pachymeningitis and analyzed their clinical presentations, radiological findings, and treatment. RESULTS: In the six patients, the main manifestations were cranial nerve palsies and headache. Three associations were present, namely optic neuropathy, tolosa-hunt syndrome, and diabetes insipidus. gadolinium-enhanced magnetic resonance imaging was diagnostic, showing intense dural enhancement in a linear or nodular pattern. The responses to corticosteroid therapy were better for patients who exhibited linear, rather than nodular, dural enhancement. For one patient, surgical decompression of the superior orbital fissure provided lasting relief. The course of the disease followed one of three patterns, i.e., sustained remission, relapse with corticosteroid independence, or relapse with corticosteroid dependence. pulse corticosteroid therapy provided significant relief, while reducing the daily corticosteroid requirement and avoiding side effects, for a corticosteroid-dependent relapsing patient. CONCLUSION: Idiopathic hypertrophic cranial pachymeningitis exhibits varied clinical courses. It is important to prevent irreversible cranial neuropathy during the active phase of the disease, using daily administration of corticosteroids, pulse corticosteroid therapy, or surgical decompression.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
4/64. Hypertrophic dens resulting in cervical myelopathy: histologic features of the hypertrophic dens.STUDY DESIGN: A case report of a 43-year-old woman who had hypertrophic dens in the developmentally narrow atlas ring that resulted in cervical myelopathy. OBJECTIVES: To present histologic findings of the hypertrophic dens, which was excised en block the transoral approach, and to discuss the pathogenesis of the hypertrophic change of the dens. SUMMARY OF BACKGROUND DATA: Few cases have been reported of cervical myelopathy associated with hypertrophic dens, and there have been no previous reports describing the histologic features of hypertrophic dens. methods: Clinical data were reviewed from the patient's chart, and histologic features of the hypertrophic dens were examined in the sagittally cut section. RESULTS: After posterior decompression surgery, cervical myelopathy in the patient subsided. Myelopathy reappeared 4 years after surgery. Imaging studies showed osteoarthritis of the atlantodental joint, hypertrophic dens, and degeneration of the cruciate ligament. In the second surgery, transoral removal of the dens with posterior occipitocervical fusion was performed. Histologic studies showed thickening of the cortical bone of the anterior and cranial parts of the dens. The apical portion, which was the insertion portion of the ala ligaments, showed degenerative changes of tide marks. CONCLUSION: Atlantoaxial instability and enthesopathy were probably the causes of the hypertrophic changes of the dens in this case.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
5/64. hypertrophy of the posterior longitudinal ligament is a prodromal condition to ossification: a cervical myelopathy case report.STUDY DESIGN: A histopathologic examination of a specimen that showed hypertrophy of the posterior longitudinal ligament of the cervical spine. OBJECTIVES: To illustrate the possibility of hypertrophy of the posterior longitudinal ligament as a prodromal condition to ossification of the posterior longitudinal ligament. SUMMARY OF BACKGROUND DATA: Despite much study, the pathology of ossification of the posterior longitudinal ligament still remains unclear. Hypertrophic change often is seen in the part of the ossified ligament; however, there have been few histopathologic reports on hypertrophy of the posterior longitudinal ligament. Some reports have suggested that hypertrophy of the posterior longitudinal ligament is a prodrome of ossification of the posterior longitudinal ligament. methods: A 64-year-old man was admitted to the hospital because of gait disturbance and developed oliguria. In a plain radiograph, segmental ossification of the posterior longitudinal ligament was found at C4, C5, and C6. Computed tomograph myelogram revealed a soft tissue shadow, maximum 3.8 mm in diameter, on the dorsal side of the ossification of the posterior longitudinal ligament at C5 and C6. Magnetic resonance T1-weighted image (T1WI) showed an equivalent signal with the intervertebral disc on the dorsal side of ossification of the posterior longitudinal ligament. This lesion was enhanced with Gd-DTPA and confirmed as hypertrophy of the posterior longitudinal ligament. Cervical anterior decompression and fusion were performed using Yamaura's technique. The ossified and thickened lesion was elevated and removed en bloc. Then, hematoxylin-eosin and toluidine blue staining was performed to detect metachromasia. RESULTS: Macroscopic examination of the specimen revealed that soft tissue formation was connected with the C4-C5 intervertebral space and extended downward to C6-C7. Histopatholgically, collagen fibers were proliferating in the long-axis direction on both ventral and dorsal sides. This was surrounded by extended nucleus pulposus-like chondrocyte tissue, where endplate cartilage was detected around the C4 pedicle. Roux staining was low, and partial vascular and cellular infiltration was observed, although it was not marked. CONCLUSION: The herniated nucleus pulposus involving endplate cartilage from C4-C5 was limited to the superficial layer, and proliferation of nucleus pulposus-like chondrocytes occurred in the herniated tissue, where they might undergo a change in cell phenotype. The results of the present study support the hypothesis that hypertrophy of the posterior longitudinal ligament is a prodromal condition to ossification of the posterior longitudinal ligament.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
6/64. Hypertrophic non-union of the first rib causing thoracic outlet syndrome: a case report.We experienced a rare case of thoracic outlet syndrome caused by hypertrophic nonunion of the first rib. A diagnosis was made mainly upon provocative tests and imaging studies. Pain and tingling could be reproduced and the radial pulse obliterated by the hyperabduction test. Abundant callus formation on the posterior aspect of the first rib with fracture line was visible on plain radiograph. Two-dimensional computed tomography showed right thoracic outlet narrowing mainly caused by the mass-effect of the callus. Dynamic arteriographic studies revealed an external compression of the right subclavian artery and duplex ultrasonography demonstrated a reduction in right subclavian artery blood flow when the shoulder is in 90 degrees of abduction. Surgery was performed after the conservative management for three months which failed to relieve the patient of his complaints. Resection of the first rib via transaxillary approach was undergone uneventfully in combination with the myotomy of the scalenus anticus muscle. At postoperative one year follow up, the patient was free of symptoms, and had a full range of motion of the right shoulder with no evidence of arterial insufficiency.- - - - - - - - - - ranking = 0.51123698293427keywords = compression, fracture (Clic here for more details about this article) |
7/64. Lumbar canal stenosis caused by hypertrophy of the posterior longitudinal ligament: case report.STUDY DESIGN: This is a case report of a patient with hypertrophy of the posterior longitudinal ligament (HPLL) in the lumbar spine, with assessment of operative treatment and a 10-year follow-up using magnetic resonance imaging. OBJECTIVES: To report on the long-term outcome of a case of lumbar HPLL, to review the literature on case reports of HPLL, and to outline the pathology of HPLL in the lumbar spine. SUMMARY OF BACKGROUND DATA: There have been several reports of HPLL in the cervical spine and thoracic spine. However, the authors found no reports of this condition in the lumbar spine and no reports of long-term follow-up. Two types of pathology are associated with HPLL: primary hypertrophy of the ligament and secondary hypertrophy associated with intervertebral disc herniation. methods: A 10-year follow-up evaluation of a 56-year-old man with HPLL at L2 is reported. The patient was observed using serial physical examinations, radiographs, and MRIs over 10 years. Because he did not respond to conservative management, surgical treatment was applied. After complete decompression by hemilaminectomy and resection of hypertrophied ligament, the nerve roots were freed of constriction through the neural foramens at L2 and L3. RESULTS: One year after the operation the patient was asymptomatic without evidence of recurrence of the disease. CONCLUSIONS: HPLL is a very rare disease. This appears to be the first report of the disease in the lumbar spine.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
8/64. Myelopathy due to scoliosis with vertebral hypertrophy in klippel-trenaunay-weber syndrome.We describe a 37-year-old man complaining of right back pain and gait disturbance. He had a big soft tumor on his right back, hemihypertrophy of the right lower extremity, and right thoracic scoliosis. We diagnosed klippel-trenaunay-weber syndrome based on the pathological findings of the soft tumor. Computed tomography (CT) scan revealed severe spinal stenosis due to a hypertrophic vertebral body and facet joint at T7. Treatment by decompression of hypertrophic bone led to complete neurological recovery. To our knowledge, no case has been reported of klippel-trenaunay-weber syndrome with myelopathy which originated from thoracic scoliosis with a hypertrophic facet joint and vertebral body. We suggest that the cause of myelopathy in klippel-trenaunay-weber syndrome originated not only from arteriovenous fistula, medullary angioma, and extradural hemangioma but also vertebral hypertrophy with scoliosis.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
9/64. Intramedullary fibular allograft and nail for treatment of femoral shaft nonunion.We present a difficult case of hypertrophic nonunion associated with a large cavity in the lower third of the femur. The cavity had been created by a windshield-wiper effect after failure of fixation with a Schneider intramedullary rod in a patient weighing 450 pounds. Treatment consisted of exchanging the Schneider nail with a larger-diame-ter interlocking nail and using the intramedullary fibular allograft to fill the cavity. The fracture healed 4 months after the procedure. At 5-year follow-up, the patient had no complaint, and plain radiographs showed obliteration of the large cavity in the distal femur. Intramedullary fibular graft technique can be used as an adjunct to use of an intramedullary nail when the distal femur contains a large cavity or when the intramedullary rod does not provide adequate fixation stability.- - - - - - - - - - ranking = 0.011236982934269keywords = fracture (Clic here for more details about this article) |
10/64. Treatment of rigid hypertrophic posttraumatic pseudarthrosis of the tibia in children using distraction osteogenesis.Posttraumatic tibial pseudarthrosis is a relatively uncommon complication of tibia fractures in children. Although reported as a successful method of treating tibial nonunions in adults, distraction osteogenesis through a nonunion site via ring external fixation has not been described in children. The authors report three consecutive cases of distraction through an angulated, shortened, hypertrophic, posttraumatic nonunion to achieve successful union and concurrent correction of deformity. Distraction was carried out using a ring fixator with computer-guided correction. Union was achieved in each of the three patients with complete correction of deformity and length. Lengthening of 8 to 31 mm was achieved. The length of time in the external fixator ranged from 7 to 27 weeks. Pin tract infections developed in all patients; they were treated successfully using oral antibiotics. No deep infections or other significant complications developed. Each patient was followed up for at least 1 year.- - - - - - - - - - ranking = 0.011236982934269keywords = fracture (Clic here for more details about this article) |
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