1/5. Ventral transdural herniation of the thoracic spinal cord: surgical treatment in four cases and review of literature.BACKGROUND: A specific cause of progressive brown-sequard syndrome has been identified: a ventral herniation of the thoracic spinal cord through the dural sleeve on one side. METHOD: Four female patients who were affected by a progressive Brown Sequard syndrome related to a transdural spinal cord herniation have been investigated and were submitted to surgery and postoperative evaluation. FINDINGS: The MRI scan showed atrophy and forward displacement of the spinal cord on one side and adhesion of the spinal cord to the dura mater. CT myelography demonstrated the disappearance of the premedullar rim at the level of the herniation and the shadow of the extradural herniation. Surgical treatment consisted in the excision of the arachnoid cyst when there was one, section of the dentate ligament, release of the adhesions, detachment of the spinal cord from the hernial orifice, and lastly suture of the dural tear or placement by a patch. Follow-up examination showed motor improvement with persistent sensory deficit in two cases and stabilisation in two cases. INTERPRETATION: The cause of the dural tear, either traumatic or congenital could not be confirmed in the four cases. Symptoms probably occur when herniation fills the orifice and strangulation happens which explains the late appearance and progressive evolution of this myelopathy. Mobilisation of the herniated spinal cord back into the intradural space can be achieved by surgery and may stop the evolution of the symptoms and signs.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/5. Post-colposuspension syndrome following a tension-free vaginal tape procedure.A 51-year-old nurse underwent an uneventful TVT procedure. Two weeks postoperatively she developed intractable suprapubic pain directly over the iliopectineal ligaments consistent with a "post-colposuspension syndrome". This failed to respond to conservative therapy and she subsequently underwent exploration of the retropubic space. The TVT sling was found to be densely adherent to the iliopectineal ligaments, from which it was dissected free and then divided, leaving the part where it passes through the endopelvic fascia intact. The pain resolved immediately and the woman remained continent. This diagnosis should be considered in a woman presenting with groin pain following a sling procedure.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
3/5. pudendal nerve entrapment as source of intractable perineal pain.Perineal pain caused by pudendal nerve entrapment is a rarely reported entity, with only a handful of cases in the modern literature. A 25-yr-old male medical student had refractory unilateral orchialgia for 32 mo and concomitant proctalgia for 14 mo. pain was positional in nature, exacerbated by sitting and partially relieved when standing or recumbent. pudendal nerve entrapment was diagnosed clinically, with computed tomography-guided nerve blocks providing temporary relief. A prolonged left pudendal nerve distal motor latency on electrodiagnostic testing later confirmed the diagnosis. At surgery, the left pudendal nerve was found flattened in the pudendal canal of Alcock and in contact with the sharp inferior border of the sacrospinous ligament. After surgical decompression and rehabilitation, the patient experienced significant relief of pain and returned to medical school. This case suggests pudendal nerve entrapment should be considered in the differential diagnosis of chronic urogenital or anorectal pain, particularly if the pain is aggravated by sitting or if there is a history of bicycle riding.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
4/5. evoked potentials from the motor tracts in humans.spinal cord monitoring during operation is of increasing importance in the prevention of injury. However, there is no direct monitor of the motor tracts available. We have reported a system using direct stimulation of the area overlying the motor tract between the intermediolateral sulcus and the dentate ligament in cats. This produces a 100-m/second signal with later components, which is abolished by section of the motor area, but not by section of the dorsal columns or the anterior quadrant of the spinal cord. Such stimulation also produces motor movement when the correct frequency is used. We now report the first application of this technique in humans, in whom we found the same 100-m/second signal, as well as slower components. We were able to elicit distal limb motor movement with stimulation of the motor tract area, but not with stimulation of the dorsal column area. This technique can be used either in open surgical cases or percutaneously and should provide an additional valuable technique for assessing spinal cord function.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
5/5. Nonconstrained total elbow arthroplasty.Thirty capitellocondylar unhinged implant arthroplasties were performed on 27 patients during the period from October 1976 through June 1981. The average patient age was 59.4 years, with a preoperative diagnosis of rheumatoid arthritis in 28 elbows and osteoarthritis in two elbows. Follow-up periods averaged 39.9 months (range, 10-62 months). The indication for elbow arthroplasty were intractable pain, joint instability, failed synovectomy, or bilateral limitation of motion. Ranged of motion evaluations showed moderate increases in flexion, pronation and supination after operation, although there was no significant improvement in extension. Ewald functional evaluation scores improved significantly from the mean of eight points prior to operation to the postoperative mean of 85 points. The significant complications occurring were deep wound infections, necessitating removal of the prosthesis (6.6%), and subluxation (13.2%), which responded to conservative treatment by long-arm casting. One patient required reconstruction of the medial collateral ligament for subluxation. ulnar nerve paresthesia developed in 10% of the patients. One patient required neurolysis and transposition of the nerve for relief of symptoms. The posterolateral approach was adopted to reduce the incidence of ulnar nerve complications.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |