1/53. sciatica caused by cervical and thoracic spinal cord compression.STUDY DESIGN: Two case reports of sciatica that was considered to be caused by cervical and thoracic spinal cord compression. OBJECTIVES: To point out that sciatica can be an initial major symptom in patients with cervical or thoracic spinal cord lesions. SUMMARY OF BACKGROUND DATA: Usually, tract pain caused by cord compression is considered to be diffuse and does not resemble sciatica. methods: Medical history, physical findings, and the results of imaging studies were reviewed in one case of cervical cord tumor and one case of thoracic kyphosis. RESULTS: In both cases, sciatica was the initial and major symptom. Imaging studies showed no lesion in the lumbar spine. In one patient, a cervical dumbbell tumor was found to compress the cervical cord, and in the other the spinal cord was severely compressed at the thoracic kyphosis. The sciatica disappeared immediately after decompression surgery in both cases. CONCLUSIONS: leg pain resembling sciatica can be caused by cord compression at the cervical and thoracic level. Thoracic kyphosis may be a causative factor in sciatica, in addition to spinal cord tumor and disc herniation, which have been reported previously.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/53. diagnosis of herniated intervertebral disc assisted by 3-dimensional, multiaxial, magnetic resonance imaging.Magnetic resonance (MR) imaging with multiaxial cross sections has been used to improve the resolution of small, fine, and slender spinal roots to more precisely diagnose herniated intervertebral disc (HIVD), especially in cases of far lateral disc (FLD) herniation. However, false-negative results remain a problem because of the unsatisfactory resolution of these methods. We report the use of a volume visualization technique to generate three-dimensional (3D) images from multiaxial sections. In our study, 10 patients with FLD herniation each underwent MR imaging (method 1), 3D MR image reconstruction with single-axis cross-sections (method 2), and 3D MR image reconstruction with multiaxial cross sections (method 3). Final diagnoses were confirmed at surgery. The preoperative diagnosis matched the operative findings in five patients using method 1, six patients using method 2, and nine patients using method 3. In addition, the software developed for this application includes functions which simulate decompression of the spinal cord and roots. Therefore, this computer-aided diagnosis system using multiaxial cross sections is a useful tool for diagnosing HIVD and for training medical residents and students. This technique has three main advantages over conventional imaging modalities: 1) resolution of small, fine, or slender anatomic structures, which reduces the possibility of false-positive and false-negative image findings; 2) segmentation (disarticulation) of images; and 3) simulation of surgery.- - - - - - - - - - ranking = 0.125keywords = compression (Clic here for more details about this article) |
3/53. sciatica in the community--not always disc herniation.Three cases of sciatica seen in general practice are described. The clinical features were consistent with pyriformis syndrome, a condition of compression of the sciatic nerve at the pelvic outlet. The literature on causes and clinical features is briefly reviewed. The prevalence of the condition in the community and the accuracy of clinical diagnosis are unknown. It is suggested that pelvic outlet syndrome, comparable to carpal tunnel syndrome, is a more appropriate name for the condition.- - - - - - - - - - ranking = 0.125keywords = compression (Clic here for more details about this article) |
4/53. Multiple peripheral nerve compressions related to malignantly transformed hereditary multiple exostoses.Autosomal dominantly transmitted hereditary multiple exostoses is an uncommon disorder consisting of multiple projections of bone capped by cartilage. The lesions are most numerous in the metaphyses of long bones but may appear on flat bones. Sarcomatous transformation occurs in 1-25% of patients. We report a 33-year-old man with sciatica, previously diagnosed as hereditary multiple exostoses, presenting with multiple peripheral nerve compressions. Electrodiagnostic studies showed profound axon-loss multiple neuropathies involving the sciatic, superior gluteal, and inferior gluteal nerves. magnetic resonance imaging of the left pelvis showed a large mass in the sacral area that was suggestive of a chondrosarcoma. An open intralesional excision biopsy confirmed chondrosarcoma transformed from chondromatosis. Excision of the lesion was effective in eliminating the impingement of nerves and retarding progressive osseous growth. We suggest that malignant transformation be suspected in cases with focal compression neuropathy of patients known to have multiple exostoses. osteochondroma as a possible cause for compression neuropathy is discussed.- - - - - - - - - - ranking = 0.875keywords = compression (Clic here for more details about this article) |
5/53. Acute cauda equina syndrome caused by a gas-containing prolapsed intervertebral disk.Gas production as a part of disk degeneration can occur, but it rarely causes clinical nerve compression syndromes. A rare case of gaseous degeneration in a prolapsed lumbar intervertebral disk causing acute cauda equina syndrome is described. Radiologic features and intraoperative findings are reported. A 78-year-old woman with severe lumbar canal stenosis had acute cauda equina syndrome. magnetic resonance imaging revealed a large disk protrusion, and she underwent an urgent operation for this. Surgery confirmed the severe lumbar canal stenosis, but the disk prolapse contained gas that had caused the nerve compression.- - - - - - - - - - ranking = 0.25keywords = compression (Clic here for more details about this article) |
6/53. An unusual cause of sciatic pain.We describe a 47-year-old woman with sciatic neuropathy caused by compression of the sacral plexus by posterior shift of the uterus.- - - - - - - - - - ranking = 0.125keywords = compression (Clic here for more details about this article) |
7/53. Rapid progression of acute sciatica to cauda equina syndrome.OBJECTIVE: To demonstrate the importance of clinical examination and continued vigilance for neurologic deterioration in patients with sciatica. cauda equina syndrome, a rare sequela of sciatica, is considered a medical emergency requiring surgical decompression. Clinical Features: A 32-year-old woman had sciatica that rapidly progressed to cauda equina syndrome. magnetic resonance imaging revealed the presence of a large nonsequestered disk fragment in the lower lumbar spine. Intervention and Outcome: The disk fragment was surgically excised. The patient experienced immediate pain relief after surgery but retained neurologic deficits. After 6 months of rehabilitation, neurologic integrity was restored, aside from patchy sensory loss of the left foot and buttocks. At the 6-month follow-up, the patient's sciatica had not returned. CONCLUSIONS: Most cases of sciatica, regardless of cause, will self-resolve; as a result, there might be a tendency to maintain a low index of suspicion for serious, progressive disorders such as cauda equina syndrome. patients need to be educated as to signs of this emergency condition and informed as to the possible consequences of delaying treatment. By maintaining a high index of suspicion for any case that fails to respond as expected to a course of conservative therapy or that demonstrates signs of cauda equina syndrome, chiropractors can assume a pivotal role by investigating and referring appropriately and by aiding in active rehabilitation postoperatively.- - - - - - - - - - ranking = 0.125keywords = compression (Clic here for more details about this article) |
8/53. Fibrous adhesive entrapment of lumbosacral nerve roots as a cause of sciatica.STUDY DESIGN: Report of seven patients with fibrous adhesive entrapment of lumbosacral nerve roots as a cause of sciatica, whose radiographic findings were negative and who experienced relief from sciatica immediately after the entrapment was released. OBJECTIVES: To describe a new clinical entity of fibrous adhesive entrapment of lumbosacral nerve roots with negative radiographic findings. SETTING: Orthopaedic department, japan. methods: Clinical evaluation and post-operative outcome in seven patients with entrapment of lumbosacral nerve roots because of fibrous adhesion confirmed intraoperatively. RESULTS: Radiographic examinations by magnetic resonance imaging (MRI), myelography, and computed tomographic (CT) myelography demonstrated neither disc herniations nor spinal stenosis in all seven patients, and differential nerve root block was effective for relieving sciatica and low back pain. We confirmed, intraoperatively, entrapment of the nerve root by fibrous adhesion, and all seven patients were relieved from sciatica and low back pain postoperatively. CONCLUSION: This study presented seven patients with sciatica caused by fibrous adhesive entrapment of lumbosacral nerve roots who underwent decompression and release of fibrous adhesion. Radiographic examinations, such as MRI, myelography and CT myelography, showed no compressive shadows and also differential nerve root block was effective for its diagnosis. This study seems to be the first report of patients with entrapment of lumbosacral nerve roots caused by fibrous adhesion, whose radiographic findings were negative.- - - - - - - - - - ranking = 0.125keywords = compression (Clic here for more details about this article) |
9/53. Juxtafacet cyst of the lumbar spine. Clinical, radiological and therapeutic aspects in 28 cases.OBJECT: A consecutive series of 28 "operated" juxtafacet cysts is reported. We emphasize the clinical and radiological aspects leading to diagnosis. We also discuss the results of the surgical treatment. MATERIAL AND methods: Medical information and radiological studies involving 28 patients were analyzed. Each patient has been operated on by decompressive laminectomy and resection of the cyst. The diagnosis was always confirmed by a pathological examination. The cyst most frequently occurred at the L4-L5 level (n = 18), and seldom at the L5-S1 (n - 6) or L3-L4 (n - 4) levels. RESULTS: The differential diagnosis from other pathological causes responsible for a radicular compression could not be done by physical examination. spine x-rays or myelogram were nonspecific. Computed tomography or CT-myelography could help in the diagnosis but MR imaging was the most sensitive. In our series, the respective sensitivities of these techniques are 56, 42 and 77%. The preoperative diagnosis was correct in 18 patients (64%). The cyst was sometimes adherent to the underlying dura, then significantly increasing the risk of dural tear and spinal fluid leak, especially when located at L3-L4 level. Surgical ablation lead to a complete recovery or an important improvement in 26 patients. CONCLUSIONS: The diagnosis of the juxtafacet cyst of the lumbar spine is better achieved by MRI. Surgery is the gold standard treatment, safe and long-term effective. When a total cyst removal with an internal facetectomy are performed, recurrence is exceptional.- - - - - - - - - - ranking = 0.125keywords = compression (Clic here for more details about this article) |
10/53. Myxomatous degeneration of the ligamentum flavum of the lumbar spine.STUDY DESIGN: Report of two cases of acute lumbar nerve root compression caused by myxomatous degeneration of the ligamentum flavum. OBJECTIVE: To report a rare cause of acute lumbar nerve root compression. SETTING: Orthopaedic department, Osaka, japan. SUMMARY OF BACKGROUND DATA: Two patients, both 50-year-old men presenting with signs and symptoms suggestive of acute lumbar nerve root compression were found to have a ligamentum flavum mass. The masses were removed and the patients regained normal function postoperatively. methods: To reveal the nature of the mass, histopathological studies were made. Continuous sections were prepared from the removed mass lesions. The sections were stained with hematoxylin and eosin, van Gieson's stain, azan stain, periodic acid Schiff reaction, alcian blue stain and von Kossa's stain. RESULTS: Histological examination revealed myxomatous degeneration of the ligamentum flavum. No elastic fibers were found at the degeneration site. Diffuse mucopolysaccharide deposition was found at the degeneration site, however, no cyst was found. collagen fibers were not increased. hypertrophy or ossification of the ligamentum flavum was not recognized in the sections. At a follow-up examination over 2 years later, the patients were free of symptoms and the findings of a neurological examination were normal. CONCLUSION: Two cases of myxomatous degeneration of the ligamentum flavum of the lumbar spine were reported, which have seldom been described as the cause of acute lumbar nerve root compression.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
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