1/219. Wasting of the small hand muscles in upper and mid-cervical cord lesions.Four patients are described with destructive rheumatoid arthritis of the cervical spine and neurogenic wasting of forearm and hand muscles. The pathological connection is not immediately obvious, but a relationship between these two observations is described here with clinical, radiological, electrophysiological and necropsy findings. Compression of the anterior spinal artery at upper and mid-cervical levels is demonstrated to be the likely cause of changes lower in the spinal cord. These are shown to be due to the resulting ischaemia of the anterior part of the lower cervical spinal cord, with degeneration of the neurones innervating the forearm and hand muscles. These findings favour external compression of the anterior spinal artery leading to ischaemia in a watershed area as the likeliest explanation for this otherwise inappropriate and bizarre phenomenon.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/219. Myelopathy secondary to spinal epidural abscess: case reports and a review.Spinal epidural abscess (SEA) is a rare disease with an unknown incidence rate. This paper will illustrate that early diagnosis and rehabilitation may result in improved outcomes for patients with neck or back pain presenting with neurological deficits. Three cases of SEA in individuals without the commonly acknowledged risk factors of intravenous drug abuse (IVDA), invasive procedures, or immunosuppression were seen at our institution during a 10-month period between October 1995 and July 1996. The patients presented with neck or thoracic back pain and progressive neurological deficits without a febrile illness. Predisposing factors were thought to be urinary tract infection with underlying untreated diabetes mellitus in the first case, a history of recurrent skin infection in the second, and alcoholism without a definite source of infection in the third. leukocytosis, elevated sedimentation rate, and confirmatory findings reported on magnetic resonance imaging (MRI) led to the diagnosis of SEA in all three cases. Immediate surgical drainage and decompression followed by proper antibiotic treatment and early aggressive rehabilitation led to good functional outcomes. All the individuals became independent in activities of daily living, wheelchair mobility, and bowel and bladder management. Two eventually became ambulatory.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
3/219. A clinico-pathological study of cervical myelopathy in rheumatoid arthritis: post-mortem analysis of two cases.Two patients who developed cervical myelopathy secondary to rheumatoid arthritis were analyzed post mortem. One patient had anterior atlanto-axial subluxation (AAS) combined with subaxial subluxation (SS), and the other had vertical subluxation (VS) combined with SS. In the patient with AAS, the posterior aspect of the spinal cord demonstrated severe constriction at the C2 segment, which arose from dynamic osseous compression by the C1 posterior arch. A histological cross-section of the spinal cord at the segment was characterized by distinct necrosis in the posterior white columns and the gray matter. In the patient with VS, the upper cervical cord and medulla oblongata showed angulation over the invaginated odontoid process, whereas no significant pathological changes were observed. At the level of SS, the spinal cord was pinched and compressed between the upper corner of the vertebral body and the lower edge of the lamina. Histologically, demyelination and gliosis were observed in the posterior and lateral white columns.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
4/219. Ankylosing spondylitis and multiple sclerosis.Ankylosing spondylitis can be associated with extra-articular involvement. Besides internal and ocular complications, neurological manifestations such as single root lesions, compression of the myelum or the cauda equina syndrome have also been described. We present a patient with ankylosing spondylitis who developed a monophasic myelopathy resembling multiple sclerosis. literature data show no conclusive evidence for an increased association of ankylosing spondylitis and multiple sclerosis. However, a monophasic myelopathy may be a separate neurological manifestation associated with ankylosing spondylitis.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
5/219. Respiratory sinus arrhythmia of brainstem lesions.In this pilot study we investigated the hypothesis that intrinsic and extrinsic brainstem lesions situated within the pontomedullary region would effect the integrity of respiratory sinus arrhythmia. The study sample consisted of three patients with anatomic brainstem abnormalities associated with isolated Chiari I malformation, Chiari II malformation with syringobulbia, and achondroplasia with cervicomedullary compression. They were compared to an age- and sex-matched control group of nine patients. Each subject's electrocardiogram was recorded in a quiet room and digitized by a personal computer during five 1-minute periods. R-R intervals within each 1-minute period were converted to heart rate in 120 successive 0.5-second intervals. The resultant heartrate time series was converted to its underlying frequency composition by a fast Fourier transform and averaged across minutes. Respiratory sinus arrhythmia was defined as the variability in the time series over a frequency range (0.096 to 0.48 Hz) corresponding to a range of respiratory rates from 6 to 30 breaths per minute. Analysis revealed a significant reduction in respiratory sinus arrhythmia (P < .05), defined as the summated area under the curve, with a mean for controls of 35.42 /-28.13 SD and for subjects of 17.20 /-11.50 SD. There was a gradient of abnormality noted, with the mildest deviation in respiratory sinus arrhythmia for the patient with isolated Chiari I malformation and maximum deviation seen in the patient with extrinsic cervicomedullary compression.- - - - - - - - - - ranking = 2keywords = compression (Clic here for more details about this article) |
6/219. Symptomatic sacral extradural arachnoid cyst associated with lumbar intradural arachnoid cyst.A case of sacral extradural arachnoid cyst associated with lumbar intradural arachnoid cyst in a 35-year-old male is reported. The patient presented with a history of severe sacrococcygeal pain, constipation, and dysuria for several months. Computed tomographic (CT) myelograms and magnetic resonance imaging (MRI) scans showed a huge sacral cyst without neural components. A favorable outcome could be achieved by decompression of the cyst, obliteration of the fistulous channel between the cyst and the thecal sac, and fenestration of the arachnoid cyst into the subarachnoid space. The relevant literatures are also reviewed.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
7/219. Epidural blood patch under fluoroscopic control: non-surgical treatment of lumbar cerebrospinal fluid fistula following implantation of an intrathecal pump system.The treatment of lumbar cerebrospinal fluid fistula in the presence of an intrathecal catheter is known to be difficult. Open revision surgery is recommended in the literature, although the rate of recurrence is high. The epidural blood patch technique is well established as a successful treatment for post-dural-puncture headaches. Recent work about the distribution of the injected blood and theoretical considerations about the mechanism of action make this method suitable for the occlusion of spinal leakage even in the presence of an intrathecal catheter. In this note technical details are given for a successful therapy of lumbar cerebrospinal fluid fistula including the right positioning of the opening of the needle (cerebrospinal fluid can be expected intrathecally and epidurally) by injection of contrast medium first for myelography then for epidurography. In this procedure the (epidural) distribution of autologous blood can be indirectly controlled by compression of the dural sac. The method is easy to perform, and the possible risks are small.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
8/219. 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 = 2keywords = compression (Clic here for more details about this article) |
9/219. Spinal lesions, paraplegia and the surgeon.Thirty-six patients with spinal cord lesions and varying degrees of paraplegia were seen by the surgical team at the Angau Memorial Hospital, Lae, over a thirty month period. Because the continued presence of a spinal lesion may lead to progressive cord destruction and ischaemic myelopathy, prompt treatment is advocated. The depressing results that have followed treatment of fracture dislocations of the cervical spine and secondary neoplasm with paraplegia is recorded and some suggestions are made that may improve the outlook in future cases. Early and major surgery is advocated in the treatment of spinal abscesses, tumours, Pott's paraplegia and unstable fracture dislocations of the lumbar spine.- - - - - - - - - - ranking = 0.032903513050655keywords = fracture (Clic here for more details about this article) |
10/219. Extended extradural spinal arachnoid cyst: an unusual cause of progressive spastic paraparesis.A 15-year old girl presented with a slowly progressive spastic paraparesis since the age of 12. creatine kinase was slightly increased. Muscle biopsy carried out during tendon surgery for severe toe-walking showed 'myopathic' changes. Subsequent neurological evaluation and radiological studies revealed a large extradural arachnoid cyst extending from the 11th thoracic vertebra to the first lumbar vertebra. Her condition improved after operation. The 'myopathic' features turned out to be the result of chronic spinal compression. MRI is the method of choice to examine patients with non-hereditary progressive spastic paraparesis. Muscle biopsy and tendon surgery should not be performed, without careful neurological examination.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
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