1/32. The use of Gore-Tex membrane for adhesion prevention in tethered spinal cord surgery: technical case reports.OBJECTIVE: The incidence of retethering caused by postoperative adhesions at the repair site after initial tethered spinal cord surgery is not uncommon. To assess the effectiveness of a Gore-Tex membrane in preventing these adhesions, only clinical radiological and experimental animal evaluation has been reported. In this report, we describe two cases in which Gore-Tex membrane was implanted at the initial untethering surgery and in which we were able to confirm the real effectiveness of the Gore-Tex membrane during a second operation. methods: In the first patient, Gore-Tex membrane was used for dural repair in the untethering surgery of the split spinal cord malformation. Because of the suspicion of a thickened filum terminale, repeated surgery was indicated 10 months after the initial procedure. In the second patient, Gore-Tex membrane was implanted during the initial untethering surgery for a lipomyeloschisis and a dermal sinus. Because of a persistent fistula of the dermal sinus, a second operation was necessary 1 year after the first operation. RESULTS: During the repeated surgery, a thorough inspection of the implanted Gore-Tex membrane revealed no adhesions between the Gore-Tex membrane and the intradural content in both cases. CONCLUSION: We support the use of Gore-Tex membrane in the prevention of postoperative dural adhesions in the repair of spinal dysraphism.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/32. 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 = 3.1716302280813keywords = lamina (Clic here for more details about this article) |
3/32. Anterior sacral meningocele completely occupied by an epidermoid tumor.A 2-year-old girl presented with an anterior sacral meningocele completely occupied by an epidermoid tumor. Preoperative magnetic resonance imaging had shown the meningocele with contents of the same intensity as cerebrospinal fluid. Surgery via a posterior sacral approach disclosed the tumor beneath an unexpected membrane inside the meningocele. Additionally, the presence of pus inside epidermoid tumor suggested that possible episodes of asymptomatic meningitis or other infection might have occurred before treatment, these being the major complication in anterior sacral meningocele. Therefore, we recommend that surgical treatment should be performed at the earliest possible stage in childhood, once the diagnosis is established, and dural plasty carried out to prevent infectious complications.- - - - - - - - - - ranking = 0.083333333333333keywords = membrane (Clic here for more details about this article) |
4/32. Spontaneous spinal cord herniation: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Spontaneous herniation of the spinal cord substance through a previously uninjured and/or untouched dura is a very exceptional occurrence. Spontaneous spinal cord herniation, which was first reported 25 years ago, is a cause of myelopathy that is treatable but difficult to diagnose. CLINICAL PRESENTATION: A 49-year-old female patient who presented with a 3-year history of a burning sensation and hyperesthesia in her right leg and a 3-month history of left leg stiffness was diagnosed as exhibiting signs of Brown-Sequard syndrome. magnetic resonance imaging of the thoracic spinal canal demonstrated S-shaped anterior kinking and transdural herniation of the spinal cord at the T3-T4 levels. INTERVENTION: The patient underwent surgery via a three-level laminectomy. The herniated part of the spinal cord was microsurgically reduced, and the dural defect was repaired with Gore-Tex membrane (WL Gore & Associates, Flagstaff, AZ). The outcome of surgery was excellent. CONCLUSION: review of the world literature revealed 29 reported cases, with 27 of these cases being published since 1990. The clinical features, radiological diagnosis, and treatment options for this unique entity are summarized, with a synopsis of numerous misconceptions that appeared in the literature. With more familiarity with and increased awareness of this entity, more cases will be diagnosed.- - - - - - - - - - ranking = 0.083333333333333keywords = membrane (Clic here for more details about this article) |
5/32. Neural hearing loss in a child with poliomyelitis: a histopathological study.The temporal bones of a 26-month-old white female with a paralytic syndrome clinically and pathologically identical to poliomyelitis were examined. The aetiological agent was unknown although a non-poliomyelitis enterovirus infection seemed likely. There was a complete absence of the cochlear neurons and substantially reduced peripheral and central axons with loss of some inner hair cells but preservation of outer hair cells. Scarpa's ganglion, and the geniculate ganglion were partially atrophied. The saccule and utricle were mildly dilated and Reissner's membrane of the apical turn was bulging. In two previous audiological studies a 10--20 dB bilateral sensorineural hearing loss was found in poliomyelitis patients and a neuronal lesion was postulated which is now supported by our findings. This is a rare example of an almost pure neural hearing loss.- - - - - - - - - - ranking = 0.083333333333333keywords = membrane (Clic here for more details about this article) |
6/32. Spinal toxoplasmic arachnoiditis associated with osteoid formation: a rare presentation of toxoplasmosis.STUDY DESIGN: An extremely rare presentation of an isolated spinal toxoplasmic arachnoiditis is described. OBJECTIVE: To draw attention to the fact that spinal arachnoid membranes may be a potential reservoir for toxoplasma gondii. SUMMARY OF BACKGROUND DATA: central nervous system toxoplasmosis is a common manifestation in patients who are immunodeficient. Reports on the spinal toxoplasmosis are rare and focused on spinal cord involvement. methods: An adult patient presented with symptoms of spastic paraparesis that had begun 13 years before admission. Thoracic spinal magnetic resonance imaging showed small lesions in posterior subarachnoid space at Th7-Th8. A Th7-Th8 laminectomy was performed. Intradural-extramedullary lesions were excised. RESULTS: Clinical, immunologic, and pathologic examinations showed adhesive spinal arachnoiditis associated with osteoid formation caused by past toxoplasmic infection. There was no impairment of the immunologic defense system. CONCLUSION: Where no causative factor is found in serious spinal adhesive arachnoiditis, the possibility of spinal toxoplasmosis should also be investigated.- - - - - - - - - - ranking = 0.083333333333333keywords = membrane (Clic here for more details about this article) |
7/32. Myelopathy caused by ossification of ligamentum flavum.STUDY DESIGN: Retrospective study of seven cases of ossification of ligamentum flavum from two urban hospitals in a Chinese population. OBJECTIVES: To inspect the epidemiology, clinical presentation, pathology, and treatment outcome in these Chinese patients with ossification of ligamentum flavum. SUMMARY OF BACKGROUND DATA: Ossification of ligamentum flavum involving the lower thoracic region is relatively common in the Japanese population. It is usually presented with myelopathy of progressive nature. MATERIALS AND methods: Five patients were male and two were female. The mean age was 52 years (range 41-73 years). diagnosis was made by CT scan, MRI, and subsequent histology. Six patients have been treated by laminectomy and one by laminoplasty. The average follow-up duration is 34 months (range 26-44 months). The outcome is evaluated by Japanese Orthopaedics association (JOA) score. RESULTS: The average time of presentation from the onset of symptoms was 9 months (range 3-12 months). Most of the patients presented with lower limb numbness and gait disturbance. One case was presented after a minor trauma. Mean JOA score was 4.8 (range 2-7, of 11). The lower thoracic level was the most frequently involved region. One case was associated with ossification of the posterior longitudinal ligament. Two patients had transient postoperative neurologic deterioration, which improved subsequently. Mean percentage of recovery after surgery in terms of JOA score is 65% (25-100%), with a mean final JOA score of 7.8. CONCLUSION: Ossification of ligamentum flavum is an uncommon cause of myelopathy in the Chinese population. It can present acutely after minor trauma. Posterior decompression, especially with en bloc dissection of laminae, gives satisfactory results.- - - - - - - - - - ranking = 3.1716302280813keywords = lamina (Clic here for more details about this article) |
8/32. A case of nontraumatic spinal epidural hematoma caused by extradural varix: consideration of etiology.BACKGROUND CONTEXT: Many cases of nontraumatic spinal epidural hematoma (SEH) have been reported, although the etiology of SEH remains unclear. PURPOSE: Our purpose was to report a rare case of nontraumatic acute SEH caused by extradural varices and to discuss the etiology of this entity. STUDY DESIGN/SETTING: Case report. PATIENT SAMPLE: A 27-year-old man. OUTCOME MEASURES: Resolution of the patient's paraplegia, and pathological examination of the epidural vein of the patient and three other patients with cervical spondylosis. methods: Not applicable. RESULTS: The patient recovered from paresis of both hands, although paraplegia remains complete. Pathological examination of the patient revealed abnormal veins that had thickened walls, varying caliber, and internal elastic lamina. In two of the three patients with cervical spondylosis, abnormally dilated veins resembling those in the SEH patient were observed. CONCLUSIONS: We describe a rare case of SEH caused by extradural varices. It is speculated that spinal epidural veins can possibly develop an abnormal structure and fragility as seen in the present case and in spondylotic cases.- - - - - - - - - - ranking = 3.1716302280813keywords = lamina (Clic here for more details about this article) |
9/32. Cervical peridural calcification in patients undergoing long-term hemodialysis. Report of two cases.The authors report on two patients undergoing long-term hemodialysis in whom cervical myelopathy was caused by calcification related to the cervical dural sac. The lesions were demonstrated on plain computerized tomography (CT) scans as dotted curvilinear bands outlining the dural sacs in almost the whole of their cervical spines. During posterior decompressive surgery in both cases, the CT scanning--documented curvilinear bands were identified as calcified plaques infiltrating the fibrous membranes beneath the ligamenta flava, constricting the cervical dural tube. In each case, the spinal cord could not be decompressed by merely enlarging the osseous spinal canal; rather, it required removal of the calcified membrane from the posterior surface of the dura. Based on the operative findings, the lesion should be described as cervical peridural calcification.- - - - - - - - - - ranking = 0.16666666666667keywords = membrane (Clic here for more details about this article) |
10/32. A cervical myelopathy due to invaginated laminae of the axis into the spinal canal.STUDY DESIGN: A case report and review of previous literature are presented. OBJECTIVE: The objective of this manuscript was to report a case of cervical myelopathy due to anomalous laminae of the axis in a patient with spina bifida. SUMMARY OF BACKGROUND DATA: In previous studies, few cases of invaginated anomalous laminae of the axis have been reported. Treatment was surgical removal of the invaginated laminae. methods: The patient's history, clinical examination, imaging findings, and treatment were reported. RESULTS: Characteristic findings were revealed from imaging studies, a multiplane reconstruction of the CT images, and a stereolithographic model of the cervical spine. The patient was treated with a posterior decompressive operation. The outcome was satisfactory, with an improvement in the patient's neurology. CONCLUSIONS: This is a report of a rare characteristic anomaly of the laminae of the axis. A multiplane reconstruction of the CT images and a stereolithographic model were useful for treatment of this case. Possible causes of this anomaly may be the failure of ossification or fusion of the embryological term.- - - - - - - - - - ranking = 25.37304182465keywords = lamina (Clic here for more details about this article) |
| | Next -> |