1/60. 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) |
2/60. 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) |
3/60. Myelopathy due to calcification of the cervical ligamenta flava: a report of two cases in West Indian patients.Two cases of cervical myelopathy due to calcification of the ligamenta flava (CLF) are described for the first time in black patients from the French west indies. A pre-operative CT scan differentiated the diagnosis from one of ossification of the ligamenta flava. Microanalysis on the operatively excised specimen in one patient revealed a mixture of calcium pyrophosphate dihydrate crystals and hydroxypatite crystals. Poor outcome in one patient contrasting with excellent recovery in the other one, who had undergone posterior decompressive laminectomy, emphasizes the importance of surgery in the management of CLF.- - - - - - - - - - ranking = 204.6483430998keywords = ligament (Clic here for more details about this article) |
4/60. 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) |
5/60. Ossification of the ligamentum flavum as a cause of myelopathy in north america: report of three cases.Myelopathy caused by ossification of the ligamentum flavum is a rare condition in north america. The authors describe three patients whose myelopathy was attributed to posterior cord compression warranting laminectomy to decompress the cervical spine (in one patient) and the thoracic spine (in two patients). The spinal computed tomographic scan (especially after myelography) can be instrumental in guiding the management of this condition.- - - - - - - - - - ranking = 170.5402859165keywords = ligament (Clic here for more details about this article) |
6/60. Simultaneous cervical diffuse idiopathic skeletal hyperostosis and ossification of the posterior longitudinal ligament resulting in dysphagia or myelopathy in two geriatric North Americans.BACKGROUND: Cervical diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) rarely coexist in the North American population. Here, different surgical strategies were used to manage simultaneous DISH and OPLL resulting in dysphagia or myelopathy in two geriatric patients. methods: A 74-year-old male with esophageal compression and dysphagia attributed to DISH, and cord compression with myelopathy due to OPLL, was treated with a cervical laminectomy followed by anterior DISH resection. On the other hand, an 80-year-old male with asymptomatic DISH but moderate myelopathy (Nurick Grade III) secondary to OPLL required only a cervical laminectomy. RESULTS: In the first patient, dysphagia resolved within 3 months of surgery, while in the second individual, myelopathy improved to Nurick Grade I (mild myelopathy) within 6 months postoperatively. Improvement in both patients was maintained 1 year after surgery. CONCLUSIONS: While DISH and OPLL may coexist in geriatric patients, only those with dysphagia should undergo DISH resection, while others demonstrating myelopathy should have laminectomy alone.- - - - - - - - - - ranking = 170.5402859165keywords = ligament (Clic here for more details about this article) |
7/60. 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) |
8/60. 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) |
9/60. Degenerative intraspinal cyst of the cervical spine: case report and literature review.STUDY DESIGN: A case report and a literature review are presented. OBJECTIVE: To describe and review the clinical presentations, characteristic findings from imaging studies, and treatment of synovial and ganglion cysts arising within the cervical spinal canal. SUMMARY OF BACKGROUND DATA: Synovial and ganglion cysts in the cervical spine are rare. To the authors' knowledge, 24 sporadic cases in all, designated by various terms, have been reported in the literature. methods: Three cases of synovial and ganglion cysts in the cervical spine are reported as well as a review of the literature. RESULTS: Characteristic findings from imaging studies included a fluid-containing extradural lesion demonstrated on magnetic resonance images and gas content in the lesion demonstrated on ordinary or sagittally reconstructed computed tomography images. A laminectomy with removal of the cyst was the treatment of choice in most cases. CONCLUSIONS: Neither communication with an adjacent facet joint nor histopathology of the cyst wall provides a persuasive basis for differentiating ganglion, synovial cyst, and cyst arising from the ligaments. To accommodate the varied presentations, the authors propose a comprehensive term for these lesions: "degenerative intraspinal cyst."- - - - - - - - - - ranking = 34.108057183299keywords = ligament (Clic here for more details about this article) |
10/60. 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 = 306.9725146497keywords = ligament (Clic here for more details about this article) |
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