1/43. The role of acute decompression and restoration of spinal alignment in the prevention of post-traumatic syringomyelia: case report and review of recent literature.STUDY DESIGN: Case report. INTRODUCTION: Acute post-traumatic syringomyelia formation after spinal cord injury has been considered a rare complication. At this writing, most recent reports have surfaced in neurosurgical journals. As an entity, post-traumatic syringomyelia has not been widely appreciated. It has been confused with conditions such as Hansen's disease or ulnar nerve compression at the cubital tunnel. One study also demonstrated that the occurrence of syrinx is significantly correlated with spinal stenosis after treatment, and that an inadequate reduction of the spine may lead to the formation of syrinx. This reported case describes a patient in whom post-traumatic syringomyelia began to develop 3 weeks after injury, which improved neurologically after adequate decompression. SUMMARY OF BACKGROUND DATA: A 30-year-old man sustained a 20-foot fall at work. He presented with a complete spinal cord injury below T4 secondary to a T4 fracture dislocation. The patient underwent open reduction and internal fixation of T1-T8. After 3 weeks, the patient was noted to have ascending weakness in his bilateral upper extremities and some clawing of both hands. methods: A computed tomography myelogram demonstrated inability of contrast to pass through the T4-T5 region from a lumbar puncture. An incomplete reduction was noted. The canal showed significant stenosis. A magnetic resonance image of the patient's C-spine showed increased signal in the substance of the cord extending into the C1-C2 area. The patient returned to the operating room for T3-T5 decompressive laminectomy and posterolateral decompression including the pedicles, disc, and posterior aspect of the body. Intraoperative ultrasound monitoring showed a good flow of cerebrospinal fluid past the injured segment. RESULTS: On postoperative day 1, the clawing posture of the patient's hands was significantly diminished, and the patient noted an immediate improvement in his hand and arm strength. Over the next few days, the patient's strength in the bilateral upper extremities increased to motor Grade 4/5 on manual testing. A magnetic resonance image 4 weeks after decompression showed significant improvement in the cord diameter and signal. CONCLUSIONS: Post-traumatic syringomyelia has not been reported at so early a stage after injury. This disorder is an important clinical entity that must be recognized to prevent potentially fatal or devastating complications. As evidenced by the reported patient and the literature, if this disorder is discovered and treated early, permanent deficit can be avoided. The prevention of post-traumatic syringomyelia requires anatomic realignment and stabilization of the spine without stenosis, even in the case of complete injuries, to maintain the proper dynamics of cerebrospinal fluid flow.- - - - - - - - - - ranking = 1keywords = post-traumatic (Clic here for more details about this article) |
2/43. Metastatic thyroid carcinoma in the presence of struma ovarii.A 27-year-old woman presented with metastatic follicular carcinoma of thyroid cell type. Assessment was complicated by recent surgery for "benign" struma ovarii. She underwent total thyroidectomy which failed to show a neoplasm, leaving the struma ovarii as the likely source of the metastasis.- - - - - - - - - - ranking = 1.1818381754521E-5keywords = neoplasm (Clic here for more details about this article) |
3/43. Delayed presentation of post-traumatic aneurysm of the posterior inferior cerebellar artery in a patient with spinal cord injury.STUDY DESIGN: A case report. OBJECTIVE: To present and discuss the case of a patient with serious head and spinal injuries who suffered delayed haemorrhage from a post-traumatic aneurysm of the right posterior inferior cerebellar artery following surgical treatment of vertebral fracture and hydrocephalus. SETTING: National spinal injuries Unit and Institute of Neurological Sciences, Southern General Hospital, Glasgow, scotland, UK. methods: Clinical and radiological follow-up of the patient. RESULTS: The aneurysm was treated by coil occlusion of the right vertebral artery. Post-operative films showed that the aneurysm had been successfully obliterated. CONCLUSION: Post-traumatic cerebral aneurysms are very rare. Neurosurgical and rehabilitation teams need to be aware of this late treatable sequela of head injury.- - - - - - - - - - ranking = 0.625keywords = post-traumatic (Clic here for more details about this article) |
4/43. Percutaneous vertebroplasty in the management of a patient with malignant pain and associated osteolytic compression fractures.Percutaneous vertebroplasty is a minimally invasive procedure that is effective in the treatment of pain resulting from pathologic compression fractures, osteolytic bone metastases from solid tumors, myeloma, vertebral hemangioma, and osteoporotic compression fractures. A discussion of a patient with severe, aggressive metastatic breast cancer to the spine with compression and osteolysis of multiple lumbar vertebral bodies is presented. Despite treatment with opiates, chemotherapy, radiation therapy, and the implantation of a morphine pump, her pain was not adequately treated until she underwent multilevel vertebroplasty. The clinical and technical application of vertebroplasty in the context of the management of vertebral pain of malignant origin is presented as an integral part of multidisciplinary pain management.- - - - - - - - - - ranking = 5.9282706114353E-6keywords = cancer (Clic here for more details about this article) |
5/43. F-18 FDG positron emission tomography and benign fractures.PURPOSE: F-18 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) has been used extensively in the imaging of cancer, including metastatic skeletal disease. Although uptake into benign osseous disease has been reported, there is very limited information regarding uptake into benign fractures. This report provides additional information regarding the appearance of benign fractures on FDG-PET images. MATERIALS AND methods: Four case reports of FDG-PET scanning are presented in patients with proved benign fractures. RESULTS: In three of these cases, FDG uptake was noted in fractures when images were obtained 17 days to 8 weeks after injury, with the most avid uptake observed when FDG-PET imaging was performed 17 days after fracture. In the patient in whom imaging was performed 8 weeks after fracture, no uptake of FDG was seen in a benign fracture. CONCLUSIONS: Fractures may accumulate FDG to varying degrees, and false-positive findings may occur when FDG-PET imaging is performed to assess for metastases, although the different pattern of uptake and clinical correlation usually allows accurate differentiation of fracture from skeletal metastases.- - - - - - - - - - ranking = 5.9282706114353E-6keywords = cancer (Clic here for more details about this article) |
6/43. Huge retroperitoneal germinoma presenting with pathological fracture of the spine.Primary retroperitoneal germ cell tumors are extremely rare neoplasms. The most common presenting features are abdominal pain and palpable abdominal masses. Pathological fractures of the spine presenting as bilateral lower leg weakness are exceptionally rare. We describe a 16-year-old girl who developed progressive paraplegia after a minor falling injury. Radiological study demonstrated a huge retroperitoneal tumor with invasion of the T12 vertebral body and spinal canal. A posterior surgical approach was used to perform laminectomy (T12, L1), removal of the intraspinal tumor and internal fixation with transpedical screws (T10, T11 to L2,3), and posterolateral fusion. Postoperative combination chemotherapy for six cycles with cisplatin (100 mg/m2 per day for 1 day every 3 weeks), bleomycin (15 units intravenously weekly for 18 weeks) and etoposide (100 mg/m2 per day for 3 days every 3 weeks) were given and the tumor responded dramatically. The patient had fully recovered without evidence of sequelae or recurrence at 2 years after operation. To the authors' knowledge, this is the first case in which a huge retroperitoneal germinoma presented as pathological fracture of the spine and spinal cord compression. The effectiveness of the postoperative cisplatin-based chemotherapy against this tumor made major retroperitoneal surgery to remove the main tumor mass unnecessary is also demonstrated.- - - - - - - - - - ranking = 1.1818381754521E-5keywords = neoplasm (Clic here for more details about this article) |
7/43. Management of degenerative changes and stenosis of the lumbar spinal canal secondary to cervical spinal cord injury.We describe the case of a 47-year-old female who sustained a C5/6 fracture with C6 complete spinal cord injury 26 years ago. She presented with increased spasticity of the lower extremities, the abdominal wall and episodes of autonomic dysreflexia. Imaging of the spine revealed post-traumatic kyphosis at the level of the injury and degenerative changes of the lumbar spine with marked facet joint hypertrophy at the level of L4/5 causing severe spinal canal stenosis. Discussants of this case comment on the possible pathophysiological mechanisms causing autonomic dysreflexia, especially the development of degenerative changes, Charcot arthropathy and the role of tethering mechanisms. The diagnostic options and management approaches are also discussed.- - - - - - - - - - ranking = 0.125keywords = post-traumatic (Clic here for more details about this article) |
8/43. Metastatic compression fractures--vertebroplasty for pain control.quality of life issues remain at the forefront for individuals with life-threatening disease, such as metastatic cancer. The pain of metastatic bone cancer can severely hamper an individual's quality of life. Percutaneous vertebroplasty offers a minimally invasive way to reinforce bony elements, provide substantial improvement in pain control, allow for mobilization, and overall improve quality of life in these patients.- - - - - - - - - - ranking = 1.1856541222871E-5keywords = cancer (Clic here for more details about this article) |
9/43. Acute spinal epidural hematoma and systemic mastocytosis.BACKGROUND: Systemic mastocytosis is a mast cell proliferative disorder affecting many organs that is rarely associated with internal bleeding. OBJECTIVE: To describe a case of spinal epidural hematoma in a patient with past medical history of urticaria pigmentosa and osteoporosis diagnosed with systemic mastocytosis. CASE REPORT: A 63-year-old woman with urticaria pigmentosa was admitted to hospital for severe back pain after minor trauma. physical examination showed pain on pressing T12 and L1 spinous processes, bilateral Lasegue sign, absent ankle jerk, and extensor plantar response. Computed tomography disclosed L3 fracture, and magnetic resonance imaging revealed spinal epidural hematoma and T2 hyperintensive scattered vertebral foci that suggested malignancy. The 24-hour urine histamine was very high. Mast cell infiltration was found in bone marrow biopsy. Because power was normal and there was no clinical sphincter disorder, the patient was successfully treated with conservative care. CONCLUSIONS: To our knowledge, acute intraspinal epidural hematoma has never been associated with mastocytosis. The hematoma was likely related to the vertebral fracture as well as a hemorrhagic diathesis due to anticoagulants released by local mast cells.- - - - - - - - - - ranking = 3.3573423751559E-6keywords = malignancy (Clic here for more details about this article) |
10/43. Unilateral cervical facet fracture: presentation of two cases and literature review.STUDY DESIGN: Two patients with diagnosis of unilateral cervical facet fracture due to motor vehicle accident (MVA) are presented, and the literature is reviewed. OBJECTIVE: To discuss the diagnostic difficulties and management strategies in two patients with post-traumatic cervical facet fracture. SETTING: Department of neurosurgery, Zonguldak Karaelmas University, faculty of medicine, turkey. SUBJECT: Nonoperative treatment with immobilization was preferred in two female cases (33-34 years old) with diagnosis of C6-7 facet fracture following MVA. magnetic resonance imaging (MRI) could be performed in acute period in the first case, but not in the second because of inadequate technical condition. RESULT: The first case with a good compliance to immobilization recovered without any neurological complication. However, the second case mobilized earlier and used a collar irregularly. Instability developed in the second case on the second month and surgical intervention with anterior approach was performed. CONCLUSION: The diagnosis of unilateral facet fractures is often missed and the treatment is still controversial. The compliance of the patient to cervical immobilization in nonoperative treatment plays a very important role in the development of late complications. MRI in the acute period may be useful in determining instability.- - - - - - - - - - ranking = 0.125keywords = post-traumatic (Clic here for more details about this article) |
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