1/17. Distant skip level discitis and vertebral osteomyelitis after caudal epidural injection: a case report of a rare complication of epidural injections.STUDY DESIGN: A case report of distant discitis and vertebral osteomyelitis involving skip levels after caudal epidural steroid injection. OBJECTIVES: To report and investigate the occurrence of distant infective discitis and vertebral osteomyelitis involving skip levels after epidural injection. SUMMARY OF THE BACKGROUND DATA: Distant discitis and vertebral osteomyelitis is a serious but rare complication after epidural injection. A case involving skip levels and without the occurrence of epidural abscess formation has apparently not been previously reported in the literature. methods: An elderly woman presenting with clinical, radiologic, and magnetic resonance imaging evidence of spinal canal stenosis involving L3/4 and L4/5 levels and degenerative spondylolisthesis of the L4/5 level was given an epidural injection of steroids and lignocaine via the caudal route. A month later, she presented with worsened low back pain, elevated serum acute phase reactants, and plain radiographic evidence of L4/5 infective discitis. magnetic resonance imaging and microbiologic examination of computed tomographically guided biopsy specimens confirmed infective discitis involving L2/3 and L4/5 intervertebral levels, together with adjacent vertebral osteomyelitis. RESULTS: The patient was successfully treated with antibiotics targeted at pseudomonas aeruginosa, which was isolated in the culture of the biopsy specimens. Follow-up improvements in the clinical condition, serum acute phase reactants levels, radiographs, and magnetic resonance imaging were noted. CONCLUSIONS: Distant discitis and vertebral osteomyelitis involving skip levels and without the occurrence of epidural abscess formation is a serious but rare complication after epidural injection.- - - - - - - - - - ranking = 1keywords = spondylolisthesis (Clic here for more details about this article) |
2/17. risk factors for adjacent segment degeneration after PLIF.STUDY DESIGN: A retrospective study of 87 patients who underwent posterior lumbar interbody fusion (PLIF) at L4-L5 for L4 degenerative spondylolisthesis. OBJECTIVE: To clarify: 1) the correlation between radiologic degeneration of cranial adjacent segment and clinical results, 2) risk factors for radiologic degeneration of cranial adjacent segment, and 3) preoperative radiologic features of patients who underwent additional surgery with cranial adjacent segment degeneration. SUMMARY OF BACKGROUND DATA: Whereas PLIF with pedicle screw fixation has shown satisfactory clinical results, a solid fusion has been reported to accelerate a degenerative change at unfused adjacent levels, especially in the cranial level. Although several authors have reported the adjacent segment degeneration after PLIF, there are no previous reports of risk factors for adjacent segment degeneration after PLIF. MATERIALS AND methods: Eighty-seven patients who underwent PLIF for L4 degenerative spondylolisthesis and could be followed for at least 2 years were included in this study. We measured lumbar lordosis, scoliosis, laminar inclination angle at L3, facet sagittalization at L3-L4, facet tropism at L3-L4, preexisting disc degeneration at L3-L4, and lordosis at the fused segment. Progression of L3-L4 segment degeneration was defined as a condition in which disc narrowing, posterior opening, and progress of slippage in comparison with preoperative dynamic lateral radiographs. patients were divided into three groups according to postoperative progression of L3-L4 degeneration: Group 1 with neither progression of L3-L4 degeneration nor neurologic deterioration, Group 2 with progression of L3-L4 degeneration but no neurologic deterioration, and Group 3 with an additional surgery required for neurologic deterioration. Correlation between clinical results and radiologic progression of L3-L4 degeneration, and risk factors for progression of radiologic degeneration were investigated. Further, preoperative radiologic features of Group 3 were studied to detect risk factors for clinical deterioration. RESULTS: There were 58 (67%) patients classified into Group 1, 25 (29%) patients into Group 2, and 4 (4%) patients into Group 3. There was no significant difference in average age in each group. No obvious difference was observed in recovery rate between Groups 1 and 2. Laminar inclination angle and facet tropism in Group 3 were more significant than those in Groups 1 and 2. Further, apparent lamina inclination and facet tropism coexisted in Group 3. There were no obvious differences in other factors between each group. CONCLUSION: 1) There was no correlation between radiologic degeneration of cranial adjacent segment and clinical results. 2) risk factors for postoperative radiologic degeneration could not be detected in terms of each preoperative radiologic factor. 3) Coexistence of horizontalization of the lamina at L3 and facet tropism at L3-L4 may be one of the risk factors for neurologic deterioration resulting from accelerated L3-L4 degenerative change after L4-L5 PLIF.- - - - - - - - - - ranking = 2keywords = spondylolisthesis (Clic here for more details about this article) |
3/17. Spontaneously stabilized severe dysplastic spondylolisthesis without operation: long-term follow-up of a preteenage patient.Surgical management is the accepted treatment choice for grade III or IV spondylolisthesis, and many satisfactory clinical and radiologic follow-up results have been reported. Very little, however, has been written about long-term results in preteenage patients in whom dysplastic spondylolisthesis has been treated nonoperatively, especially in those who have > or =50% displacement of the fifth lumbar vertebra on the sacrum. We report an unusual case of spontaneous stabilization of severe dysplastic spondylolisthesis in an 8-year-old girl who presented with grade III spondylolisthesis of L5-S1 and was followed up for >14 years in the absence of surgical intervention. On presentation, she complained of a restriction in forward bending and tightness of hamstrings, but she was undisturbed in her daily activities. Initial radiographs showed severe dysplastic spondylolisthesis; however, magnetic resonance imaging (MRI) performed at age 9 years showed that the amount of listhesis was much less than that seen in the initial radiograph. Routine radiographic follow-ups were chosen over early operative measures until she became a teenager. There was no change in the slip, and unusually a gradual ossification of the cartilaginous promontory of the S1 and the posterior lip of the L5 was observed. At 22 years old, the patient is asymptomatic and not conscious of her cosmetic appearance. Surgical treatment has generally been indicated for patients with grade III or IV spondylolisthesis, because slippage progression has been noted in most reported cases. However, MRI may be a tool for predicting which dysplastic spondylolisthesis cases are more likely to progress and therefore circumvent surgical intervention, while maintaining an excellent outcome.- - - - - - - - - - ranking = 11keywords = spondylolisthesis (Clic here for more details about this article) |
4/17. Novel bioabsorbable interbody fusion spacer-assisted fusion for correction of spinal deformity.OBJECT: The authors report the cases of 12 patients with medically refractory mechanical low-back pain and intermittent radicular symptoms in whom radiography demonstrated evidence of multilevel lumbosacral degenerative kyphotic and scoliotic deformity and spondylolisthesis. methods: These patients underwent multilevel posterior lumbar interbody fusion in which Macropore bioabsorbable spacers were placed. Each patient underwent at least 1 year of clinical and radiographic follow up. CONCLUSIONS: This series illustrates the novel use of bioabsorbable interbody spacers and fusion technique for correction of spinal deformity due to advanced degenerative kyphoscoliosis and spondylolisthesis.- - - - - - - - - - ranking = 2keywords = spondylolisthesis (Clic here for more details about this article) |
5/17. Crystal arthropathy of the lumbar spine: a series of six cases and a review of the literature.There have been very few reports in the literature of gout and pseudogout of the spine. We describe six patients who presented with acute sciatica attributable to spinal stenosis with cyst formation in the facet joints. Cytopathological studies confirmed the diagnosis of crystal arthropathy in each case.Specific formation of a synovial cyst was identified pre-operatively by MRI in five patients. In the sixth, the diagnosis was made incidentally during decompressive surgery. Surgical decompression alone was undertaken in four patients. In one with an associated degenerative spondylolisthesis, an additional intertransverse fusion was performed. Another patient had previously undergone a spinal fusion adjacent to the involved spinal segment, and spinal stabilisation was undertaken as well as a decompression.In addition to standard histological examination material was sent for examination under polarised light which revealed deposition of urate or calcium pyrophosphate dihydrate crystals in all cases.It is not possible to diagnose gout and pseudogout of the spine by standard examination of a fixed specimen. However, examining dry specimens under polarised light suggests that crystal arthropathy is a significant aetiological factor in the development of symptomatic spinal stenosis associated with cyst formation in a facet joint.- - - - - - - - - - ranking = 1keywords = spondylolisthesis (Clic here for more details about this article) |
6/17. Cerebellar hemorrhage after spinal surgery: case report and review of the literature.Recent reports indicate that cerebellar hemorrhage after spinal surgery is infrequent, but it is an important and preventable problem. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanisms are unknown. This report details the case of a 48-year-old woman who developed remote cerebellar hemorrhage after spinal surgery. The patient presented with a herniated lumbar disc, spinal stenosis, and spondylolisthesis, and underwent multiple-level laminectomy, discectomy, and transpedicular fixation. The dura mater was opened accidentally during the operation. There were no neurologic deficits in the early postoperative period; however, 12 h postsurgery the patient complained of headache. This became more severe, and developed progressive dysarthria and vomiting as well. Computed tomography demonstrated small sites of remote cerebellar hemorrhage in both cerebellar hemispheres. The patient was treated medically, and was discharged in good condition. At 6 months after surgery, she was neurologically normal. The case is discussed in relation to the ten previous cases of remote cerebellar hemorrhage documented in the literature. The only possible etiological factors identified in the reported case were opening of the dura and large-volume cerebrospinal fluid loss.- - - - - - - - - - ranking = 1keywords = spondylolisthesis (Clic here for more details about this article) |
7/17. Spinal disassociation masquerading as iatrogenic listhesis above a previous fusion.STUDY DESIGN: A case of remarkable instability adjacent to an L5-S1 fusion is reported. OBJECTIVES: The objective of this study was to review a case of marked instability adjacent to a prior fusion. Diagnostic workup and surgical management options are discussed. SUMMARY OF BACKGROUND DATA: Junctional degeneration above or below the levels of a spinal fusion may be associated with instability. We present an unusual case of instability whose severity was only apparent when the patient was under general anesthesia. MATERIALS AND methods: A 52-year-old man with a history of prior L5-S1 fusion presented with severe back pain and lower extremity weakness. Workup including multiple imaging methods revealed junctional degeneration and a Grade I spondylolisthesis at L4-L5 with minimal translation on dynamic imaging. Operative intervention was planned. RESULTS: Intraoperative imaging revealed marked distraction at the L4-L5 disc space not apparent on preoperative dynamic films. The surgical approach was modified accordingly. CONCLUSIONS: Adjacent segment degeneration next to a prior lumbar fusion may be associated with extreme instability. Treatment may require complex stabilization.- - - - - - - - - - ranking = 1keywords = spondylolisthesis (Clic here for more details about this article) |
8/17. Brace treatment of spinal claudication in an adolescent with a grade IV spondylosisthesis--a case report.Although spinal claudication may arise from spondylolisthesis, little information exists about successful conservative treatment of this condition. However there are studies describing pain reduction due to physiotherapy and bracing. Significant improvement of walking distance and pain intensity in an adolescent with scoliosis, spondylolisthesis and spinal claudication while wearing a delordosing spondylogic brace is presented here. MATERIAL AND METHOD: A 14 year old girl with a 25 degrees thoracic scoliosis (2 years postmenarchial), grade IV spondylolisthesis and spinal claudication underwent treatment with a delordosing spondylogic brace. walking distance without brace was at around 300 steps before intolerable pain appeared. Self reported walking distance was recorded in the brace 14 days after adjustment. RESULTS: walking distance increased to an unlimited number of steps after 14 days while pain intensity decreased three points in the VRS. However, no correction effect of the orthosis on the degree of slippage was found. CONCLUSIONS: Although there is evidence that pain in patients with spondylolithesis can be reduced using exercises and bracing in mild to moderate symptomatic cases, this case demonstrates that bracing can also improve signs and symptoms of spinal claudication in patients with spondylolisthesis of higher degrees. A prospective case series study seems desirable.- - - - - - - - - - ranking = 4keywords = spondylolisthesis (Clic here for more details about this article) |
9/17. Cotrel-Dubousset pedicle screw system for various spinal disorders. Merits and problems.Eighty-five consecutive patients with various spinal disorders who underwent surgery using the Cotrel-Dubousset pedicle screw system at Kantoh Rosai Hospital between August 1986 and November 1989 were studied. The group included 52 men and 33 women, ranging in age from 19 to 76 years, with an average age of 53 years. The postoperative follow-up period was from 15 to 54 months, with an average of 33 months. The diagnoses were lumbar degenerative disorders in 69 cases (spondylolisthesis in 32, lumbar degenerative spinal canal stenosis without spondylolisthesis in 21, and "unstable lumbar spine" in 16), spinal trauma in 9, spinal deformities in 5 (scoliosis in 3 and kyphosis in 2), and tumor in 2 (1 spinal cord tumor and 1 vertebral tumor). The Cotrel-Dubousset pedicle screw system proved not only to be useful in fixing an unstable spine from the lower thoracic vertebra to the sacrum, as is the case with the other pedicle screw systems, but also to have great advantages for use in various spinal disorders, including reduction of slipped vertebra, correction of spinal deformity combined with a hook system, and for anterior spinal instrumentation. Postoperative clinical results were good in most of the cases, but pseudarthrosis considerably affected the results in a few cases. Therefore, great care must be taken, both strategically and technically, to prevent pseudarthrosis.- - - - - - - - - - ranking = 2keywords = spondylolisthesis (Clic here for more details about this article) |
10/17. Degenerative spondylolisthesis. Pathophysiology and results of anterior interbody fusion.With special attention to the articular facets, an inspection of dry human spinal columns, microradiographic studies of cadaveric specimens, and animal experiments revealed that development of degenerative spondylolisthesis is attributable to rotational strain on the facetal joints at the level of involvement. Disc degeneration predisposes to intersegmental instability and rotational strain, which result in secondary osteoarthritic change of the articular processes and segmental canal stenosis. Thirty-six patients with degenerative spondylolisthesis were treated with anterior interbody fusion (AIF) for segmental canal stenosis at the authors' hospital during 1958-1985. The surgical results of these patients reveal that AIF corrects malalignment of the lumbar spine by complete discectomy, reduces the slip and restores the disc height, and resolves nerve compression, both from the front and from behind, by enlargement of the stenosing canal. In addition, AIF has consistent and satisfactory clinical results at long-term follow-up evaluation because it resolves intersegmental instability, an important problem of degenerative spondylolisthesis. AIF is a reasonable and reliable treatment for patients younger than 60 years of age with segmental stenosis.- - - - - - - - - - ranking = 7keywords = spondylolisthesis (Clic here for more details about this article) |
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