1/34. Lumbar disc herniation in a 27-month-old child. Case report.The occurrence of disc herniation is rare in children. A 27-month-old child fell from his cradle and developed, in the following 2 weeks, irritability, low-back pain, and difficulty in walking. On physical examination a compensatory gait, paravertebral muscle spasm, and a restricted right straight-leg raising test were demonstrated. Plain x-ray films revealed a narrowed L4-5 intervertebral space. magnetic resonance imaging of the lumbosacral spine demonstrated decreased signal in the L4-5 disc, with posterior disc protrusion. At surgery, blood infiltrating the subperiosteal plane was observed. Via a left hemilaminectomy and under microscopic magnification, the left L-5 nerve root was found to be intact, and on the right side significant nerve root compression was identified. During dissection an accidental dural tear occurred. A right L-4 hemilaminectomy was performed, and the disc fragments were removed until a complete nerve root decompression was obtained and the dura was repaired. The child recovered uneventfully and was asymptomatic 7 years postsurgery. This child is one of the youngest patients with a herniated disc reported in the world literature. The authors discuss the diagnostic difficulties and management of this entity in children.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/34. Multiple independent, sequential, and spontaneously resolving lumbar intervertebral disc herniations: a case report.STUDY DESIGN: A case report is presented. OBJECTIVE: To highlight the potential for spontaneous resolution of large extruded intervertebral lumbar disc herniations in a patient with three independent herniations. SUMMARY OF BACKGROUND DATA: The most effective methods of treatment for lumbar intervertebral disc herniations remain in question. This is partly because the potential for intrinsic spontaneous resolution is not understood, and because many believe that large extruded lumbar intervertebral disc herniations require surgical intervention. This case report addresses both issues. methods: A case is reported and the literature is reviewed. RESULTS: In the patient described, multiple independent lumbar intervertebral disc herniations resolved spontaneously both clinically and radiographically with nonoperative treatment. CONCLUSIONS: Not only is the question concerning the cause of disc herniation unresolved, but the best methods of treatment also are generally unclear. This case report documents a patient with the intrinsic capability not only to herniate multiple lumbar intervertebral discs, but also to resolve them clinically and anatomically. Extruded lumbar intervertebral disc herniations may be treated without surgery, as highlighted by this case report. The immunohistologic pathomechanism for resorption remains unclear.- - - - - - - - - - ranking = 2.2keywords = herniation (Clic here for more details about this article) |
3/34. Dural ectasia and back pain: review of the literature and case report.Dural ectasia is defined as a ballooning of the dural sac which is more common in patients with connective tissue disorders such as the marfan syndrome. Several studies have shown that dural ectasia may be associated with such conditions as back pain, headaches, radiculopathies, or incontinence. We present a case of a 52 year old woman with marfan syndrome who presented with a significantly large anterior sacral meningocele without having associated symptoms. In light of this case, we recommend that asymptomatic Marfan patients with dural ectasia should be closely observed without need for immediate surgical intervention.- - - - - - - - - - ranking = 0.21844012186363keywords = meningocele (Clic here for more details about this article) |
4/34. Disc herniation after lumbar fusion.STUDY DESIGN: Eight patients with a herniated disc after lumbar spinal fusion are reported. Their clinical features, imaging studies, and management are reported. OBJECTIVES: To identify the incidence and features of disc herniation above a spinal fusion, and to describe their management. SUMMARY OF BACKGROUND DATA: Late complications of lumbar spinal fusions have been reported in the literature, but disc herniation has not been specifically addressed in detail. The motion segment above a spinal fusion undergoes additional stresses, as documented by increased pressure and excessive motion, resulting in degenerative changes. These factors likely predispose to disc herniation. methods: Of 601 consecutive lumbar fusion cases over an 8-year period, herniated nucleus pulposus above the fusion was diagnosed in 8 patients. The clinical findings and imaging studies were reviewed, including a myelogram computed tomography scan, a magnetic resonance image with positive documentation of the herniation, or both. The management of these cases was reviewed. RESULTS: Eight patients (1.3%) (4 men and 4 women) were identified, whose average age was 56.4 years. Nonoperative treatment failed in six patients. Two of these patients underwent simple discectomy, and the remaining four underwent discectomy and fusion. All four patients went on to fusion. The average time from disc herniation onset to fusion was 28.4 months. CONCLUSIONS: Herniated disc after lumbar spinal fusion was found in approximately 1.3% of patients. Although rare, this entity that should be considered when patients complain of recurring back pain after a lumbar spinal fusion.- - - - - - - - - - ranking = 1.8keywords = herniation (Clic here for more details about this article) |
5/34. Radicular compression by lumbar intraspinal epidural gas pseudocyst in association with lateral disc herniation. role of the posterior longitudinal ligament.Among unusual abnormalities of the lumbar spine reported since the introduction of Computed tomography (CT), the presence of gas lucency in the spinal canal, known as vacuum phenomenon, is often demonstrated. On the contrary, epidural gas pseudocyst compressing a nerve root in patients with a lateral disc herniation has rarely been reported. We report a case of a 44-year-old man who experienced violent low back pain and monolateral sciatica, exacerbated by orthostatic position, one week before admission. A lumbosacral spine CT showed the presence of vacuum phenomenon associated with a degenerated disc material and a capsulated epidural gas collection with evidence of root compression. A microsurgical interlaminar approach was carried out and, before the posterior longitudinal ligament was entered, a spherical "bubble" compressing the nerve roots was observed. The capsulated pseudocyst was dissected out, peeled off and excised en bloc. A large part of the posterior longitudinal ligament and the lateral disc herniation were removed. Postoperatively the patient was completely free of symptoms. The mechanism of exacerbation of pain was probably due to the increased radicular compression in the upright posture and, besides the presence of a lateral disc herniation, could be related to a pneumatic squeezing of gas from the intervertebral space into the well capsulated sac by the solicitated L4-L5 motion segment. Histological study of the wall of the pseudocyst showed the presence of fibrous tissue identical to the ligament. We conclude that, in case of a lumbar disc herniation, it is recommended to perform a complete microdiscectomy and an accurate removal of the involved portion of posterior longitudinal ligament in order to prevent pseudocystic formations.- - - - - - - - - - ranking = 1.6keywords = herniation (Clic here for more details about this article) |
6/34. A giant herniated disc following intradiscal electrothermal therapy.The introduction of intradiscal electrothermal therapy for the management of discogenic back pain has been met with intense interest over the past few years. During this time there have been several noncontrolled studies published on the procedure, most of which have shown excellent outcomes but few, if any, complications. The authors describe a 29-year-old, 152-kg active duty male soldier who underwent two-level intradiscal electrothermal therapy for L4-L5 and L5-S1 discogenic pain. Before the procedure, the patient had a small L5-S1 contained herniation, with no signs of radiculitis. Postprocedure, the patient developed radicular symptoms and was noted on MRI to have a large L5-S1 disc herniation effacing the left S1 nerve root. Follow-up discography revealed a negative discogram at L4-L5. The patient proceeded to undergo a single-level lumbar fusion, which resulted in nearly complete relief of his radicular and axial low back pain. Two years post-surgery, he is off all narcotic medications and continues to work full-time as a soldier. This case illustrates both the potential benefits and complications that may be associated with intradiscal electrothermal therapy.- - - - - - - - - - ranking = 0.4keywords = herniation (Clic here for more details about this article) |
7/34. Intraspinous postlaminectomy pseudomeningocele.Pseudomeningoceles are uncommon complications of lumbar surgery. They are encapsulated cerebrospinal fluid collections developing extradurally as a consequence of incidental dural tears. They are typically located in the paraspinal compartment and occasionally reach the subcutaneous space. We describe the case of a patient in whom a postlaminectomy pseudomeningocele developed over a 10-year period within the L5 spinous process and remained completely encircled within its bony boundaries. The surgical implications of this finding are discussed.- - - - - - - - - - ranking = 1.3106407311818keywords = meningocele (Clic here for more details about this article) |
8/34. Acute back pain associated with a calcified Schmorl's node: a case report.This is a case report of a 56-year-old woman with an unusual acute attack of back pain associated with a calcified intervertebral disk and herniation into the 10th dorsal vertebral body.- - - - - - - - - - ranking = 0.2keywords = herniation (Clic here for more details about this article) |
9/34. Anterior sacral meningocele: report of five cases and review of the literature.Five new cases of anterior sacral meningocele are presented, including one secondary to neurofibromatosis, a previously undescribed association. The literature is reviewed, drawing attention to the relationship between anterior sacral meningocele, sacral dysgenesis, and other congenital anomalies. Special consideration is given to the clinical features of this entity, as well as to the techniques and results of surgical management.- - - - - - - - - - ranking = 1.3106407311818keywords = meningocele (Clic here for more details about this article) |
10/34. Spinal tumors in coexisting degenerative spine disease--a differential diagnostic problem.The clinical presentation of spinal tumors is known to vary, in many instances causing a delay in diagnosis and treatment, especially with benign tumors. neck or back pain and sciatica, with or without neurological deficits, are mostly caused by degenerative spine and disc disease. Spinal tumors are rare, and the possibility of concurrent signs of degenerative changes in the spine is high. We report a series of ten patients who were unsuccessfully treated for degenerative spine disease. They were subsequently referred for operative treatment to our department, where an initial diagnosis of a tumor was made. Two patients had already been operated on for disc herniations, but without long-lasting effects. In eight patients the diagnosis of a tumor was made preoperatively. In two cases the tumor was found intraoperatively. All patients showed radiological signs of coexisting degenerative spine disease, making diagnosis difficult. MRI was the most helpful tool for diagnosing the tumors. A frequent symptom was back pain in the recumbent position. Other typical settings that should raise suspicion are persistent pain after disc surgery and neurological signs inconsistent with the level of noted degenerative disease. Tumor extirpation was successful in treating the main complaints in all but one patient. There was an incidence of 0.5% of patients in which a spinal tumor was responsible for symptoms thought to be of degenerative origin. However, this corresponds to 28.6% of all spine-tumor patients in this series. MRI should be widely used to exclude a tumor above the level of degenerative pathology.- - - - - - - - - - ranking = 0.2keywords = herniation (Clic here for more details about this article) |
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