Cases reported "Low Back Pain"

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1/75. Migrated disc in the lumbar spinal canal--case report.

    A 49-year-old man who had complained of back pain for 20 years presented with numbness and pain in his left leg persisting for 6 weeks. magnetic resonance imaging demonstrated a peripherally enhanced intraspinal mass at the L-3 level. The mass was completely removed. The operative and histological findings revealed degenerated disc fragments surrounded by granulation tissue. His symptoms were completely relieved. Migrated disc should be included in the differential diagnosis of patients with a long history of back pain and an intraspinal mass.
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2/75. Giant cauda equina schwannoma. A case report.

    STUDY DESIGN: Case report. OBJECTIVES: To present a rare case of a giant schwannoma of the cauda equina. SUMMARY OF BACKGROUND DATA: Giant spinal schwannoma of the cauda equina, which involves many nerve roots, is rare and there is usually no ossification in the schwannoma. It is unknown whether or not complete excision is preferable if the tumor is located in the lumbar lesion. methods: A 57-year-old woman had a 10-year history of low back pain. Scalloping of the posterior surface of the vertebral bodies from L3 to the sacrum was found. magnetic resonance imaging disclosed a giant cauda equina tumor with multiple cysts. Central ossification revealed by computed tomography and an unusual myelogram made the preoperative diagnosis difficult. RESULTS: The patient underwent incomplete removal of the tumor, decompression of cysts, and spinal reconstruction. The tumor was proved to be a schwannoma. The postoperative course was uneventful and she has been almost free from low back pain for 3 years and 4 months. CONCLUSIONS: Giant schwannoma in the lumbar spine region is usually excised incompletely, because complete removal had the risk of sacrificing many nerve roots. In spite of the incomplete removal of the tumor, the risk of recurrence is low.
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3/75. Lumbar spinal synovial cyst presenting with neurological deficit. A case report and review of the literature.

    A spinal synovial cyst is a rare condition. We reported a case of lumbar spinal synovial cyst presenting neurological deficit. A 78-year-old woman was admitted to our hospital with the low back pain radiating to the left buttock. A myelography with computed tomography and magnetic resonance imaging revealed an extradural cystic lesion at the L5 and S1 level. At the time of surgery, a standard posterior approach was used to expose the posterior elements from L5 to S1. An en bloc laminectomy and total removal of the cyst was performed at the L5 to S1 level. The postoperative recovery was uneventful except for a slight pain in the left leg which persisted for some time.
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4/75. Bilateral subdural hematomas following routine lumbar diskectomy.

    intracranial hypotension is a rare, and possibly underrecognized, cause of headache in middle age. Occurring spontaneously in the vast majority of cases, it has been occasionally reported after certain neurosurgical procedures involving craniectomy. We report a unique situation in which a patient developed severe postural headache typical of intracranial hypotension, which was complicated by bilateral subdural hematomas, immediately following a routine lumbar diskectomy; the headache resolved spontaneously. We suggest that an intraoperative microscopic dural breach was the site of sustained, but self-limited, cerebrospinal fluid leakage that eventually led to intracranial hypotension.
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ranking = 1
keywords = operative
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5/75. Ureteral injury during laparoscopy-assisted anterior lumbar fusion.

    STUDY DESIGN: A case report of ureteral injury as a complication incurred during a laparoscopy-assisted lumbar fusion. OBJECTIVE: To alert orthopedic surgeons to this injury, which may occur during such surgery. SUMMARY OF BACKGROUND DATA: laparoscopy-assisted lumbar fusion is a minimally invasive surgical technique to accomplish lumbar fusion with excellent patient satisfaction, reduced hospital stay, and decreased rehabilitative time. METHOD AND RESULTS: A case report is presented detailing ureteral injury as a complication of laparoscopy-assisted lumbar fusion and the subsequent treatment of the injury. CONCLUSION: laparoscopy-assisted lumbar fusion is a new, less invasive technique with excellent patient satisfaction; however, ureteral injury may occur, and the surgeon should keep this in mind if a postoperative fluid collection occurs in the pelvis.
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6/75. Ligament-sparing lumbar microdiscectomy: technical note.

    BACKGROUND: The prevention or inhibition of postoperative adhesions is a significant goal for successful lumbar discectomy, not only to reduce the probable risk of recurrent radiculopathy, but also to improve the likelihood of success of re-operation. methods: We describe a new technique for sparing the ligamentum flavum in lumbar microdiscectomy. The superficial layer of the ligament is removed by horizontal splitting. Additional horizontal splitting of the ligament yields a paper-thin deep layer. Lateral vertical splitting and retraction is then carried out to provide a sufficient operative window. The split ligament returns to its original position after releasing the retraction, thereby closing the operative window. RESULTS: This method could preserve a layer of the ligamentum flavum to act as a physical barrier, which in turn greatly restricts the peridural fibrosis. CONCLUSIONS: This ligament-sparing technique enables surgeons to preserve the original anatomic plane and to reduce the extent of postoperative adhesion.
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ranking = 4
keywords = operative
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7/75. Spinal epidural gas after cardiac surgery.

    The authors describe a patient with severe lower back and left leg pain in the early postoperative period after cardiac surgery. Radiologic examination revealed gas in the spinal epidural space at the level of L4-5. The pain could not be relieved with analgesics and the patient underwent lumber surgery after cardiac surgery. After decompression, the patient improved and was discharged with no symptoms.
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8/75. Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis.

    The aims of the current study were to evaluate the long-term clinical and radiologic results of anterior lumbar interbody fusion (ALIF) for isthmic spondylolisthesis. Between 1981 and 1988, a total of 35 patients underwent ALIF for isthmic spondylolisthesis. Of these, 23 patients were followed clinically and radiographically for more than 10 years (average, 13.3 years). The Japanese Orthopaedic association low-back pain score was used to evaluate the outcome of subjective symptoms and clinical signs. The preoperative and postoperative percentage of slip, preoperative and postoperative intervertebral disk height, interbody graft union, and pars defect union were evaluated by serial radiographs. The adjacent disk degeneration was also evaluated by radiographs and magnetic resonance imaging. Although the low-back pain score worsened after 5 years, ALIF provides satisfactory overall long-term clinical results. The preoperative percentage of slip and the disk height were corrected after surgery, but at the time of interbody graft union, slip and disk height recurred as a result of grafted bone collapse. The rate of union in the grafted area was 83%. In the nonunion cases, the scores gradually deteriorated with time, but the overall results were not different from those of union cases. Radiographs showed adjacent disk degeneration in 52% of cases in the upper adjacent level and in 70% of cases in the lower adjacent level, but these changes were not correlated with clinical outcomes.
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ranking = 5
keywords = operative
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9/75. Early retropulsion of titanium-threaded cages after posterior lumbar interbody fusion: a report of two cases.

    STUDY DESIGN: Two patients had postoperative posterior migration of titanium fusion cages after posterior lumbar interbody fusion. They underwent a repeat posterior procedure and posterior fusion with pedicle screws. OBJECTIVE: To suggest a treatment for posterior migration of titanium-threaded cages causing spinal stenosis after posterior lumbar interbody fusion. SUMMARY OF BACKGROUND DATA: The use of titanium fusion cages in posterior lumbar interbody fusion is gaining popularity as a technique for arthrodesis. The literature contains only a few reports concerning complications associated with their use. methods: Two patients had retropulsion of titanium threaded cages, ten days and 2 months after posterior lumbar interbody fusion. The retropulsed cages compressing the dura, caused sudden onset of back pain and radiating pain to the lower extremities. Both patients underwent repeat posterior procedure that included repositioning of the cages and posterior fusion with pedicle screws. RESULTS: Symptoms of back and leg pain subsided after repositioning of the cages and application of the pedicle screws. CONCLUSIONS: A repeat posterior approach and repositioning of the retropulsed titanium fusion cages in addition to posterior fusion with pedicle screws successfully managed this complication.
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keywords = operative
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10/75. Sacral meningeal cyst associated with valve-like mechanism--case report.

    A 58-year-old woman presented with low back pain radiating to the lower extremities. magnetic resonance imaging revealed a cystic lesion in the sacrum compressing the nerve roots. At operation, a valve-like communication was found between the subarachnoid space and the cyst cavity in the vicinity of the sacral nerve root. The communication was obliterated with a purse-string suture and reinforced with a free muscle graft. Postoperatively, she reported improvement of the pain. Valve-like communication between the cyst cavity and subarachnoid space can cause enlargement of spinal meningeal cyst, and could also explain enlargement of sacral meningeal cyst. Surgical obliteration of the communication rather than the cyst resection is more important for sacral meningeal cyst.
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