1/6. Intradural disc herniation at the T1-T2 level.Intradural disc herniations comprise 0.26-0.30% of all herniated discs. Five percent are found in the thoracic, 3% in the cervical, and 92% in the lumbar region. Although intradural disc herniation may be suspected on preoperatively made CT scans, myelograms, and MRI scans, establishing the diagnosis prior to the surgery is difficult. We present a case of the patient with severe neurological deficits, caused by intradural thoracic disc herniation at T1-T2 interspace, which required surgical treatment. The symptoms were relieved immediately after surgery. This is the first description of an intradural disc herniation at that level.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/6. paraparesis after excision of intrathoracic meningoceles in a patient with neurofibromatosis.Intrathoracic meningocele associated with neurofibromatosis is a rarity. We treated a 16-year-old boy with neurofibromatosis, marked kyphoscoliosis, and two right-sided intrathoracic meningoceles. Because his chief complaints of cough and chest pain were thought to be caused by the meningoceles, resection of these lesions was performed prior to correction of the spinal deformity. On the day after the resection, complete paraplegia developed, followed by recovery to paraparesis. Decompressive lumbar puncture was performed, but intraspinal pressure was normal. Postoperative spinal cord damage and consequent paresis may have resulted from a loss of pressure buffering by the meningocele, which rendered the cord vulnerable to injury. The possibility of a similar unusual complication should be borne in mind when treating patients with intrathoracic meningocele associated with neurofibromatosis.- - - - - - - - - - ranking = 1.6491051754908keywords = meningocele (Clic here for more details about this article) |
3/6. Early recovery after retropleural approach in a paraparesis thoracic disc patient.A 56 years old Thai male developed acute paraparesis 2 days before admission. The investigation showed T6-7 thoracic disc herniation on the left side with thoracic cord compression. A lateral retropleural (extracavity) approach from the left side without penetrating the pleural cavity was performed. He was able to sit up and start the rehabilitation program within the first day after the operation on the bed and neurological status was gradually recovered within 2 months after continue home program for rehabilitation. Finally he can walk with gait aids. The motor power of his legs were grade IV according to Frankel classification and he can well control the uro-genital function.- - - - - - - - - - ranking = 0.125keywords = herniation (Clic here for more details about this article) |
4/6. Thoracic herniation after lumbar spine fusion.We report on a 65-year-old male patient with rapid onset of incomplete paraparesis, based on a massive thoracic herniation following adjacent instability of the thoracolumbar spine after lumbar fusions with transpedicular instrumentation.- - - - - - - - - - ranking = 0.625keywords = herniation (Clic here for more details about this article) |
5/6. Dural arteriovenous fistula coexisting with a lumbar lipomeningocele. Case report.The authors describe the case of a 44-year-old woman who presented with recent onset of progressive paraparesis and bladder involvement; she had an asymptomatic lumbosacral lipomatous swelling that was present since birth. Magnetic resonance imaging confirmed the diagnosis of a lipomeningocele. It also revealed intramedullary hyperintensity on T2-weighted images and serpiginous flow voids suggestive of a dural arteriovenous fistula (DAVF) at the same level; the lesion was confirmed by spinal angiography. Both lesions were surgically managed, and the patient subsequently experienced neurological improvement. The coexistence of a DAVF and a lipomeningocele at the same level is unusual and can lead to treatment failure if missed.- - - - - - - - - - ranking = 1.0994034503272keywords = meningocele (Clic here for more details about this article) |
6/6. Imaging-guided costotransversectomy for thoracic disc herniation.The surgical management of thoracic disc disease remains challenging. Outcomes after laminectomy had been poor, and modern posterolateral, lateral, and anterior approaches have evolved to replace this older procedure. Each has its own set of complications, and all are hampered, to varying degrees, by the limited visualization of the ventral disc space and spinal cord during decompression. The authors present their early experience with computer-assisted image guidance as an adjunctive tool for preoperative planning and navigation in the treatment of thoracic disc disease. Five consecutive patients underwent image-guided costotransversectomies between January 1999 and April 2000. The levels of herniation were T8-9 in three and T7-8 and T5-6, respectively, in the other two. There were four centrolateral herniations and one midline herniation. Three discs were soft and two hard. Two patients had previously undergone failed disc excisions. All patients had axial pain and myeloradiculopathies preoperatively. Three were unable to walk. Four patients enjoyed good or excellent outcomes, with return of ambulation. One patient experienced only mild improvement in her severe paraparesis. Image-guidance was invaluable in planning the corpectomy and aiding visualization in situations in which the dura or disc were obscured; its use allowed successful surgical excisions in the most challenging circumstances.- - - - - - - - - - ranking = 0.875keywords = herniation (Clic here for more details about this article) |