1/69. sciatica caused by cervical and thoracic spinal cord compression.STUDY DESIGN: Two case reports of sciatica that was considered to be caused by cervical and thoracic spinal cord compression. OBJECTIVES: To point out that sciatica can be an initial major symptom in patients with cervical or thoracic spinal cord lesions. SUMMARY OF BACKGROUND DATA: Usually, tract pain caused by cord compression is considered to be diffuse and does not resemble sciatica. methods: Medical history, physical findings, and the results of imaging studies were reviewed in one case of cervical cord tumor and one case of thoracic kyphosis. RESULTS: In both cases, sciatica was the initial and major symptom. Imaging studies showed no lesion in the lumbar spine. In one patient, a cervical dumbbell tumor was found to compress the cervical cord, and in the other the spinal cord was severely compressed at the thoracic kyphosis. The sciatica disappeared immediately after decompression surgery in both cases. CONCLUSIONS: Leg pain resembling sciatica can be caused by cord compression at the cervical and thoracic level. Thoracic kyphosis may be a causative factor in sciatica, in addition to spinal cord tumor and disc herniation, which have been reported previously.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/69. Ventral transdural herniation of the thoracic spinal cord: surgical treatment in four cases and review of literature.BACKGROUND: A specific cause of progressive brown-sequard syndrome has been identified: a ventral herniation of the thoracic spinal cord through the dural sleeve on one side. METHOD: Four female patients who were affected by a progressive Brown Sequard syndrome related to a transdural spinal cord herniation have been investigated and were submitted to surgery and postoperative evaluation. FINDINGS: The MRI scan showed atrophy and forward displacement of the spinal cord on one side and adhesion of the spinal cord to the dura mater. CT myelography demonstrated the disappearance of the premedullar rim at the level of the herniation and the shadow of the extradural herniation. Surgical treatment consisted in the excision of the arachnoid cyst when there was one, section of the dentate ligament, release of the adhesions, detachment of the spinal cord from the hernial orifice, and lastly suture of the dural tear or placement by a patch. Follow-up examination showed motor improvement with persistent sensory deficit in two cases and stabilisation in two cases. INTERPRETATION: The cause of the dural tear, either traumatic or congenital could not be confirmed in the four cases. Symptoms probably occur when herniation fills the orifice and strangulation happens which explains the late appearance and progressive evolution of this myelopathy. Mobilisation of the herniated spinal cord back into the intradural space can be achieved by surgery and may stop the evolution of the symptoms and signs.- - - - - - - - - - ranking = 9keywords = herniation (Clic here for more details about this article) |
3/69. High cervical disc herniation and brown-sequard syndrome. A case report and review of the literature.We describe a rare herniation of the disc at the C2/C3 level in a 73-year-old woman. It caused hemicompression of the spinal cord and led to the Brown-Sequard syndrome. The condition was diagnosed clinically and by MRI six months after onset. Discectomy and fusion gave complete neurological resolution.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
4/69. Flaccid quadriplegia from tonsillar herniation in pneumococcal meningitis.A young woman with fulminant pyogenic meningitis became quadriplegic, areflexic and flaccid due to herniation of the cerebellar tonsils and compression of the upper cervical cord. This state of spinal shock was associated with absent F-waves. intracranial pressure was greatly elevated and there was an uncertain relationship of tonsillar descent to a preceding lumbar puncture. Partial recovery occurred over 2 years. Tonsillar herniation can cause flaccid quadriplegia that may be mistaken for critical illness polyneuropathy. This case demonstrates cervicomedullary infarction from compression, a mechanism that is more likely than the sometimes proposed infectious vasculitis of the upper cord.- - - - - - - - - - ranking = 6keywords = herniation (Clic here for more details about this article) |
5/69. spinal cord compression due to multivel thoracic disc herniation: surgical decompression using a "combined" approach. A case report and review of the literature.A case presenting with signs of spinal cord compression due to double contiguous thoracic disc herniation (TDH) is reported. A 66-year-old woman presented with a 4-month history of intermittent episodes of weakness and numbness in the lower extremities, and urinary dysfunction. Six weeks prior to admission complete paraplegia developed. The diagnosis was established by MRI. Treatment consisted of complete excision of the herniated discs (T8-T9 and T9-T10) and decompression of the spinal cord with a right transpedicular approach combined with standard posterior approach. The postoperative course was uneventful, and the improvement was dramatic. We also include a review of other 39 case reports from the literature. This article highlights the importance of consideration of TDH when one deals with a case with an anterior mass causing spinal cord compression.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
6/69. Cervical intradural disc herniation.STUDY DESIGN: A case report of anterior en bloc resected cervical intradural disc herniation and a review of the literature. OBJECTIVE: To discuss the pathogenesis of cervical intradural disc herniation. SUMMARY OF BACKGROUND DATA: Including this study case, only 17 cases of cervical intradural disc herniation have been reported. There have been few detailed reports concerning the pathogenesis of cervical intradural disc herniation. methods: A cervical intradural disc herniation at C6-C7, with localized hypertrophy and segmentally ossified posterior longitudinal ligament, is reported in a 45-year-old man who had brown-sequard syndrome diagnosed on neurologic examination. Neuroradiologic, operative, and histologic findings, particularly the pathology of the anterior en bloc resected posterior vertebral portion of C6 and C7, were evaluated for discussion of the pathogenesis. RESULTS: Adhesion of dura mater and hypertrophic posterior longitudinal ligament was observed around a perforated portion of the herniated disc, and histologic study showed irregularity in fiber alignment accompanied by scattered inflammatory cell infiltration and hypertrophy in the posterior longitudinal ligament. The cervical intradural disc herniation was removed successfully and followed by C5-Th1 anterior interbody fusion with fibular strut graft. Neurologic recovery was complete except for minor residual sensory disturbance in the leg 7 years after the surgery. CONCLUSIONS: Cervical intradural disc herniation is an extremely rare condition. The pathogenesis remains obscure. Only 16 cases have been reported in the literature, and there has been little discussion concerning the local pathology of the herniated portion. The pathogenesis of the disease in the patient reported here was considered to be the adhesion and fragility of dura mater and posterior longitudinal ligament. This was caused by hypertrophy, with chronic inflammation and ossification of the posterior longitudinal ligament sustaining chronic mechanical irritation to the dura mater, leading to perforation of the herniated disc by an accidental force.- - - - - - - - - - ranking = 11keywords = herniation (Clic here for more details about this article) |
7/69. 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 = 8keywords = herniation (Clic here for more details about this article) |
8/69. Cord compression secondary to cervical disc herniation associated with calcification of the ligamentum flavum: case report.OBJECTIVE AND IMPORTANCE: Calcification of the ligamentum flavum is a rare disease that occurs almost exclusively in elderly Japanese people. We report the case of a young Caucasian woman who presented with a C5-C6 disc herniation associated with a cervical calcified ligamentum flavum. CLINICAL PRESENTATION: The patient presented with a cord compression syndrome of 76 hours' evolution. At exploration, a brown-sequard syndrome at the C6 level was found. magnetic resonance imaging and computed tomography led to a correct diagnosis and planning for decompression. INTERVENTION: We operated on the patient through a combined anterior and posterior approach. After the patient underwent anterior discectomy with intersomatic arthrodesis, we performed posterior decompression. During the operation, we observed that the dura mater could not be separated from the ligamentum, so an en bloc excision of both structures was performed. Microscopic examination indicated that the excised ligamentum had calcification, and total integration of the dura mater into the structure of the ligamentum was demonstrated. To our knowledge, this circumstance has never been described before. A posterior C3-C7 arthrodesis was performed to prevent postoperative kyphosis. Recovery was successful, with total recovery from neurological deficits 4 months later. CONCLUSION: Calcification of the ligamentum flavum is a progressive disease that starts early in life and becomes symptomatic later in life when spinal stenosis occurs. magnetic resonance imaging and computed tomography provide adequate diagnosis and allow proper surgical planning for decompression. The presence of hyperintense areas within the spinal cord parenchyma, in the absence of a traumatic antecedent, does not preclude a complete recovery.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
9/69. Intradural lumbar disc herniation: report of two cases.Intradural lumbar disc herniation (ILDH) is a rare pathology. The pathogenesis of ILDH is not known with certainty. Adhesions between the ventral wall of the dura and the posterior longitudinal ligament (PLL) could act as a preconditioning factor. diagnosis of ILDH is difficult and seldom suspected preoperatively. Prompt surgery is necessary because the neurologic prognosis appears to be closely linked to preoperative duration of neurologic symptoms. Despite preoperatively significant neurological deficits, the prognosis following surgery is good. We report on two new cases of ILDH of high lumbar locations L1-2 and L2-3 with difficult differential diagnoses, and the possible pathogenic factors are discussed.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
10/69. 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 = 1keywords = herniation (Clic here for more details about this article) |
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