Cases reported "Spinal Cord Compression"

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1/338. artifacts in magnetic resonance images following anterior cervical discectomy and fusion: report of two cases.

    Magnetic susceptibility artifacts in two patients who underwent anterior cervical discectomy with fusion for cervical intervertebral disc prolapse are described. These artifacts located at the previously operated level suggested severe ventral compression of the dural tube. Computed tomography (CT) confirmed the artifactual nature of the MR findings and delineated the possible cause for the recurrence of symptoms in these patients. elements and factors that can possibly lead to MR susceptibility artifacts in post operative imaging are elucidated. The danger of using MR imaging alone in directing the management of these patients is highlighted.
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2/338. Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy?

    STUDY DESIGN: A retrospective study evaluating magnetic resonance imaging, computed tomographic myelography, and clinical parameters in patients with cervical spondylotic myelopathy. OBJECTIVES: To investigate whether magnetic resonance imaging can predict the surgical outcome in patients with cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: No previous studies have established whether areas of high signal intensity in T2-weighted magnetic resonance images can be a predictor of surgical outcomes. methods: Fifty patients with cervical spondylotic myelopathy were examined by magnetic resonance imaging and computed tomographic myelography before surgery and by delayed computed tomographic myelography after surgery. The correlation between the recovery rate and the clinical and imaging parameters was analyzed. RESULTS: The best prognostic factor was the transverse area of the spinal cord at maximum compression (correlation coefficient, R = 0.58). The presence of high signal intensity areas on T2-weighted magnetic resonance images correlated poorly with the recovery rate (R = -0.29). However, patients with multisegmental areas of high signal intensity on T2-weighted magnetic resonance images tended to have poor surgical results associated with muscle atrophy in the upper extremities. Postoperative delayed computed tomographic myelography showed that multisegmental areas of high signal intensity on T2-weighted magnetic resonance images probably represent cavitation in the central spinal cord. CONCLUSIONS: patients with multisegmental areas of high signal intensity on T2-weighted magnetic resonance images tended to have poorer surgical results. However, the transverse area of the spinal cord at the level of maximum compression was a better prognostic indicator.
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3/338. spinal cord compression caused by unusual location and extension of ossified ligamenta flava in a Caucasian male. A case report and literature review.

    STUDY DESIGN: A case report of a spinal cord compression caused by ossification of the ligamenta flava is presented together with a review of the literature. OBJECTIVE: To present the diagnosis of ossification of the ligamenta flava in a Caucasian man with a proximal thoracic myelopathy. SUMMARY OF BACKGROUND DATA: This case shows that the upper parts of the thoracic spine can be involved in ossification of the ligamenta flava, which never before has been reported in Caucasian individuals. Furthermore, it is advised that computed tomography scanning and magnetic resonance imaging be combined to provide an accurate diagnosis and proper preoperative evaluation of the bony changes, spinal cord, and compression of the spinal cord. methods: A patient with a thoracic spinal cord compression caused by ossification of the ligamenta flava was treated surgically and made a good clinical recovery. Imaging studies, surgical findings, and results of histopathologic investigations were analyzed to substantiate the diagnosis. RESULTS: The results of the surgical findings seemed to be in contrast with those of the imaging studies. This contrast was occasioned by the uncommon perioperative finding of a fusion of the completely ossified upper and lower parts of the involved adjacent ligamenta flava. Ossification of the ligamenta flava was diagnosed by histopathologic examination, which revealed endochondral ossification and lamellar bone formation without fragments of ligamenta flava. CONCLUSION: Although rarely reported in whites, ossification of the ligamenta flava should be considered in all patients presenting with a spinal cord compression, even at high thoracic levels. The prognosis after decompressive surgery can be good, especially if intramedullary hyperintensities are absent on preoperatively performed T2-weighted magnetic resonance images.
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4/338. Cranial nerve palsy as a complication of operative traction.

    STUDY DESIGN: Case report. OBJECTIVE: This report documents one case of diplopia from abducens (sixth cranial) nerve palsy after spinal surgery using a Jackson table and cranial traction. SUMMARY OF BACKGROUND DATA: Cranial nerve deficits have frequently been described in the orthopedic literature after trauma, halo pelvic traction, and halo skeletal fixation. The theorized mechanism of injury to the abducens nerve involves stretch or traction force, which causes localized ischemia or a change in nerve position. An extensive literature search failed to show this type of injury using Gardner-Wells tongs in conjunction with the Jackson table. methods: This is a case report that included a chart review, examination of the patient, and a literature search. RESULTS: The patient had complete spontaneous resolution of abducens nerve dysfunction within 6 months. CONCLUSIONS: It is important for the surgeon to be aware of this potential complication and to inform patients who have diplopia that develops from abducens nerve palsy that most of these cranial nerve deficits spontaneously improve.
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5/338. High cervical disc lesions in elderly patients--presentation and surgical approach.

    The incidence of high cervical disc lesions is extremely rare, and the mechanism of their development is unclear. We report these three cases, and discuss the possible mechanisms. We also describe surgical strategies for these lesions. The first and second cases were an 82-year-old male and an 84-year-old male with retro-odontoid disc hernia. The third was an 83-year-old female with a herniated disc at C2/C3. To investigate Aetiological mechanisms of these lesions, we examined the findings on cervical images in extension and flexion, and compared the results in a younger than 80-year-old group and an older than 80-year-old group. The patients underwent surgery via a posterolateral intradural approach. Wide laminectomy and incision of the dentate ligaments enabled access to the ventral space of the upper cervical spinal canal and sufficient decompression. All patients became ambulatory postoperatively without special fixation of the cervical spine. In the younger group, the level mostly loaded during cervical movement was C5/6, however, the levels in the older group were C2/3 and C3/4. In elderly patients, less mobilization of the middle and/or lower cervical spine due to spondylotic change causes overloading at higher levels resulting in high cervical disc lesions. Retro-odontoid disc lesions can be caused by a herniated disc at C2/C3, which migrates upward. Regarding surgical strategy, the posterolateral intradural approach is less invasive and more advantageous for these lesions.
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6/338. Treatment of cervical compressive myelopathy with a new dorsolateral decompressive procedure.

    OBJECT: A new dorsolateral decompressive procedure involving a unilateral approach has been devised for the treatment of cervical compressive myelopathy. In this operation, the posterior spinal elements of the contralateral side are not disturbed, and thus, postoperative deformity of the cervical spine can be avoided. Following decompressive surgery via the unilateral approach, the cervical spine was kept more stable compared with the results obtained after wide laminectomy or other expansive laminoplasty procedures. methods: Twenty-six patients underwent dorsolateral decompressive surgery, and the patients' clinical and radiological results were examined during the follow-up period to evaluate neurological function and postoperative deformities of the cervical spine. The underlying conditions for myelopathy were cervical spondylosis (19 patients), ossification of posterior longitudinal ligament (three patients), and ossification of yellow ligament (four patients). The follow-up period ranged from 6 to 110 months (average 35.5 months). Functional recovery, which was rated by using the Japanese Orthopaedic association scoring system, was an average of 56% in all patients (100% being equal to full recovery). The recovery rate was compatible with those attained after other expansive laminoplasty procedures. Radiographically, progression to swan-neck or kyphotic deformity was not observed in any patient. No postoperative spinal instability was noted. Based on computerized tomography myelograph evaluation, the average transectional area of the dural tube at the C4-5 level was expanded from 122 mm2 to 169 mm2, and the transectional area of the spinal cord at the C4-5 level was expanded from 39.6 mm2 to 52.9 mm2 after surgery. CONCLUSIONS: The authors conclude that this operative procedure could be used as a new option for the treatment of cervical compressive myelopathy.
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7/338. Surgical approach to ossification of the thoracic yellow ligament.

    BACKGROUND: Symptomatic ossification of the yellow ligament (OYL) at the lower thoracic level is uncommon. Although wide laminectomy has, until now, been the primary treatment for this disease, we propose a less invasive technique based on a new method of three-dimensional computed tomography (CT). methods: The clinical features and radiologic imaging findings of 37 patients with OYL (mean age, 54 years) were analyzed. The surgical approach was selected based on the position of the depicted OYL on 3D CT scan in each patient. RESULTS: The male-to-female ratio was 3:1. Involvement of the upper thoracic region was seen 11 times; of the middle region 8 times, and of the lower region 40 times (several patients had involvement in more than one region). About half of the patients complained of gait disturbance on admission caused by the markedly enlarged OYL. No postoperative complications were found. Neurologic deterioration was observed in only one patient. CONCLUSIONS: OYL should be treated as early as possible, using the least invasive technique available. By using 3D CT, we were able to perform limited surgery consisting of foraminotomy or extended partial laminectomy at the affected level after confirming the anatomic location of the OYL. In laterally extended OYL, it is necessary to decompress the radicular artery in order to prevent ischemic damage to the spinal cord.
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8/338. spinal cord compression due to costal echinococcus multilocularis.

    We present computerized tomography (CT) and magnetic resonance imaging (MRI) findings of a costal hydatid cyst (echinococcus multilocularis) causing spinal cord compression. The hydatid disease was proved histologically. MRI was not only very useful for determining the spinal extension of the disease by its multiplanar imaging capability, but also gave important information about the texture of the cyst, thus aiding the preoperative diagnosis.
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9/338. Cervical myelopathy due to dynamic compression by the laminectomy membrane: dynamic MR imaging study.

    Dynamic magnetic resonance (MR) imaging is useful in assessing delayed neurologic deterioration after multilevel cervical laminectomy. The authors report a case of a 75-year-old woman who deteriorated 24 years after a C4-C7 laminectomy. When the extension MR demonstrated marked spinal cord compression attributable to a laminectomy membrane, the patient had an anterior diskectomy and fusion performed, after which she demonstrated significant neurologic improvement. In this and other cases, the dynamic MR may be a useful tool in discerning the etiology of the delayed neurologic changes occurring in postoperative patients.
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10/338. Extradural spinal hemangioblastomas: report of two cases.

    Two cases of predominantly extraspinally extra- and intradural spinal cord hemangioblastomas in two patients each with and without von Hippel-Lindau-disease are reported. Preoperative MRI and angiographic findings are presented and the differential diagnosis is discussed. The surgical procedure is described and the literature of hemangioblastomas in this rare localization is reviewed. Improvements in both radiologic diagnosis and microsurgical techniques, and consequent screening programs will enhance life expectancy in patients afflicted with von hippel-lindau disease.
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