Cases reported "Spinal Diseases"

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11/90. Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra: a possible cause of vertebral artery dissection in children.

    Twelve children with vertebrobasilar artery stroke are reported (seven males, five females; aged 6 months to 15 years). Patient 1 showed an arcuate foramen in the posterior arch of the atlas, an anatomical variant occurring in 3 to 15% of the population. It was hypothesized that the presence of the arcuate foramen might cause tethering of the vertebral artery and lead to its dissection by repetitive trauma. Lateral plain films of the cervical spine in cases of posterior circulation stroke were taken. Eight of 11 patients showed aberrant arcuate foramina. Of the remaining three patients, one had normal cervical spine x-rays, one had an absent right posterior arch of the atlas following previous surgery for a cervical meningocele, and one patient had incomplete ossification of the vertebrae. Seven of the nine patients with arcuate foramina had vertebral angiograms. In all cases this showed the vertebral artery passing through the arcuate foramen before entering the brain and an appearance consistent with arterial dissection and occlusion at the same site below the foramen. Most documented cases of posterior circulation stroke in children follow trauma, which may be minimal or repetitive, with thrombotic occlusion of the artery at C1-C2 level. The association with an arcuate foramen and its possible causative role in the genesis of posterior circulation stroke in children has not been previously recognized. There may be a causal association between the presence of an arcuate foramen, tethering of the vertebral artery in the foramen, and dissection from repetitive trauma with movement of the neck.
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keywords = neck
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12/90. Complications related to hydroxyapatite vertebral spacer in anterior cervical spine surgery.

    STUDY DESIGN: This is a report of complications related to the hydroxyapatite vertebral spacer used for anterior cervical reconstructive surgery. Compression of the spinal cord by broken fragments of hydroxyapatite spacer as well as its surrounding radiolucent clear zone were observed in seven patients. OBJECTIVES: To report complications related to the use of hydroxyapatite vertebral spacer for anterior cervical reconstructive surgery and to discuss how to prevent these complications. SUMMARY OF BACKGROUND DATA: Despite previous articles reporting the clinical applications of hydroxyapatite vertebral spacer for the cervical spine, clinical reports regarding the long-term results of hydroxyapatite spacer for anterior cervical surgery and its complications have been limited. methods: The authors reviewed patients who underwent anterior reconstructive surgery using the hydroxyapatite spacer at other hospitals and had postoperative complications related to hydroxyapatite spacer. RESULTS: Seven patients previously treated by anterior cervical spine surgery using the hydroxyapatite vertebral spacer were referred to the authors because of unsatisfactory surgical outcomes. All the patients had a radiolucent clear zone around the spacer and experienced severe neck pain. Four had fracture of the hydroxyapatite spacer, and two had compression of the spinal cord by retropulsed fragments of broken hydroxyapatite spacers. CONCLUSIONS: Although hydroxyapatite has been used in many medical fields because of its bioactive characteristics, its mechanical properties should be improved to lessen the risks of breakage and subsequent spinal cord compression. Gentle insertion maneuvers are also important to avoid the production of cracks inside the spacer.
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keywords = neck
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13/90. candida vertebral osteomyelitis: a case report and review of the literature.

    candida species are low virulence organisms which inhabit the skin and mucous membranes of most individuals. There has been increasing incidence of disseminated and deep-seated candida infections owing to the increasing number of immune compromised hosts. However, the candida species are still rarely suggested as causative pathogens of vertebral osteomyelitis. We present a 51-year-old man with neck pain and cervical radiculopathy. Three months prior to visiting our hospital, he had undergone a urological operation which was complicated by a urinary tract infection. magnetic resonance imaging and x-rays showed erosion of the body of the 5th cervical spine and collapse of the C5-C6 disc. After open debridement, tissue pathology results revealed candida infection. Clinical stability was achieved during the 6-month follow-up period with a combination of amphotericin b and posterior fixation method. We reviewed the literature and found a high rate of surgical intervention for patients suggested of having candida vertebral osteomyelitis. However, the surgical intervention may not be necessary. early diagnosis using noninvasive percutaneous needle biopsy may help reduce the incidence of delayed treatment.
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keywords = neck
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14/90. Cervical tuberculosis in early childhood.

    CASE history: We present a case of spinal tuberculosis in a 4-year-old girl that grounds severe vertebral destruction involving four cervical vertebrae and a large abscess with retropharyngeal expansion. Presenting symptoms were neck and right arm pain, torticollis and weakness of the right arm. We drained the abscess and removed the infected bone and reconstructed the cervical spine with a fibular allograft. The neurological deficits were recovered and the torticollis was straightened up. CONCLUSION: We emphasize the value of early diagnosis of spinal tuberculosis and early radical surgery with spinal reconstruction.
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keywords = neck
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15/90. Urethral catheter: a pain in the neck!

    Long-term urinary catheterization is well recognized in the literature as being associated with significant morbidity and mortality. We present a rare and previously unreported complication of a cervical spine abscess resulting from methicillin-resistant staphylococcus aureus septicaemia originating from the urinary tract in a patient with a urinary catheter.
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ranking = 4
keywords = neck
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16/90. Multiple hydatid cysts of the neck, the nasopharynx and the skull base revealing cervical vertebral hydatid disease.

    Hydatid disease is caused by the parasitic tapeworm echinococcus. This parasite in larval stage can thrive in many parts of the body, most commonly in the liver and the lung. Hydatid disease in the head and neck is uncommon and hydatid cyst presents rarely as a cervical mass. Cervical vertebral echinococcosis is rare. We report a 14-year-old girl with multiple cervical spine hydatid cysts of the C1-C2 vertebrae that spread into the surrounding paravertebral tissues and involve the nasopharynx and the skull base particularly the left jugular foramen. This process has caused a progressive swelling in the left side of the neck located in the retrostyloid compartment of the parapharyngeal space with paralysis of cranial nerves (VI, IX, X, XI, XII). The diagnosis was made based on the image obtained from CT and MRI examinations. Characteristics of this rare disease, diagnosis and treatment difficulty are discussed.
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keywords = neck
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17/90. Fetal spinal-cord injury secondary to hyperextension of the neck: no effect of caesarean section.

    A 24-month-old Japanese girl is reported who had upper spinal-cord injury secondary to fetal hyperextension of the neck in breech presentation. She was first noted to be in this position 10 days before the expected date of birth and was delivered by caesarean section.
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keywords = neck
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18/90. Unilateral headache with features of hemicrania continua and cervicogenic headache--a case report.

    A case is presented which has features of Cervicogenic headache and of Hemicrania Continua. A sudden maneuver of the neck and later a greater occipital nerve block, both resulted in relief of the pain. A cervical cause is suggested.
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keywords = neck
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19/90. meningitis following gunshot wound of the neck.

    It is generally assumed that a missile fired from a gun is subjected to sufficient heat to render it sterilized. For this reason, retained bullets are not usually considered a source of infection. The infectious complications associated with gunshot wounds are typically attributed to perforation of a hollow viscus with leakage of gastrointestinal contents causing peritonitis or intra-abdominal abscess. There are several reports of bacterial meningitis involving the spinal cord in gunshot wounds that perforate the intestine prior to involving the thoracic or lumbar vertebral column; however, there are no published reports of cerebral meningitis resulting from a retained projectile in the spinal canal in which there was no injury to the gastrointestinal tract. This manuscript describes a woman who died as a result of unsuspected acute bacterial meningitis which developed secondary to a gunshot wound of the neck. The projectile fractured the first thoracic vertebra, lacerated the dura and contused the spinal cord at the C7-T1 junction. meningitis developed at the C7-T1 level and ascended along the cervical spinal cord to the brain. The infection caused acute neurologic deterioration and death four days following the initial injury.
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ranking = 5
keywords = neck
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20/90. Cervical epidural abscess: approaches to diagnosis.

    We report on two cases of cervical epidural abscess (CEA). Their clinical presentation included fever, neck pain and symptoms of neural compression, and the presence of epidural abscess was documented by surgery. Several imaging methods were used to establish a prompt diagnosis of CEA in both patients. Magnetic Resonance image provided a noninvasive means of visualize both extent in the spinal canal and paravertebral locations. None of the other currently used imaging modalities could provide the same information alone. The role of these techniques in diagnosing this condition is discussed.
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keywords = neck
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