Cases reported "Spinal Fractures"

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11/150. carbon dioxide and gadopentetate dimeglumine venography to guide percutaneous vertebroplasty.

    Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) is an effective procedure for relieving pain due to vertebral body compression fractures. The technique employs iodinated contrast venography to exclude needle placement directly within the basivertebral complex. We present two cases in which carbon dioxide (CO2) and gadopentetate dimeglumine venography was used to guide percutaneous vertebroplasty in patients with a contraindication to iodinated contrast.
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12/150. blood-pool scintigraphic diagnosis of fractured lumbar vertebral hemangioma.

    A 57-year-old woman complained of lumbago of 1 year's duration. Radiographs showed a compression fracture of the third lumbar vertebra. CT and MR images revealed an enhancing mass confined to the vertebral body suggestive of a malignant process. A blood-pool scintigram with 99mTc-human serum albumin combined with DTPA (HSA-D) revealed marked accumulation. This strongly suggested a hemangioma, which was confirmed by biopsy.
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13/150. Use of a craniofacial miniplate for internal fixation in a young child with cervical instability. Case report.

    Commercially available anterior cervical internal fixation devices are designed for placement in adults and older children. Use of these systems in preschool-aged children is precluded due to the small size of their cervical vertebral bodies (VBs). The authors describe a 2-year-old boy who suffered a C3-4 injury, resulting in complete ligamentous disruption. Because of the gross cervical instability, they elected to perform surgery via posterior and anterior approaches, supplemented with internal fixation, during the same operation. The purpose of the anterior internal fixation device is to deliver compressive forces onto the interbody graft and keep it in place, thus optimizing the potential for a successful fusion. Because of the discrepancy in size between the VBs and the plate and screws, however, the authors were unable to use any of the standard anterior cervical fixation devices. Instead, they implanted a craniofacial miniplate, and the patient was required to wear an external halo brace. The miniplate provided enough stability to allow for a solid fusion. The authors believe that this technique is a reasonable option in young children who require anterior cervical fixation.
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14/150. The role of acute decompression and restoration of spinal alignment in the prevention of post-traumatic syringomyelia: case report and review of recent literature.

    STUDY DESIGN: Case report. INTRODUCTION: Acute post-traumatic syringomyelia formation after spinal cord injury has been considered a rare complication. At this writing, most recent reports have surfaced in neurosurgical journals. As an entity, post-traumatic syringomyelia has not been widely appreciated. It has been confused with conditions such as Hansen's disease or ulnar nerve compression at the cubital tunnel. One study also demonstrated that the occurrence of syrinx is significantly correlated with spinal stenosis after treatment, and that an inadequate reduction of the spine may lead to the formation of syrinx. This reported case describes a patient in whom post-traumatic syringomyelia began to develop 3 weeks after injury, which improved neurologically after adequate decompression. SUMMARY OF BACKGROUND DATA: A 30-year-old man sustained a 20-foot fall at work. He presented with a complete spinal cord injury below T4 secondary to a T4 fracture dislocation. The patient underwent open reduction and internal fixation of T1-T8. After 3 weeks, the patient was noted to have ascending weakness in his bilateral upper extremities and some clawing of both hands. methods: A computed tomography myelogram demonstrated inability of contrast to pass through the T4-T5 region from a lumbar puncture. An incomplete reduction was noted. The canal showed significant stenosis. A magnetic resonance image of the patient's C-spine showed increased signal in the substance of the cord extending into the C1-C2 area. The patient returned to the operating room for T3-T5 decompressive laminectomy and posterolateral decompression including the pedicles, disc, and posterior aspect of the body. Intraoperative ultrasound monitoring showed a good flow of cerebrospinal fluid past the injured segment. RESULTS: On postoperative day 1, the clawing posture of the patient's hands was significantly diminished, and the patient noted an immediate improvement in his hand and arm strength. Over the next few days, the patient's strength in the bilateral upper extremities increased to motor Grade 4/5 on manual testing. A magnetic resonance image 4 weeks after decompression showed significant improvement in the cord diameter and signal. CONCLUSIONS: Post-traumatic syringomyelia has not been reported at so early a stage after injury. This disorder is an important clinical entity that must be recognized to prevent potentially fatal or devastating complications. As evidenced by the reported patient and the literature, if this disorder is discovered and treated early, permanent deficit can be avoided. The prevention of post-traumatic syringomyelia requires anatomic realignment and stabilization of the spine without stenosis, even in the case of complete injuries, to maintain the proper dynamics of cerebrospinal fluid flow.
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15/150. Intradural arachnoid cyst associated with thoracic spinal compression fracture: 7-year follow up after surgery.

    STUDY DESIGN: A case report with long-term follow after a surgical procedure. OBJECTIVES: To describe a case of intradural arachnoid cyst secondary to a compression fracture in the thoracic spine and to report long-term results after surgical treatment with hemilaminectomy. SETTING: Osaka, japan. methods: A 68-year-old man who had a traumatic intradural arachnoid cyst following an adjacent compression fracture of T5 underwent surgery. Intraoperatively, after recognition of intradural arachnoid cyst with an echogram following hemilaminectomy, the dural sac was incised and the arachnoid cyst was resected under microscopic observation. RESULTS: At 7 years after the operation, the low intensity within the vertebral body of the compression fracture had resolved and the spinal cord remained in its normal shape and position. No progression of kyphotic deformity was detected. CONCLUSION: A compression fracture of the thoracic spine can be associated with an intradural arachnoid cyst. Microscopic resection via hemilaminectomy for the cyst showed a good result in a 7-year follow up.
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16/150. Salvage of a malpositioned anterior odontoid screw.

    STUDY DESIGN: Description of surgical technique with case correlation. OBJECTIVE: This article presents an alternative approach to anterior odontoid screw salvage in a patient with established nonunion. SUMMARY OF BACKGROUND DATA: Type II odontoid fractures are often treated surgically because of their risk of nonunion. Anterior odontoid screw fixation offers stable fixation without loss of atlantoaxial motion. treatment failure may occur despite adequate screw placement but is more likely when fixation is inadequate. The traditional solution is a posterior fusion. In selected cases the surgeon may want to revise the anterior instrumentation with the hope of retaining as much C1-C2 motion as possible. methods: A 43-year-old man presented 16 months after Type II odontoid fracture treated by anterior odontoid screw fixation. He had neck pain, instability, and a pseudarthrosis confirmed on radiographs. The screw was excessively long, piercing the C3 vertebral body and providing inadequate fixation. To avoid posterior fusion, a modified anterior approach was used. An entry point was selected 10 mm lateral to the midline, along the anterior rim of the C2 vertebral body. A large-diameter lag screw was then passed to the tip of the fragment. An angled curette was introduced into the fracture gap through the interval between the odontoid and the C1 ring. Autogenous bone was packed into the gap and along the old screw tract. RESULTS: At the 2-year follow-up the patient had a solid union with no neck pain, no headaches, no radicular symptoms, and excellent range of motion. The approach is described. CONCLUSION: In properly selected patients an anterior revision approach can provide a better outcome than posterior cervical fusion. This modified approach allows placement of an adequate fixation screw in a vertebra damaged by previous screw failure.
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17/150. Fractures of the posterior part of the body and unilateral spinous process of the axis: a case report.

    STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To present a case of the fractures of the posterior part of the body and unilateral spinous process of the axis. SUMMARY OF BACKGROUND DATA: A few authors have described fractures involving the body of the axis. Fractures of the posterior part of the body and unilateral spinous process of the axis are extremely rare. methods: A fracture of the posterior part of the body and unilateral spinous process was treated nonsurgically by a halo and a philadelphia brace. The relevant literature was reviewed. RESULTS: Solid bony union was shown by plain radiographs and computed tomography. The patient was free of pain and obtained a full range of motion. CONCLUSION: The presumed mechanism of injury in the fracture described here was flexion and axial rotation.
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18/150. Traumatic posterior atlantooccipital dislocation with Jefferson fracture and fracture-dislocation of C6-C7: a case report with survival.

    Atlantooccipital dislocation (AOD) is a rare and usually fatal injury. In the current study, the authors reported an extremely rare case of posterior AOD with Jefferson fracture and fracture-dislocation of C6-C7. The patient survived the injury and had only incomplete quadriplegia below the C7 segment with anterior cord syndrome. He was successfully managed with in situ occipitocervical fusion using the Cotrel-Dubousset rod system, corpectomy of C6, and anterior interbody fusion of C5-C7 with plating. To our knowledge, this is the first report of posterior AOD with two other non-contiguous cervical spine injuries. A high index of suspicion and careful examination of the upper cervical spine should be considered as the key to the diagnosis of AOD in cases that involve multiple or lower cervical spine injuries.
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19/150. C1-C2 pedicle screw fixation with rigid cantilever beam construct: case report and technical note.

    OBJECTIVE AND IMPORTANCE: Transarticular screw fixation of the C1-C2 complex provides immediate rigid fixation of the unstable spine. The technique is not feasible in a certain proportion of patients because of the position of the vertebral artery or the patient's body habitus. CLINICAL PRESENTATION: The authors describe a rigid screw technique for the surgical treatment of a woman who was excluded as a candidate for C1-C2 transarticular screw fixation. TECHNIQUE: C1-C2 pedicle screw fixation was achieved using a fixed moment arm cantilever beam system. This system provided immediate rigid fixation of the C1-C2 complex in a patient who was not a candidate for transarticular screw fixation. CONCLUSION: This technique is technically more forgiving than posterior transarticular screw fixation and may be applied to a broader spectrum of patients.
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20/150. Combined odontoid and jefferson fracture in a child: a case report.

    STUDY DESIGN: A case of combined odontoid and Jefferson fracture is reported. OBJECTIVE: To alert spine physicians to the rare combination of an odontoid and Jefferson fracture in a child. methods: A 5-year old boy presented with neck pain and torticollis after falling on his head from a four-wheeler that had rolled over. A computed tomography scan confirmed a combined odontoid and Jefferson fracture. RESULTS: The child was successfully treated nonsurgically with a hard cervical orthosis. At this writing, the child clinically is asymptomatic 2 years after the injury. DISCUSSION: The fall on to the head caused the body weight to be transmitted to the atlas. The resulting force vector produced the classic Jefferson fracture of the atlas. As the atlas fracture spread with continued compressive and axial forces, tension was exerted on the alar ligaments (check ligaments), leading to the avulsion fracture of the odontoid. CONCLUSIONS: This is only the second reported case of a child with a combined Jefferson and odontoid fracture. This diagnosis should be considered in the evaluation of a child with neck pain and torticollis from a fall on the top of the head.
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