Cases reported "Spinal Fractures"

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1/40. Lumbar intraspinal synovial cysts of different etiologies: diagnosis by CT and MR imaging.

    Intraspinal synovial cysts arises from a facet joint and may cause radicular symptoms due to nerve root compression. In the present study, three surgically and histologically proved cases of synovial cyst of the lumbar spine with different etiology are described. The purpose of this report is to illustrate the imaging features of various etiologies of intraspinal synovial cysts allowing a correct preoperative diagnosis. review of the literature enables us to say that to our knowledge, there is no reported article collecting the imaging findings of intraspinal synovial cysts with different etiologies. Only single cases with rheumatoid arthritic or traumatic origin have been reported to date. We believe that computed tomography and particularly magnetic resonance imaging are the methods of choice which provide the most valuable diagnostic information.
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2/40. Neurological complications in insufficiency fractures of the sacrum. Three case-reports.

    Three cases of nerve root compromise in elderly women with insufficiency fractures of the sacrum are reported. Neurological compromise is generally felt to be exceedingly rare in this setting. A review of 493 cases of sacral insufficiency fractures reported in the literature suggested an incidence of about 2%. The true incidence is probably higher since many case-reports provided only scant information on symptoms; furthermore, sphincter dysfunction and lower limb paresthesia were the most common symptoms and can readily be overlooked or misinterpreted in elderly patients with multiple health problems. The neurological manifestations were delayed in some cases. A full recovery was the rule. The characteristics of the sacral fracture were not consistently related with the risk of neurological compromise. In most cases there was no displacement and in many the foramina were not involved. The pathophysiology of the neurological manifestations remains unclear. We suggest that patients with sacral insufficiency fractures should be carefully monitored for neurological manifestations.
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3/40. Laminar and arch fractures with dural tear and nerve root entrapment in patients operated upon for thoracic and lumbar spine injuries.

    OBJECTIVE: To determine the neurological outcome in patients with laminar fractures associated with dural tears and nerve root entrapment, operated upon for thoracic and lumbar spine injuries. PATIENT population: Out of 103 patients operated upon consecutively for thoracic and lumbar spine injuries during the period 1990 to 1994 inclusive, 24 (23.3%) patients had laminar fractures out of whom 3 (2.9%) had an associated dural tear and an other 17 (16.5% or 70.8% of the total patients with laminar fractures) had an associated dural tear and nerve root entrapment. RESULTS: Twelve (70.5%) patients had injury at the thoraculumbar junction, 13 (76.5%) had Magerl's type A3 or above, 10 (58.8%) had a kyphotic angle deformity greater than 5 degrees. Seven (41.1%) had their spinal canal's sagittal diameter reduced by at least 50% and two had dislocations. Nine (52.9%) had initial neurological deficits. Four (50%) out of 8 patients with no initial neurological deficits (Frankel E) worsened to Frankel D. However, one patient among the 3 with initial Frankel A improved to Frankel C while both patients with initial Frankel C usefully improved to final Frankel grades D and E respectively. Two of the four patients with initial Frankel D improved to Frankel E, the other 2 remaining unchanged. All in all five patients neurological status improved, 4 worsened and 8 remained unchanged after neurosurgical treatment. CONCLUSIONS: Vertical laminar fractures with dural tears and nerve root entrapment represent a special group of thoracic and lumbar spine injuries that carry a poor prognosis. However, special operative precautions lead to significant improvement in some of them although a majority remain unchanged or even worsened.
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4/40. Management of an unstable lumbar fracture with a laminar split.

    This is a case report describing the injury sustained by a 36-year-old man injured in a motorcycle crash who sustained a fracture dislocation of L2 upon L3, associated with a split in the lamina of L3. His neurologic lesion was T12 asia B: with a motor score of 52 but with preservation of sensory function (sensory score 96) in most parts of his lower extremities. He also suffered a lower extremity fracture. Imaging of the spine is presented showing a multiplanar fracture associated with translation and with a defect in the lamina that may be seen in certain AO type B or type C fractures, that may entrap the lumbar spinal nerve roots. Discussants of this case comment on the classification and clinical significance of this fracture pattern. and present their operative approaches, both for management of this particular fracture pattern and for any associated dural tear. The issues of steroid use and the place of rehabilitation are also discussed.
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5/40. Jefferson fracture resulting in Collet-Sicard syndrome.

    STUDY DESIGN: A case report and review of the literature. OBJECTIVE: To increase awareness of and add to the spectrum of injury that can result from Jefferson fractures, to suggest a possible mechanism of injury, and to give a brief review of pertinent facts regarding C1 burst fractures and the Collet-Sicard syndrome. SUMMARY OF BACKGROUND DATA: To the author's knowledge, this is the first reported case of a Jefferson fracture resulting in Collet-Sicard syndrome. It represents only the second reported case of cranial nerve palsy caused by Jefferson fracture. methods: A 56-year-old man sustained a C1 burst fracture in a rollover motor vehicle accident. Repeated neurologic examinations over the ensuing days revealed lesions of cranial nerves IX, X, XI, and XII on the left side. RESULTS: Two weeks of traction, 10 weeks in a halo vest, and 2 weeks in a cervical collar resulted in adequate fracture healing and almost complete resolution of the patient's neurologic symptoms. CONCLUSION: Although this is the first reported case of Collet-Sicard syndrome caused by Jefferson fracture, the authors' review of the literature suggests that cranial nerve injuries may go unrecognized in some patients with C1 burst fractures. The importance of a thorough neurologic examination, including examination of the cranial nerves, in all cases of cervical spine injury cannot be overemphasized.
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6/40. Thoracic paravertebral block for management of pain associated with multiple fractured ribs in patients with concomitant lumbar spinal trauma.

    BACKGROUND AND OBJECTIVES: The need for continual neurological assessment in patients with lumbar spinal injury poses a challenge for effective management of pain associated with multiple fractured ribs. Two cases are presented to illustrate the benefits of using thoracic paravertebral block to control the pain of multiple fractured ribs without compromising the ongoing neurological assessment. CASE REPORT: Thoracic paravertebral block was used in 2 patients with concomitant multiple fractured ribs and lumbar spinal injury. Case 2 also had a head injury and there was moderate coagulopathy. The thoracic paravertebral catheter was placed in the upper thoracic region and radiological imaging was used to delineate spread before the injection of relatively small volumes (10 to 15 mL) of local anesthetic. In case 1, the thoracic paravertebral block produced ipsilateral segmental thoracic anesthesia, providing excellent pain relief for the fractured ribs. It also spared the lumbar and sacral nerve roots, preserving neurological function in the lower extremities and bladder sensation. In case 2, effective analgesia without systemic sedation and opioids resulted in the patient regaining consciousness, which allowed continuous assessment of central and peripheral neurological function. CONCLUSION: Thoracic paravertebral block is an option for managing pain associated with multiple fractured ribs in the presence of concomitant lumbar spinal injury requiring continual neurological assessment.
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7/40. 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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8/40. Posttraumatic sagittal osseous bar in the spinal canal of an adult: a case report.

    Diastematomyelia is a congenital anomaly wherein the distal spinal canal is bisected by a longitudinally oriented septum made up of fibrous tissue, cartilage, or bone. The main lesion is expressed by characteristic gait disturbances and dysfunction of the anal and vesical sphincters resulting from damage to the cord or cauda equina. Symptoms almost invariably begin during childhood. By the time symptoms appear, the damage is largely irreversible. In rare instances, the neuropathic expression of diastematomyelia is delayed until adult life. Only a dozen such cases have been reported. Described herein is the case of a patient in whom the typical symptoms appeared at 28 years of age. decompression laminectomy and resection of the septum relieved the symptoms completely and permanently. The pathogenesis of nerve damage in diastematomyelia is thought to be different in patients with adult-onset disease than in children. This could explain why surgical treatment has a better prognosis in adults.
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9/40. Spontaneous osteoporotic fractures of the sacrum causing neurological damage. Report of three cases.

    Although osteoporotic fractures of the sacrum seem to be a well-known entity, their associated rate of neurological complications has not been assessed in the literature. The authors report three such cases of nerve root compromise in elderly women and conduct a literature review. Based on their review, they estimate the incidence to be approximately 2%. The true incidence is probably higher because many case reports provide only scant information on symptoms; furthermore, sphincter dysfunction and lower-limb paresthesias are the most common symptoms and can readily be overlooked or misinterpreted in elderly patients with multiple health problems. The neurological manifestations were delayed in some cases. A full recovery is the rule. The characteristics of the sacral fracture are not consistently related with the risk of neurological compromise. In most reviewed cases the authors found no displacement and in many the foramina were not involved. The pathophysiology of the neurological manifestations remains unclear. The authors suggest that patients with sacral osteoporotic fractures should be carefully monitored for neurological manifestations.
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10/40. A new table-fixed retractor for anterior odontoid screw fixation: technical note.

    The authors describe a unique retraction device adapted for anterior odontoid screw placement. A rigidly fixed tubular retractor system obviates the need for dissecting the longus colli muscles as well as for excessive retraction of the trachea, esophagus, and recurrent laryngeal nerve. The proper trajectory for screw placement can be determined by fine manipulation of the retractor as determined by biplanar fluoroscopy. The retractor is then rigidly fixed in position. The tubular corridor permits the odontoid screw to be placed in the usual fashion.
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