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Background: Clinical compression neuropathy caused by para-articular cysts is rare. Only recently, the unifying articular theory was proposed to clarify its true etiologic nature. The authors attribute 17 cases to this theory in order to illustrate the shift in the diagnostic and treatment protocol, and the possible impact on patient outcome. Methods: Eight intraneural and nine extraneural cysts were included. The proposed diagnostic protocol includes electromyography and ultrasound, followed by magnetic resonance imaging to characterize the cyst. The proposed treatment protocol consists of (1) ligation of the pedicle connecting the cyst with the afflicted joint, (2) decompression of the nerve and, when needed and (3) disarticulation of the superior tibiofibular joint (in case of peroneal nerve involvement). Results: Outcome was good to excellent in all patients, with recovery of sensory and motor function. Cyst recurrence was observed in three intraneural cases (18 %). Analysis of our own diagnostic protocol showed that atypical compression neuropathies should follow a strict diagnostic protocol to exclude missing the presence of a cyst. Ultrasound needs to play a crucial role, with MRI for cyst characterization and pedicle identification. Conclusions: Retrospective proof in favor of the articular theory was found in all cases. An explanation for the cyst recurrences was formed based on the articular theory. In addition, a diagnostic and therapeutic protocol is proposed for all atypical peripheral compression neuropathies with the ultimate goal to achieve optimal patient outcome. [ABSTRACT FROM AUTHOR]

A consecutive series of 75 patients with fractures of the thoracolumbar spine, stabilized with the Dick internal fixator, was studied retrospectively. Posttraumatic kyphosis was measured on the preoperative lateral radiograph by the Cobb angle and the wedge angle and the results were compared with angles measured on the radiographs after instrumentation and after removal of the implants. The presence and number of broken Schanz screws was noted. In the whole group, an average correction of kyphosis of 15.5 degrees was obtained, but 7.6 degrees was lost again at follow-up. In comparing the kyphotic angle with the wedge angle, we found that this loss was almost exclusively situated in the upper intervertebral disc space. In the group of patients with transpedicular intravertebral bone grafting, the relative loss of correction in the wedge angle was smaller than in the group without bone grafting, while the relative loss of correction of the kyphotic angle was similar. Schanz screw breakage was present in 13.3% of patients, occurring in 4.6% of inserted screws. In the group of patients with broken Schanz screws, the loss of correction in the wedge angle was somewhat higher, but not markedly different from that of the patient group without breakage of screws. Risk of screw breakage was enhanced by laminectomy and reduced by transpedicular bone grafting. Screw breakage or important loss of correction did not influence the neurological outcome of the patients. The Dick internal fixator is a very reliable implant, even in patients with highly unstable fractures.(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

Surgical reconstruction and fusion form the treatment of choice for unstable thoracolumbar fractures. It remains difficult, however, to prove that surgical treatment provides an increased potential for neurological recovery. Also, the role of a decompressive laminectomy is still unclear. To address these issues, 93 consecutive cases of thoracolumbar fractures treated with dorsal instrumentation were reviewed. The neurological status at the time of admission and at a mean of 26 months postinjury was graded according to a modified Frankel scale. By using preoperative radiographs and computed tomography scans, we differentiated between fracture-dislocation lesions, dislocation lesions, flexion-distraction lesions, complete and incomplete burst fractures. Spinal stenosis was classified from grade 0 (no stenosis) to grade 3 (> 66% stenosis). All thoracolumbar fractures were treated with posterior instrumentation, using Dick's fixateur interne and Steffee's VSP plates and screws. During this procedure, laminectomy was performed in 33 patients (35%). In 17 cases (52% of the laminectomies), a surgically treatable lesion (dural tear, trapped nerve root, etc.) was found, especially in patients with a combination of a neurological deficit and a dislocation lesion, a fracture-dislocation lesion or a complete burst fracture with spinal stenosis grade 2 or 3. The neurological and functional outcome was excellent: none of the patients deteriorated, 68% made a complete neurological recovery, and 61% regained their previous level of activity. [ABSTRACT FROM AUTHOR]

Surgical reconstruction and fusion form the treatment of choice for unstable thoracolumbar fractures. It remains difficult, however, to prove that surgical treatment provides an increased potential for neurological recovery. Also, the role of a decompressive laminectomy is still unclear. To address these issues, 93 consecutive cases of thoracolumbar fractures treated with dorsal instrumentation were reviewed. The neurological status at the time of admission and at a mean of 26 months postinjury was graded according to a modified Frankel scale. By using preoperative radiographs and computed tomography scans, we differentiated between fracture-dislocation lesions, dislocation lesions, flexion-distraction lesions, complete and incomplete burst fractures. Spinal stenosis was classified from grade 0 (no stenosis) to grade 3 (> 66% stenosis). All thoracolumbar fractures were treated with posterior instrumentation, using Dick's fixateur interne and Steffee's VSP plates and screws. During this procedure, laminectomy was performed in 33 patients (35%). In 17 cases (52% of the laminectomies), a surgically treatable lesion (dural tear, trapped nerve root, etc.) was found, especially in patients with a combination of a neurological deficit and a dislocation lesion, a fracture-dislocation lesion or a complete burst fracture with spinal stenosis grade 2 or 3. The neurological and functional outcome was excellent: none of the patients deteriorated, 68% made a complete neurological recovery, and 61% regained their previous level of activity. [ABSTRACT FROM AUTHOR]

We report a case of bilateral synovial cysts at L4-L5 level, examined by myelography, computed tomography (CT) and magnetic resonance imaging (MRI). On myelography, the lesions appeared as extradural masses. On CT, the lesions were cystic, with calcifiedd walls and were in close proximity to the facet joints. On MRI, the cystic nature of the lesions was confirmed. The wall appeared hypo-intense both on T1- and T2-weighted images (WI), and enhanced after intravenous administration of Gadolinium-DTPA (Gd-DTPA). This enhancement is thought to represent the peripheral fibrous capsule of the lesion and might be of importance both in the detection and the differential diagnosis of these lesions. [ABSTRACT FROM AUTHOR]