Search

Introduction: Spinal cord herniation occurs idiopathically or is due to defective or weakened dura mater resulting from iatrogenic or traumatic lesions. Although there have been many reports of idiopathic cases, there are few reports of postoperative iatrogenic spinal cord herniation. The authors describe a rare case of postoperative spinal cord herniation in the cervical spine, with an extensive analysis of reported cases Materials and methods: This article reports a documented case of postoperative spinal cord herniation. The case description is followed by an analysis of the literature. Results: A 67-year-old woman who had cervical laminectomy 3 weeks before for cervical laminectomy, presented with neck pain and torticollis after coughing. The MRI findings showed a cervical medulla herniation with cerebrospinal fluid (CSF) leakage. The patient underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms. Over the previous 50 years (1973-- 2023), 16 post-operative spinal cord herniation cases were reported. The mean patient age was 43.3 years (range 15--67 years). There was a male predominance (80%). The mean onset period after surgery was 292 weeks (range, 1 week to 728 weeks). Clinical symptomatology was polymorphic with non-specific signs. Conclusion: Iatrogenic spinal cord herniation is an extremely rare occurrence after spine surgery. The diagnosis must be evoked in case of any neurological degradation after surgery of the cervical spine, thoracic spine or thoracolumbar junction. The surgical management gives satisfactory clinical results. [ABSTRACT FROM AUTHOR]

The occurrence of an abdominal tumor invading the spinal canal and causing symptoms of epidural compression is rare in an infant, and exceptional at birth. Peripheral neuroblastic tumors are by far the most common cause. Emergency chemotherapy is commonly curative, though permanent sequelae are possible. Although other malignancies may be involved, no case of rhabdoid tumors at birth has been reported. We describe the case of a neonate who presented symptoms of spinal epidural compression at birth secondary to a rhabdoid tumor. As expected with this highly malignant tumor, the patient experienced a rapidly progressive clinical course and died within three months of diagnosis.

Introduction: Spinal cord herniation occurs idiopathically or is due to defective or weakened dura mater resulting from iatrogenic or traumatic lesions. Although there have been many reports of idiopathic cases, there are few reports of postoperative iatrogenic spinal cord herniation. The authors describe a rare case of postoperative spinal cord herniation in the cervical spine, with an extensive analysis of reported cases Materials and methods: This article reports a documented case of postoperative spinal cord herniation. The case description is followed by an analysis of the literature. Results: A 67-year-old woman who had cervical laminectomy 3 weeks before for cervical laminectomy, presented with neck pain and torticollis after coughing. The MRI findings showed a cervical medulla herniation with cerebrospinal fluid (CSF) leakage. The patient underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms. Over the previous 50 years (1973–2023), 16 post-operative spinal cord herniation cases were reported. The mean patient age was 43.3 years (range 15–67 years). There was a male predominance (80%). The mean onset period after surgery was 292 weeks (range, 1 week to 728 weeks). Clinical symptomatology was polymorphic with non-specific signs. Conclusion: Iatrogenic spinal cord herniation is an extremely rare occurrence after spine surgery. The diagnosis must be evoked in case of any neurological degradation after surgery of the cervical spine, thoracic spine or thoracolumbar junction. The surgical management gives satisfactory clinical results.

A 7‐month‐old, crossbreed dog presented for collapsing episodes and acute non‐ambulatory tetraparesis. Magnetic resonance imaging and computed tomography revealed absence of the dorsal arch of the first cervical vertebrae and displacement of the second cervical vertebrae, with severe spinal cord compression. Surgical spinal stabilisation was performed under general anaesthesia. Postoperatively, attempts to wean the animal from mechanical ventilation were unsuccessful. Despite the dog's efforts to breathe spontaneously, severe hypercapnia (EtCO2 11.4 kPa [85.5 mmHg]) developed. Due to a lack of appropriate resources, pharmacological support of ventilation was attempted, using doxapram (2 mg/kg intravenously), followed by a variable‐rate infusion (5–30 µg/kg/min) maintained for 48 hours. The dog was discharged 48 hours after doxapram discontinuation. [ABSTRACT FROM AUTHOR]

Purpose: Hypertrophic pachymeningitis associated with immunoglobulin G4- related disease (IgG4-RD) has been rarely reported, and there is little information and no clear consensus on the management of IgG4-related spinal pachymeningitis (IgG4-RSP). The present study described its possible clinical features, including the symptoms, imaging, treatment and prognosis of patients with IgG4-RSP. Methods: We report three patients who presented with progressive neurological dysfunction due to spinal cord compression. Relevant articles were searched from the PubMed, Web of Science, and Embase databases, and the resulting literature was reviewed. Results: The literature review provided a summary of 45 available cases, which included three cases from our center. Progressive worsening of neurological impairment was observed in 22 patients (48.9%). The lesions involved the thoracic spine (n=28, 62.2%), cervical spine (n=26, 57.8%), lumbar spine (n=9, 20.0%), and sacral spine (n=1, 2.2%). Furthermore, the lesions were located in the dura mater (n=18, 40.0%), epidural space (n=17, 37.8%), intraduralextramedullary space (n=9, 20.0%), and intramedullary space (n=1, 2.2%). On magnetic resonance imaging (MRI), the lesions generally appeared as striated, fusiform, or less often lobulated oval changes, with homogeneous (n=17,44.7%) and dorsal (n=15,39.5%) patterns being the most common. Thirty-five patients had homogeneous T1 gadolinium enhancement. Early surgical decompression, corticosteroid treatment, and steroid-sparing agents offered significant therapeutic advantages. A good therapeutic response to disease recurrence was observed with the medication. Conclusion: The number of reported cases of IgG4-RSP remains limited, and patients often have progressive worsening of their neurological symptoms. The features of masses identified on the MRI should be considered. The prognosis was better with decompression surgery combined with immunosuppressive therapy. Long-term corticosteroid treatment and steroid-sparing agent maintenance therapy should be ensured. A systemic examination is recommended to identify the presence of other pathologies. [ABSTRACT FROM AUTHOR]

Spinal hydatid disease is a rare form of hydatid disease caused by the larval stage of Echinococcus granulosus. It refers to a range of conditions that affect the spinal cord, the spine, or both. The prevalence of spinal hydatid disease is highest in the thoracic spine; however, it can also occur in other regions of the spine. In this case report, we present an unusual occurrence of numerous hydatid cysts in a 42-year-old male living in a remote region. The patient has been experiencing a progressive loss of power in his lower limbs, urine incontinence, and back pain for the past four months. The patient was found to have many distinct cystic lesions with spinal cord compression syndrome. Spinal hydatidosis is an uncommon illness that causes significant suffering and has a bleak outlook. When evaluating a patient with spinal compression syndrome, it is important to evaluate this as one of the potential causes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Suryawanshi et al.)

Ewing's sarcoma is a highly malignant bone tumor commonly affecting the diaphysis of long bones and pelvic bones. It belongs to a spectrum of neoplastic diseases known as the Ewing sarcoma family of tumors (EFT) with the same histologic, immunohistochemical characteristics and chromosomal translocation. It commonly affects children between the ages of 5-15 years. Spinal involvement might be primary or metastatic. Primary spinal involvement is infrequent. We report a 7-year female with acute paraplegia caused by dorsal osseous Ewing's sarcoma that her presentation mimics other causes of acute lower limb weakness in children. Early detection of this rare case and prompt treatment will ensure better outcomes for the patient. [ABSTRACT FROM AUTHOR]

Spinal arachnoid cysts (SACs) are an uncommon cause of spinal cord compression. A nine-year-old female child presented with pain, stiffness, and weakness in both lower limbs. The girl could walk with support. She had clinical features suggestive of Marfan's syndrome. On examination, she had spastic paraparesis. Neuroimaging revealed multiple extradural arachnoid cysts (EACs) causing cord compression, extending from the cervical to sacral level. Computerized tomography (CT) myelogram did not demonstrate a communication of the EAC with the spinal subarachnoid space at any level or within adjacent cysts. The patient underwent a dorsal laminoplasty (D6 to D8) with excision of the underlying EAC, which was causing maximum compression. Postoperatively, the patient showed significant improvement in her gait. She could walk independently at the time of discharge. The EACs are rare and the present case is the only case to have extensive spinal cord involvement from cervical to sacral levels and only the second in literature in which multiple EACs caused symptomatic cord compression. The relevant literature is reviewed. [ABSTRACT FROM AUTHOR]

Neck pain and injuries are growing healthcare burdens with women having a higher incidence rate and poorer treatment outcomes than males. A better understanding of sex differences in neck biomechanics, foundational for more targeted, effective prevention or treatment strategies, calls for more advanced subject-specific musculoskeletal modeling. Current neck musculoskeletal models are based on generic anatomy, lack subject specificity beyond anthropometric scaling, and are unable to accurately reproduce neck strengths exhibited in vivo without arbitrary muscle force scaling factors or residual torque actuators. In this work, subject-specific neck musculoskeletal models of 23 individuals (11 male, 12 female) were constructed by integrating multi-modality imaging and biomechanical measurements. Each model simulated maximal voluntary neck static exertions in three postures: neck flexion in a neutral posture, flexion in a 40° extended posture, and extension in a 40° flexed posture. Quantitative model validation showed close agreement between model-predicted muscle activation and EMG measurement. The models unveiled that (1) males have greater moment arms in one flexor muscle group and five extensor muscle groups, (2) females exhibited higher cervical spinal compression per unit exertion force in the flexed posture, and (3) the variability of compression force was much greater in females in all three exertions but most notably in the extension with a flexed "dropped head" position. These insights illuminated a plausible pathway from sex differences in neck biomechanics to sex disparities in the risk and prevalence of neck pain. [ABSTRACT FROM AUTHOR]

Background: Spontaneous spinal epidural hematoma (SSEH) is a rare neurologic entity, especially in infants, that develops in the absence of underlying coagulopathy, bleeding diathesis, infection, vascular malformation, trauma, iatrogenic, or other identifiable cause. In contrast to adults, diagnosis is frequently delayed or missed in infants due to non-specific symptoms and limited clinical examination. Case illustration: An 11-month-old female demonstrated symptoms of irritability, intermittent diarrhea, lethargy, decreased oral intake, and difficulties crawling before presenting to the emergency room. At time of presentation, she was noted to have minimal spontaneous movement of the lower extremities and anisocoria with ptosis of the right eye. Given her clinical presentation, a magnetic resonance image (MRI) of the spine was obtained which revealed an epidural hematoma with compression extending from C7-T3. She underwent C7-T3 laminoplasty and hematoma evacuation. Following surgical intervention, she demonstrated significant improvements in her lower extremity strength and resolution of Horner syndrome. Conclusion: SSEH in infants is a rare neurologic condition, with diagnosis often delayed due to nonspecific symptomatology. Prompt diagnosis and intervention are essential in the treatment of SSEH to prevent permanent neurologic dysfunction. Physicians should have a high index of suspicion for SSEH in these instances, and investigation with spinal MRI imaging is recommended. [ABSTRACT FROM AUTHOR]

Background & Aim: Histoplasma capsulatum var. duboisii is a rare fungus that is endemic in the Sahara and Madagascar in southern Africa. The present study was conducted to explain the confirmed cases of histoplasmosis. Methods and Materials/Patients: This retrospective study was conducted at the Division of Neurosurgery of Brazzaville teaching hospital in the Republic of Congo. The clinical records of all of the confirmed cases admitted between January 2014 and December 2017 were reviewed. Results: All of the five cases of confirmed histoplasmosis, including two women and three men, with a mean age of 42 years old, admitted to the Division of Neurosurgery over four years were immunocompetent to HIV. Radiological imaging identified a localized form of cold abscess in two of the patients and disseminated forms in three male cases. Lung lesions were also observed in two patients with multilevel spondylodiscitis and lung diseases, and clavicular osteitis in the other patient. Clavicular osteitis was also found to be associated with cutaneous fistulization in one of the patients, with cutaneous nodules in the second patient and with cutaneous nodules and pulmonary lesions in the third. Appropriate outcomes were observed for the localized forms but undesirable ones for the disseminated forms. Four patients had received medical and surgical treatments. This treatment caused an appropriate evolution in patients with localized forms and an undesirable evolution in the two scattered forms. These patients died upon admission due to the complications associated with their severe neurological condition. The final case died before beginning the antifungal treatment following a septic shock with the fistulization of osteitis clavicularis as its potential cause. Conclusion: Although infections with Histoplasma capsulatum var. duboisii are rare, the lack of comprehensive knowledge on this fungus in the majority of medical staff can explain the delays in treating these infections. Microbiological analyses are therefore required to be performed on pathological materials in the event of suppuration to assist with early diagnosis and effective management.

Brown tumors (BTs) represent the typical nonmalignant lesions of hyperparathyroidism. Mandibles, ribs, and large bones are the most usual localization of BT. The diagnosis of these tumors requires biological and radiologic assessments. Their treatment is essentially based on parathyroidectomy. The present case report describes a patient with primary hyperparathyroidism who developed a cervical BT revealed by slow spinal compression. The brown tumor, when localized at the level of the spine, can be life-threatening and must be managed as soon as possible. [ABSTRACT FROM AUTHOR]

Ligamentous cyst is a cystic formation arising from degeneration of ligamentous structures all around the spinal cord. They can cause spinal cord compression, like synovial cyst. Unlike synovial cyst, there is no spinal instability in pathogenesis of ligamentous cyst. Differential diagnosis through pre-operative MRI is difficult and intraoperative findings plus histopathology are crucial to achieve a diagnosis. In this case report, we deal with a rare case of cervical junction ligamentous cyst. A 59-year-old Caucasian female was admitted in our ward with left-sided hemiparesis, cervical pain, and upper limb diffused paresthesias, due to an oval-shaped formation into ALL, of 13 mm in maximum diameter, with peripheral contrast enhancement. The patient underwent, under general anesthesia, a surgery through a posterolateral suboccipital approach which aimed to decompress the spinal cord and to drain the cyst with total removal of the compression by emptying the cyst and fulfilling it with muscle graft and glue. No posterior fixation was needed. After the surgery, symptoms improved and a post-operative MRI scan demonstrated the good result of the surgery. [ABSTRACT FROM AUTHOR]

Inosine is a naturally occurring purine nucleoside, the effect of which was discovered only in recent decades. It has potential to prevent neuronal and glial death and can stimulate axonal outgrowth. This study evaluated the effect of inosine (400 mg per rat) administered orally two hours after experimental spinal cord injury and continuously daily for 12 days. We observed the effect of inosine on clinical and histological changes by means of measurement of recovery of hind leg motor function and urinary bladder function, frequency of spasms, neuronal profile and spinal cord tissue sparing. The rats were randomly divided into three groups, SCI-Aqua and SCI-Inosine, with daily administration of aqua for injection or inosine, and SCI-Sham group without spinal injury. The motor function of hind legs and urinary bladder function were evaluated daily for 12 days after the spinal cord injury. In the SCI-Inosine group we recorded lower incidence of spasms due to spinal cord irritation in the early postoperative period when compared to the SCI-Aqua group. We used immunohistochemistry with specific neuronal antibodies to determine the neuronal profiles and the Luxol fast blue staining method to detect the white and grey matter tissue sparing. In our study we recorded significant differences in recovery between the SCI-Aqua and SCI-Inosine group from eighth days after surgery. Moreover, the post mortem investigation of transverse spinal cord sections revealed significantly higher numbers in the SCI-Inosine group (more neurons, greater tissue sparing). According to our findings inosine accelerates the recovery of neurological functions.

Abstract Background Primary spinal epidural lymphoma (PSEL) is one of the rarest categories of tumors. Spinal cord compression is an uncommon primary manifestation and requires to be treated with surgery for the purpose of diagnosis and decompression. Case Presentation A 45-year-old man presented with a new onset thoracic pain and progress to an anterior spinal syndrome with hypoesthesia and loss of thermalgesia. Magnetic resonance image showed a paravertebral mass that produces medullary compression at T3. The patient was taken up to surgery, where the pathology examination showed a diffuse large B-cell lymphoma. Conclusions PSEL is a pathological entity, which must be considered on a middle-aged man who began with radicular compression, and the treatment of choice is decompression and biopsy. The specific management has not been established yet, but the literature suggests chemotherapy and radiotherapy; however, the outcome is unclear.

Spinal cord injury without radiological abnormalities (SCIWORA) has been defined as a direct trauma to the spinal cord, with no radiological or tomographic abnormalities, although there is a deficit, whether motor, sensory or both. (1) To establish the final diagnosis, shock, obstetrical complications, penetrating trauma to the spine and congenital malformations should be excluded. (2) [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a devastating condition of the central nervous system (CNS) often resulting in severe functional impairment and for which there are not yet restorative therapies. In the present study, we performed a widely used model of SCI to determine the neuroprotective propriety of palmitoylethanolamide (PEA) and the antioxidant effect of a flavonoid luteolin (Lut), given as a co-ultramicronized compound co-ultraPEALut. In particular, by western blot analysis and immunofluorescence staining, we investigated whether this compound (at the dose of 1 mg/kg) was able to modulate autophagy. Our results showed that treatment with co-ultraPEALut after SCI reduced the expression of proteins promoter of autophagy such as Beclin-1 and microtubule-associated protein 1A/1B-light chain 3 (MAP-LC3). In contrast, this compound decreased the levels of mammalian target of rapamycin (mTOR), p-Akt, and p-70S6K which are proteins that inhibit autophagy. These data confirmed that the protective role of co-ultraPEALut is associated with inhibition of excessive autophagy and regulation of protein degradation. Therefore, treatment with co-ultraPEALut could be considered as a possible therapeutic approach in an acute traumatic lesion like SCI. [ABSTRACT FROM AUTHOR]

Introduction: Clinical treatment of spinal metastasis is gaining in complexity while the underlying biology remains unknown. Insufficient biological understanding is due to a lack of suitable experimental animal models. Intercellular adhesion molecule-1 (ICAM1) has been implicated in metastasis formation. Its role in spinal metastasis remains unclear. It was the aim to generate a reliable spinal metastasis model in mice and to investigate metastasis formation under ICAM1 depletion.Material and Methods: B16 melanoma cells were infected with a lentivirus containing firefly luciferase (B16-luc). Stable cell clones (B16-luc) were injected retrogradely into the distal aortic arch. Spinal metastasis formation was monitored using in vivo bioluminescence imaging/MRI. Neurological deficits were monitored daily. In vivo selected, metastasized tumor cells were isolated (mB16-luc) and reinjected intraarterially. mB16-luc cells were injected intraarterially in ICAM1 KO mice. Metastasis distribution was analyzed using organ-specific fluorescence analysis.Results: Intraarterial injection of B16-luc and metastatic mB16-luc reliably induced spinal metastasis formation with neurological deficits (B16-luc:26.5, mB16-luc:21 days, p<0.05). In vivo selection increased the metastatic aggressiveness and led to a bone specific homing phenotype. Thus, mB16-luc cells demonstrated higher number (B16-luc: 1.2±0.447, mB16-luc:3.2±1.643) and increased total metastasis volume (B16-luc:2.87±2.453 mm3, mB16-luc:11.19±3.898 mm3, p<0.05) in the spine. ICAM1 depletion leads to a significantly reduced number of spinal metastasis (mB16-luc:1.2±0.84) with improved neurological outcome (29 days). General metastatic burden was significantly reduced under ICAM1 depletion (control: 3.47×10(7)±1.66×10(7); ICAM-1-/-: 5.20×10(4)±4.44×10(4), p<0.05 vs. control)Conclusion: Applying a reliable animal model for spinal metastasis, ICAM1 depletion reduces spinal metastasis formation due to an organ-unspecific reduction of metastasis development. [ABSTRACT FROM AUTHOR]

Inosine is a naturally occurring purine nucleoside, the effect of which was discovered only in recent decades. It has potential to prevent neuronal and glial death and can stimulate axonal outgrowth. This study evaluated the effect of inosine (400 mg per rat) administered orally two hours after experimental spinal cord injury and continuously daily for 12 days. We observed the effect of inosine on clinical and histological changes by means of measurement of recovery of hind leg motor function and urinary bladder function, frequency of spasms, neuronal profile and spinal cord tissue sparing. The rats were randomly divided into three groups, SCI-Aqua and SCI-Inosine, with daily administration of aqua for injection or inosine, and SCI-Sham group without spinal injury. The motor function of hind legs and urinary bladder function were evaluated daily for 12 days after the spinal cord injury. In the SCI-Inosine group we recorded lower incidence of spasms due to spinal cord irritation in the early postoperative period when compared to the SCI-Aqua group. We used immunohistochemistry with specific neuronal antibodies to determine the neuronal profiles and the Luxol fast blue staining method to detect the white and grey matter tissue sparing. In our study we recorded significant differences in recovery between the SCI-Aqua and SCI-Inosine group from eigth days after surgery. Moreover, the post mortem investigation of transverse spinal cord sections revealed significantly higher numbers in the SCI-Inosine group (more neurons, greater tissue sparing). According to our findings inosine accelerates the recovery of neurological functions. [ABSTRACT FROM AUTHOR]

Background: Spinal hemangiomas are rare vascular malformations resulting from proliferation of vascular endothelial cells. The cavernous form is the most common and represents 5-12% of spinal vascular malformations, while the capillary form is rare., Case Description: A 56-year-old patient with no past medical history presented with progressive spinal cord compression symptoms localizing to the T10 level with MRC grade 4 proximal paraparesis. Preoperative MRI demonstrated a well-delineated, dumbbell-shaped, epidural lesion, without bony involvement, resulting in spinal cord compression at the T7 and T8 levels. The patient underwent gross total surgical resection of the lesion. At the one month follow up, the patient's strength improved to MRC grade 5, and sensation had fully returned. The histopathological diagnosis was a capillary hemangioma. Exclusively epidural capillary hemangiomas are extremely rare with only 26 cases reported in the literature. They are mainly located at the thoracic level (T4-T6). The MRI features include a well-circumscribed mass, hyperintense on T2-weighted sequence in 92% of cases, isointense on T1-weighted sequence in 88% of cases, and homogeneous contrast enhancement in 100% of cases. No tumor recurrence has been observed after gross total surgical removal., Conclusions: When evaluating progressive spinal cord compression by a purely epidural spinal lesion, the differential diagnosis should include capillary hemangioma, in addition to schwannoma, meningioma, and lymphoma. Early and complete surgical removal is the first line treatment., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background context Conventional circumferential stabilization for pathologies causing instability of the thoracic spine requires a two or even a three-staged procedure. The authors present their tertiary care center experience of single-staged procedure to establish a circumferential fusion through an extended costotransversectomy approach. Objective To demonstrate neural canal decompression, removal of the pathology, achieve circumferential fusion, and correcting the deformity through a single procedure. Study design Prospective and observational. Patient sample Forty-six patients with pan thoracic column instability due to various pathologies. Outcome measures Neurologic condition was evaluated using American Spinal Injury Association and Eastern Cooperative Oncology Group grading systems. Outcome was evaluated with regard to the decompression of neural canal, correction of deformity, and neurologic improvement. All patients were evaluated for neural canal compromise and degree of kyphosis preoperatively, early, and late postoperatively. Methods All patients had severe spinal canal compromise (mean, 59%±9%) and loss of vertebral body height (mean, 55%±10%). A single-stage circumferential fusion was performed (four-level pedicle screw fixation along with a ventral cage fixation after a vertebrectomy or corpectomy) through an extended costotransversectomy approach. Results The pathologies included trauma (21), tuberculosis (18), hemangioma (2), aneurysmal bone cyst (1), recurrent hemangioendothelioma (1), solitary metastasis (1) and plasmacytoma (1), and neurofibromatosis (1). Thirty-five of 46 patients (76%) demonstrated improvement in the performance status. The major complications included pneumonitis (3), pneumothorax (3) and neurologic deterioration (3; improved in two), deep venous thrombosis (2), and recurrent hemoptysis (1). No implant failures were noted on last radiology follow-up. There were two mortalities; one because of myocardial infarction and another because of respiratory complications. Conclusions The following study demonstrated that extended costotrasversectomy approach is a good option for achieving single-staged circumferential fusion for correcting unstable thoracic spine due to both traumatic and nontraumatic pathologies. [ABSTRACT FROM AUTHOR]

Despite the evidence suggesting that between 8% and 55% of manual labourers experience thoracic pain, research on spinal loading during occupational tasks has been almost invariably limited to the lumbar spine. In this study, we determined the ratio of thoracic to lumbar compression force and the relative risk of injury to each region in various postures. Compressive forces on the spine were calculated based on previously reported thoracic and lumbar intradiscal pressures and disc cross-sectional areas. Flexion postures were associated with an approximate doubling in lumbar compression force but only small increases (or even decreases) in thoracic compression. The ratio of thoracic to lumbar compression was above the tolerance ratio (i.e. the ratio of thoracic to lumbar compressive strength) during upright postures and below the tolerance ratio during flexion postures, indicating that upright postures may pose a greater relative risk of injury to the thoracic spine than to the lumbar spine. Practitioner summary:Previously reported thoracic and lumbarin vivodisc pressures during various postures were compared. The ratio of thoracic and lumbar compression increased during upright postures and decreased in flexed postures, indicating that upright postures may pose a greater risk of injury to the thoracic spine than to the lumbar spine. [ABSTRACT FROM PUBLISHER]

This study aimed to evaluate the outcome of a simple subtotal debulking surgical management of intradural spinal lipoma without spinal dysraphism.The study included 6 adult patients; 4 were males and 2 females with a mean age of 40.2±8.6 years. All patients underwent full history taking, complete general and neurologic examinations, and radiologic evaluation including plain x-ray and magnetic resonance imaging (MRI). All patients underwent generous internal decompression through removal of as much as possible of the lesions leaving only tissues adherent to the spinal cord.Three patients had dorsal lipomas, 2 patients had lumber lipomas, and only 1 patient had cervical lipoma. The lipomas were found extended through 1-vertebral level in 4 patients, but 4-vertebral level lipoma was detected in 2 patients. Pain was improved in all patients within the first 2 months after surgery. Motor weakness was improved in 2 patients but foot drop did not improve. Parathesia and numbness improved in 4 patients; however, 2 patients still exhibited hypoesthesia. Urinary incontinence was improved in 1 of 2 patients. Postoperative MRI showed some sort of residual tumor tissue and a normal posterior subarachnoid space. Follow-up neurologic examinations during 2 years revealed no abnormalities apart from hypothesia.Intradural spinal lipomas are not a frequent spinal space occupying lesion, they are associated with varied neurologic deficits and early surgical decompression without attempts for complete excision is an ideal therapeutic option associated with satisfactory neurologic improvement and serial MRI for follow-up is mandatory. [ABSTRACT FROM AUTHOR]

Twenty-three patients with atypical forms of spinal tuberculosis treated between 1975 and 1985, are described. All presented with signs and symptoms of compression of the spinal cord or cauda equina, ranging from paraesthesiae and increasing weakness of extremities to paraplegia and loss of sphincter control. None of them showed visible or palpable spinal deformity nor the typical radiographic appearance of destruction of the intervertebral disc and the two adjoining vertebral bodies. These atypical forms constituted about 12 percent of all the cases of spinal tuberculosis seen (a total of 190 cases); and fell into three well-defined groups: those with the involvement of neural arch only; those with the inolvement of a single vertebral body; and, those without bony involvement. The correct surgical approach in these groups was found to be different: spinal cord compression caused by the tuberculous disease of the neural arch was best treated by laminectomy; whereas single vertebral body disease required an anterior or anterolateral approach. Spinal computerized tomography was helpful in defining the extent of disease and planning the surgical approach. Histological confirmation of tuberculosis was obtained in all the cases and acid fast bacilli (A.F.B.) were found in, and cultured from, the biopsy specimens of 18 cases. [ABSTRACT FROM AUTHOR]

A wide range of methods to evaluate posture in work situations relies on simple, unaided visual observation. In the present study the validity of visual observation to assess posture in a dynamic job was evaluated. Postural aspects were observed and recorded during a manual materials handling job simulated in a laboratory. The results from these observations, concerning gross body posture, torso flexion, arms and legs position, and load to be handled, were compared to the results obtained by direct opto-electronic recording. The agreement on a sample-to-sample basis (expressed by Cohen's k) was poor for the variables torso flexion (mean value for tc = 0.38), position of arms (tc = 0.43) and legs (tc = 0.46) and load to be handled (tc — 0.50) and acceptable only for the gross body posture (k = 0.79). Moreover, for each variable except gross body posture, the crude distributions of all observations and recordings across categories (irrespective of time) were significantly different. The results demonstrate that the observations are not valid. It is concluded mat dynamic work situations require less simple, more time consuming methods (e.g., analyzing film or video records of the job) than a posture registration method based on direct visual observation. [ABSTRACT FROM PUBLISHER]

Context: Osseous epithelioid hemangioma is uncommon, and reports of epithelioid hemangiomas of the spine are especially rare. Study Design: Case report. Findings: A 43-year-old male was referred to our department with progressive gait disturbance. CT scans showed a lucent mass in the vertebral body at the T3 level. MRI of the thoracic spine showed a strongly enhanced mass compressing the spinal cord. The patient underwent laminectomy from T2 to T4, debulking of the tumor, and posterior fusion from T1 to T5. After the operation, the patient's neurological status improved significantly, and he was able walk without assistance. Histological examination determined that the tumor was an epithelioid hemangioma. The patient was treated with 40 Gy radiation for local control of the tumor. The patient could walk without difficulty 12 months after the surgery. Conclusion: This is a rare example of an epithelioid hemangioma that developed in the thoracic spine and compressed the spinal cord, and was treated successfully.

Neurological complications of SCS are exceptionally observed and result generally from intraoperative root or spinal cord injury or from compression by spinal infection or epidural hematoma. In some patients long-term SCS can result in the development of epidural mass lesion with loss of stimulation efficacy and myelopathy This rare complication may occur in majority of cases using paddle lead placed via open surgical approach and but it was reported also using percutaneous wire lead. Due to the diagnostic difficulties it is possible that it is diagnosed with delay or remains underestimated and unreported. We review the long-term complications of 439 definitive implants of SCS systems using 373 percutaneous wire leads (50/13.4% cervical and 323/86.6% thoracic) and 66 surgical paddle leads (12/18.2% cervical and 54/81.8% thoracic): in our series we found only two cases of symptomatic spinal cord compression due to epidural scar tissue formation at the site of implanted lead, one with paddle lead implanted surgically at cervical level and one with wire lead implanted percutaneously at thoracic level. In both cases leads were removed and thick scar tissue overlying the dura was dethaced by means of laminectomy with use of microscopic dissection technique. After surgery patients experienced progressive but incomplete improvement of neurological signs without the develop of new deficits. To put this complication into an appropriate context we performed a review of the pertinent literature and we discuss the pathogenetic hypothesis. In conclusion formation of hypertrophic epidural scar tissue at the level of implanted lead must be considered in presence of onset of progressive myelopathy with loss of stimulation efficacy. Resolution of CT imaging and artifacts generated by lead make difficult to detect the mass lesion around lead and its true extension. Despite severity of spinal cord compression the rapid removal of lead and scar tissue may allow satisfactory functional recovery. [ABSTRACT FROM AUTHOR]