Journal of neurological surgery reports
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Background Advancements in radiological imaging and diagnostic criteria enable doctors to more accurately identify lumbosacral transitional vertebrae (LSTV) and their association with back and L5 distribution leg pain. It is considered the most common congenital anomaly of the lumbosacral spine with an incidence between 4 and 35%, 3 although many practitioners describe 10 to 12% overall incidence. LSTVs include sacralization of the L5 vertebral body and lumbarization of the S1 segment while demonstrating varying morphology, ranging from broadened transverse processes to complete fusion. 5 The most common types of LSTV that present with symptomatic Bertolotti's syndrome are the Castellvi type I and type II; type III and type IV variants rarely present with symptoms referable with confirmatory and provocative testing to the transitional vertebra itself, and therefore there is limited experience and no case reports of treatment toward this particular entity. ⋯ Conclusion Patients who present with symptoms consistent with Bertolotti's syndrome, even if they have a type III or type IV LSTV, should be considered for surgical treatment of their LSTV. These patients can respond well, even if symptoms have been present for years. Given the prevalence of these anatomic variants in the general population (10-12% in most series), Bertolotti's syndrome should be considered in the differential diagnosis of any patient with a presentation of L5 radiculopathy and/or back pain.
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Encephalocele is a rare condition that consists of herniation of cerebral matter through openings of dura and skull. A majority of encephaloceles are congenital and manifest in childhood. ⋯ Surgical treatment with reduction of the encephalocele achieved near resolution of preoperative hemiparesis on follow-up. The pathogenesis and a literature review of IE are discussed.
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Spinal cord stimulators (SCSs) have long been in use as a modality for the management of numerous pain pathologies. Along with commonly anticipated morbidities such as displacement, failure (due to fracture or breakage), or infection, there have also been rare but well-documented complications of fibrous scarring, resulting in spinal cord compression. This is the first known case that demonstrates osteolysis and bony destruction of the vertebrae adjacent to the SCS along with the foreign-body granulomatous reaction. ⋯ Tissue cultures were negative for bacterial, fungal, or mycobacterial infection. No malignancy was seen. The current case illustrates the inherent possibility of foreign-body granulomatous reactions with SCS and its silicone particulate matter, made unique in this instance by the associated bony destruction of the adjacent vertebrae.