Journal of spinal disorders & techniques
-
J Spinal Disord Tech · Dec 2002
Case ReportsIntracranial subdural hematoma after resection of a thoracic spinal cord tumor.
Intracranial subdural hematoma associated with intracranial hypotension is a rare complication of dural puncture and other procedures on the dura. This report describes the case of a 25-year-old man who developed intracranial subdural hematoma after resection of a thoracic spinal cord tumor. Intracranial subdural hematoma could result in severe and permanent neurologic deficit if it remains unrecognized. Severe and prolonged postdural puncture headache should be regarded as a warning sign of an intracranial subdural hematoma, and in those patients early investigation is recommended.
-
J Spinal Disord Tech · Dec 2002
Review Case ReportsEsophageal perforation after fracture of the cervical spine: case report and review of the literature.
We present a posttraumatic esophageal tear that occurred in a 55-year old patient after a truck accident. He sustained a two-level injury with a type II odontoid fracture and a unilateral fracture of the left superior articular process of C6 with an incomplete quadriplegia at C5. Both lesions were treated nonoperatively. ⋯ The diagnosis of the esophageal perforation was delayed for 6 days. The treatment consisted of surgical debridement, volume expansion, antibiotic therapy, hyperbaric oxygenation, assisted ventilation, and esophageal exclusion. A complete review of the literature was performed.
-
J Spinal Disord Tech · Dec 2002
The biomechanical effects of multilevel posterior foraminotomy and foraminotomy with double-door laminoplasty.
The aim of this study is to evaluate the biomechanical effects of multilevel foraminotomy and foraminotomy with double-door laminoplasty compared with foraminotomy with laminectomy. Using fresh human cadaveric specimens (C2-T1), sequential injuries were created in the following order: intact, bilateral foraminotomies (C3-C4, C4-C5, C5-C6), laminoplasty (C3-C6) using hydroxyapatite spacer, removal of the spacers, and laminectomy. Changes in the rotations of each vertebra in each injury status were measured in six loading modes: flexion, extension, right and left lateral bending, and right and left axial rotation. ⋯ After removal of the spacers and following laminectomy, the motion increased significantly in flexion and axial rotation. The ranges of initial slack showed similar trends when compared with the results at maximum load. Clinical implications of these observations are presented.
-
J Spinal Disord Tech · Dec 2002
Lumbar disc herniation regression after successful epidural steroid injection.
In some lumbar disc herniation patients, noninvasive measures fail, necessitating more aggressive treatment, such as epidural steroid injections or surgery. This study sought to determine whether improvement in patients who receive epidural steroid injections is related to regression of herniated nucleus pulposus or whether such patients' symptoms decrease because of the steroid effect in the presence of continued herniated nucleus pulposus. Two nonoperatively treated patient cohorts were followed who had follow-up MRI. ⋯ The epidural steroid injection group had fewer sequestered or extruded herniations that resorbed, and most were of lower hydration. In conclusion, epidural steroid injections do not alter ultimate herniated nucleus pulposus regression. Patients in whom the disc herniation has less hydration may have prolonged symptoms, but many improve with epidural steroid injections.