Journal of spinal disorders & techniques
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J Spinal Disord Tech · Dec 2005
Review Case ReportsSpinal epidural hematoma after removal of an epidural catheter: case report and review of the literature.
We report a case of spinal epidural hematoma after removal of an epidural catheter. The patient had no background of anticoagulant therapy or coagulopathy; sudden severe back pain occurred immediately after removal of the catheter. The chance of this occurring is estimated to be between 1:150,000 and 1:190,000. ⋯ In 23 cases (57.5%), anticoagulant therapy had been performed, and in 5 cases (12.5%), coagulopathy or liver dysfunction had been recognized. In 20 cases (50%), the initial symptoms were recognized within 24 hours after removal of the epidural catheter. Although spinal epidural hematoma is a very rare condition, it is a serious complication of continuous epidural anesthesia.
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J Spinal Disord Tech · Dec 2005
Controlled Clinical TrialSelective nerve root injections can predict surgical outcome for lumbar and cervical radiculopathy: comparison to magnetic resonance imaging.
Diagnostic selective nerve root injection (SNI) results were analyzed in 101 patients who underwent lumbar or cervical decompression for radiculopathy and compared to surgical outcome 1 year postoperatively. A comparison of surgical outcomes was also examined between magnetic resonance imaging (MRI) and SNI results. ⋯ Our study found that a diagnostic SNI can safely and accurately discern the presence or absence of cervical or lumbar radiculopathy. The diagnostic SNI can persuade surgeons from operating on an initially suspicious, but incorrect, level of radiculopathy. In cases where MRI findings are equivocal, multilevel, and/or do not agree with the patient's symptoms, the result of a negative diagnostic SNI (ie, lack of presence of radiculopathy) becomes superior in predicting the absence of an offending lesion.
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J Spinal Disord Tech · Dec 2005
Review Case ReportsMonostotic fibrous dysplasia of the lumbar spine: case report and review of the literature.
Monostotic fibrous dysplasia of the spine is extremely rare. We present a 57-year-old man who complained of persistent low back pain with monostotic fibrous dysplasia of the lumbar spine. ⋯ The patient underwent total excision of the tumor via a posterior approach. Two years later, he is asymptomatic with no recurrence of the lesion, as confirmed by imaging.
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J Spinal Disord Tech · Dec 2005
Randomized Controlled Trial Comparative StudyPosterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation.
The treatment of thoracolumbar burst fracture is a controversial issue. Short-segment (SS) pedicle fixation has become a popular treatment option. However, there are several studies regarding the high rate of failure. The aim of this prospective study was to compare SS versus long-segment (LS) instrumentation. ⋯ In conclusion, radiographic parameters demonstrated that LS instrumentation is a more effective management of thoracolumbar burst fractures. Nevertheless, clinical outcome was the same between the two groups. However, our conclusions were based on posterior-only surgery. Anterior column support would negate the need for LS fixation. Also, SS would have been more successful if two above and two below pedicle screws were used.
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J Spinal Disord Tech · Dec 2005
Comparative StudySurgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options.
Ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine produces myelopathy through anterior spinal cord compression that is usually progressive and unaffected by conservative treatment. Therefore, early decompressive surgery is imperative. However, decompression surgery of thoracic myelopathy is difficult, and the outcome is often poor. A retrospective study was conducted to investigate the surgical outcome of 21 patients with thoracic OPLL to evaluate which type of surgical approach is better and which type of thoracic OPLL results in a better surgical outcome. ⋯ There were five instances of neurologic deterioration in our thoracic OPLL series, and all of them exhibited beak-type OPLL. In the beak-type OPLL, a subtle alteration in the spinal alignment during posterior decompression procedures may increase spinal cord compression, leading to the deterioration of symptoms. A potential increase in kyphosis following laminectomy should be avoided by fixation with a temporary rod. If intraoperative monitoring suggests spinal cord dysfunction, an anterior decompression procedure should be attempted as soon as possible.