Journal of neurosurgery. Spine
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Spinal surgery-associated rhabdomyolysis, although rare, is a life-threatening condition. Presented here is the case of a middle-aged, overweight man who underwent posterior lumbar surgery because of pain and neurogenic claudication. His postoperative course was complicated by the occurrence of rhabdomyolysis. ⋯ His condition was grave enough to require the administration of intermittent hemodialysis. After a prolonged hospitalization and 5 sessions of hemodialysis, the patient achieved a full recovery. In view of the fact that rhabdomyolysis-induced acute renal failure is associated with a mortality rate of 20-50%, the outcome was favorable.
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In this paper the authors' goal was to identify histological and immunohistochemical differences between cervical disc hemrniation and spondylosis. ⋯ The authors' results indicate that herniated and spondylotic intervertebral discs undergo different degenerative processes. It is likely that TNFa, MMP-3, bFGF, and VEGF expression is upregulated via the herniated mass in the herniated intervertebral discs, but by nutritional impairment in the spondylotic discs. Macrophage accumulation around newly formed blood vessels in the herniated disc tissues seemed to be regulated by MMP-3 and TNFalpha expression, and both herniated and spondylotic discs exhibited marked neoangiogenesis associated with increased bFGF and VEGF expression. Nerve fibers were associated with NGF overexpression in the outer layer of the anulus fibrosus as well as in endothelial cells of the small blood vessels.
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This study was undertaken to examine the correlation between change in graft height and change in angulation across grafted segments (segmental angle) in patients undergoing central corpectomy (CC) with autologous bone reconstruction for cervical spondylotic myelopathy (CSM). ⋯ Among patients undergoing uninstrumented CC for CSM, there is a significant correlation between postoperative settling and kyphotic change across fused segments in those who had straight or kyphotic cervical spines or segments preoperatively but not in those who had lordotic cervical spines or segments preoperatively. A more vigorous surgical correction of the segmental kyphosis than achieved in this study might have caused the kyphotic segments to behave like the lordotic segments. Paraspinal muscles and ligaments may play a role in determining the segmental angle as graft settling in patients with lordotic spines or segments is not linearly correlated with angular change.
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The authors report the case of a 54-year-old woman who presented with an intraparenchymal granuloma in her lower thoracic spinal cord. On imaging studies there was an intramedullary enhancement at the left dorsal aspect of the cord immediately adjacent to the tip of an intrathecal arachnoid catheter used for intraspinal drug therapy. ⋯ A 5-mm caseating chalklike granuloma was carefully dissected away. To the authors' knowledge, this is the first reported case of an intrathecal catheter-tip granuloma growing inside the spinal cord parenchyma.