Journal of neurosurgery. Spine
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Near-drowning predisposes one to infection by the fungus Scedosporium apiospermum, and brain abscess is the most common consequence. Vertebral osteomyelitis due to this organism is exceedingly rare. ⋯ The rare nature of this infection led to a delay in diagnosis. A combination of surgical debridement, instrumentation, and antifungal therapy resulted in an excellent outcome at 1 year of follow-up.
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Case Reports
Spine-shortening vertebral osteotomy in a patient with tethered cord syndrome and a vertebral fracture. Case report.
The authors report a rare case of tethered cord syndrome with low-placed conus medullaris complicated by a vertebral fracture that was successfully treated by a spine-shortening vertebral osteotomy. The patient was a 57-year-old woman whose neurological condition worsened after a T-12 vertebral fracture because a fracture fragment and the associated local kyphotic deformity directly compressed the tethered spinal cord. ⋯ Two years after the surgery, the patient's neurological symptoms were resolved. The bone union was complete with no loss of correction.
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Although clinical guidelines for sciatica have been developed, various aspects of lumbar disc herniation remain unclear, and daily clinical practice may vary. The authors conducted a descriptive survey among spine surgeons in the Netherlands to obtain an overview of routine management of lumbar disc herniation. ⋯ Unilateral transflaval discectomy was the most frequently performed procedure. Minimally invasive techniques were expected to be less effective, with higher recurrence rates but less postoperative low-back pain. Variety was shown between surgeons in the management of patients with neurological deficit. Most responding surgeons allowed early mobilization but appeared to give conservative advice in resumption of work.
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Increased signal intensity of the spinal cord on magnetic resonance (MR) imaging was classified pre- and postoperatively in patients with cervical compressive myelopathy. It was investigated whether postoperative classification and alterations of increased signal intensity could reflect the postoperative severity of symptoms and surgical outcomes. ⋯ The postoperative increased signal intensity classification reflected postoperative symptomatology and surgical outcomes to some extent, without statistically significant differences. The alteration of increased signal intensity was seen postoperatively in 24 patients (23%) and was not correlated with surgical outcome.
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Cervical kyphosis in patients with ankylosing spondylitis (AS) can be severely disabling. Surgical treatment of this disorder is technically demanding, however, with a considerable risk of neurological and vascular injuries. The extension osteotomy is a well-described posterior treatment for this condition, but this approach presents the risk of acute subluxation and spinal column translation during the reduction. ⋯ Controlled correction was performed by using a hinged rod affixed to posterior cervical and thoracic screws, allowing for free sagittal correction while restricting translational forces. Once the desired angle of correction was achieved, the hinge connector was locked, transforming the rod into a rigid device for permanent internal fixation. The use of hinged rods in cervical kyphosis correction provides a controlled method for reduction at the osteotomy site, decreasing the risk of neurological injury.