Journal of neurosurgery. Spine
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The authors report a case of spontaneous resorption of intradural disc material in a patient with recurrent intradural lumbar disc herniation and review magnetic resonance (MR) imaging and histopathological findings. Intradural lumbar disc herniation is rare, and most patients with this condition require surgical intervention due to severe leg pain and vesicorectal disturbance. ⋯ The authors conclude that when rim enhancement is present on Gd-enhanced MR images, there is a possibility of spontaneous resorption even though the herniated mass may be located within the intradural space. Moreover, when radiculopathy is controllable and cauda equina syndrome is absent, conservative therapy can be selected.
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The purpose of the present study was to compare spinal motion generated during log-rolling and kinetic therapy with that generated when using a kinetic treatment table (KTT). The authors' hypothesis was that the KTT would produce less spinal motion while maintaining the benefits of body position changes. ⋯ Although the global instability will require surgical stabilization, consideration should be given to initial immobilization on a KTT to decrease the likelihood of secondary injury.
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Acupuncture is a frequently used adjuvant treatment for chronic pain conditions. The authors report the case of a patient in whom the delayed migration of embedded acupuncture needles into the lumbar spinal canal caused the formation of a cerebrospinal fluid fistula and spine-related headache. The needles were safely removed surgically and the patient improved clinically.
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The incidence of postoperative C-5 spinal nerve root palsy following decompressive cervical spinal surgery has been reported to be as high as 12% for anterior procedures and 30% for posterior procedures. The present study was conducted to document the prevalence of iatrogenic C-5 nerve root deficit during anterior cervical spinal surgery, as well as to evaluate the sensitivity and specificity of intraoperative transcranial electrical stimulation (TES)-induced motor evoked potentials (MEPs) and spontaneous electromyographic (EMG) activity for identifying evolving C-5 nerve root impairment. ⋯ Transcranial electrical stimulation-induced MEPs and spontaneous EMG activity offer complementary information about evolving iatrogenic C-5 spinal nerve root impairment during anterior cervical spinal surgery. The TES-induced MEPs provide prognostic information and show increased sensitivity to C-5 deficit compared with spontaneous EMG activity alone. Monitoring of spinal nerve root function using only EMG activity carries a risk of false-negative findings; without timely warning of impending neurological impairment, timely intervention to prevent permanent deficit cannot occur.
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The nucleus pulposus has been reported to be an immunologically privileged site. The expression of Fas ligand (FasL) on normal and herniated lumbar disc cells has been reported. The relationship between a physiological barrier and the role of FasL has not yet been addressed. To clarify this relationship and to investigate a possible pathogenesis of intervertebral disc degeneration (IDD), the expression of Fas and FasL (a mean apoptosis index) on normal and stabbed-disc cells was examined in a rabbit model of IDD. ⋯ These observations indicate that the nucleus pulposus is an immunologically privileged site. This immunological privilege is maintained by FasL and the physiological barrier together. When the physiological barrier was damaged (by stabbing the disc), the role of FasL changed, and FasL was coexpressed with Fas to induce apoptosis of disc cells. These results indicate that an autoimmune reaction may be a possible pathogenesis of IDD.