European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Review Case Reports
Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case.
Intradural spinal arachnoid cysts with cord compression are rare. When becoming symptomatic they cause variable symptoms involving gait disturbance, paraparesis or tetraparesis and neuropathic pain, decreasing significantly the patients' life quality. The extension of such cysts averages 3.7 vertebral bodies. ⋯ Surgical treatment with partial cyst resection in the compressed levels with an interlaminar approach brought similar results as complete resection. The patient was able to walk without help which was not possible before surgery. The cysts' extension is impressive as well as the minimal operative procedure.
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Review Case Reports
Cervical synovial cyst: case report and review of literature.
Synovial cysts, typically observed in the lumbar spine eventually associated with degenerative changes of the facet joints, only rarely present in the cervical spine. Up to now, only 28 symptomatic cases are described in literature. Typically, the treatment of these cases is a decompressive laminectomy followed by complete surgical removal of the lesion. The authors present the case of an 84-year-old man with a symptomatic synovial cyst involving the space between C7 and T1.
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Randomized Controlled Trial
Efficacy of triamcinolone acetonide and bupivacaine for pain after lumbar discectomy.
The study is a prospective blinded randomised controlled trial to compare the efficacy of triamcinolone acetonide, bupivacaine or in combination in managing pain after lumbar discectomy. Patients undergoing primary single-level lumbar discectomy were randomised. Triamcinolone acetonide, bupivacaine or in combination was instilled at the nerve root as decompression. ⋯ A significant difference was noted in day one postoperative mean pain score, mean 24-h opiate requirement and mean inpatient stay in the triamcinolone acetonide and bupivacaine group. At 8 weeks postoperatively, no significant differences were seen in the pain score in all groups. Significant postoperative pain reduction and opiate requirements in the first 24 h, and significantly shortened duration of inpatient stay were achieved in the triamcinolone acetonide and bupivacaine group compared with other groups.
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Review Case Reports
Post-traumatic thoracic scoliosis with rib head dislocation and intrusion into the spinal canal: a case report and review of literature.
The objective of the study was to report a rare occurrence of dislocation and intrusion of two rib heads into the spinal canal at the convex apex of a post-traumatic thoracic scoliosis in an adult in the absence of any neurological impairment. A 47-year-old male presented with a slowly progressive, post-traumatic thoracic scoliosis and a mild aching sensation over the posterior chest wall. The lower limb neurology and bowel and bladder function were normal. ⋯ CT scans showed that the 8th and 9th ribs on the convex apex of the scoliotic curve had intruded into the spinal canal and were lying adjacent to the dura and spinal cord. The MRI scan did not show any cord signal intensity changes. Although rib dislocation and intrusion into the spinal canal is uncommon, images should be carefully analysed to rule out this condition in sharp angular scoliotic curves.
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Studies of EMG power spectra have established associations between low-back pain (LBP) and median frequency (MF). This 2-year prospective study investigates the association of LBP with EMG variables over time. 120 health care workers underwent paraspinal EMG measurements and assessment of back pain disability. The EMG recordings were performed under isometric trunk extension at 2/3 maximum voluntary contraction and acquired from erector spinae muscles at the level of L4/L5. 108 (90%) subjects were reviewed at a minimum 2-year follow up. 16 out of 93 subjects with no history of chronic low-back pain became worse as measured by time off work, disability, reported pain and self-assessment rating. ⋯ The value of the initial median frequency (IMF) and MF slope at inception were also associated with the subjects' own assessment of LBP at follow up. Subjects with an IMF greater than 49 Hz were at 5.8-fold greater risk of developing back pain compared with the remainder of the population (p = 0.014). EMG variables recorded from lumbar paraspinal muscles can identify a sub group of subjects at increased risk of developing low-back pain in the future.