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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To present a rare case of multiple compressive thoracic intradural cysts with pathologic arachnoid ossification, review the literature and present the surgical options. Few reports have identified the existence of arachnoid calcifications and intrathecal cysts causing progressive myelopathy. The literature regarding each of these pathologies is limited to case reports. Their clinical significance is not well studied, although known to cause neurologic sequelae. ⋯ On last examination, the patient's neurologic status had not improved, but had stabilized. The rate of neurologic improvement from excision and decompression is variable, but it may still be warranted in the face of progressive neurologic deficits.
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With regard to the literature, several factors are considered to have an impact on postoperative mobility after lumbar total disc replacement (TDR). As TDR results in a distraction of the ligamentous structures, theoretically the postoperatively disc height and ligamentous integrity have also an influence on biomechanics of a treated segment. The purpose of the study was to evaluate the influence of posterior longitudinal ligament (PLL) resection and segmental distraction on range of motion (ROM). ⋯ But it still remains unclear if this increase which is in median not more than 1° may alter the clinical results. Moreover, the destabilizing effect of PLL resection can be reversed using a higher implant. The prosthesis height seems more crucial than PLL preservation to maintain the primary stability after TDR.
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Case Reports
Hemodialysis-related upper cervical extradural amyloidoma presenting with intractable radiculopathy.
Destructive spondyloarthropathy may occur in long-term hemodialysis patients, but focal amyloid deposits in the spine are rare. We present a case of upper cervical extradural amyloidoma with a history of long-term hemodialysis presenting with progressive and intractable radiculopathy. ⋯ Development of an upper cervical extradural amyloidoma after long-term hemodialysis is extremely rare. Prompt evaluation of long-term hemodialysis patients suffering from progressive cervical pain should be recommended, and treatment is required if there are signs or symptoms of compression of a nerve root or the spinal cord.
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Case report and literature review. ⋯ Chordoma is a highly uncommon epidural neoplasm of the thoracic spine and is vanishingly rare in elderly patients. This report documents the oldest reported patient with thoracic spine chordoma at 89-year-old. Their locally aggressive behavior typically prompts consideration of aggressive surgical resection. When tailored to the individual patient, such procedures are feasible without excessive morbidity even in elderly patients.
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Despite the advantages of modern instrumentation techniques, the treatment of severe rigid idiopathic scoliosis could be very demanding. Traction can provide better, safer correction and minimize complications related to forceful intra-operative maneuvers; however, several side effects are associated with prolonged periods of traction. The aim of this work is to review the clinical and radiographic results of limited perioperative halo-gravity traction in severe rigid curves analyzing its efficacy, advantages and possible complications and comparing it to classic two staged corrections performed without traction. ⋯ Limited halo-gravity traction is an efficient, safe modality in the treatment of severe rigid adolescent scoliosis. The application of gradual traction over a limited period of 2 weeks led to better correction, shorter operative time with no significant complications.