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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Case Reports
Surgical treatment of an atlantoaxial fracture after a delayed diagnosis in a comatose patient.
Case report. ⋯ To avoid unnecessary surgery, surgeons should recognize the possibility of cervical fractures that cannot be detected without CT, especially in patients who are comatose at injury. Atlantoaxial fixation with a hook and lamina screw in C2 is an option for old upper cervical fractures in cases where a pedicle screw cannot be inserted into C2.
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Spinal arteriovenous fistula (AVF) is treated by embolization or surgery. However, transarterial embolization or surgery is difficult in rare cases when the fistula site is very complicated to access especially as in fistular nidus supplied by posterior and anterior spinal artery. We present the case which was treated with intraoperative direct puncture and embolization (IOPE) using glue material, since the usual transarterial or transvenous neurointerventional approach was difficult to embolize the AVF. ⋯ In spinal AVF which is not feasible to access by usual intervention approach and to dissect surgically, IOPE with glue material can be considered for the treatment.
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Thoracic cord herniation is a well-established entity in the literature. Majority of the published literature deals with its surgical management in terms of "mere" detethering of cord. However, not much is written about the degree of herniation and ectopic cord tissue and its management. A 58-year-old male presented to us with progressive difficulty in walking. Imaging revealed a cord herniation at T7-8 level. Surgical detethering was planned. However, a significant amount of "ectopic" cord tissue was found outside the dural defect intra-operatively. Simple detethering and repositioning was difficult. Hence, the ectopic tissue was excised under neuro-physiologic monitoring and no major change was recorded intra-operatively/post-operatively. ⋯ Thoracic cord herniation surgery may be more than simple detethering and cord repositioning. If encountered in similar situations intra-operatively, surgeons should be able to excise ectopic tissue without grave post-operative deficits. Neuronal plasticity probably plays an important role in the pathophysiology of long-standing cord herniation.
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Lumbar epidural injection is a popular treatment for degenerative lumbar disease. Although post-procedural epidural infection is rare, meningitis and epidural abscess are life-threatening conditions, and need additional medical and surgical intervention. The purpose of this article is to report a patient with fatal whole cerebrospinal axis infection after lumbar epidural injections. ⋯ 5.
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We set out to establish a magnetic resonance imaging (MRI) and computed tomography (CT)-based diagnostic method for determining the responsible segments in thoracic myelopathy due to ossification of the ligamentum flavum (OLF). ⋯ Spinal canal compromise is relevant to spinal cord deficits in patients with OLF, and a canal grade (paramedian) can be used to quantify spinal cord deficits. Additionally, a canal grade (paramedian) of <60% on axial CT scan can serve as a critical value for diagnosing OLF-induced myelopathy, especially for Grade III compression on T2-weighted MRI.