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
Spontaneous cervical intradural disc herniation presenting with Brown-Séquard and Horner's syndrome: lesson learned from a very unique case.
Cervical spontaneous intradural disc herniation (IDH) is an extremely rare condition. We describe a unique case of a patient presenting with a Brown-Séquard syndrome (BSS) and Horner's syndrome (HS). This study aimed to report an unusual case of spontaneous cervical intradural disc herniation that presented with Horner's and Brown-Séquard syndrome (BSS) and discuss difficulties in preoperative diagnosis and treatment difficulties of intradural cervical disc. ⋯ We would like to emphasize that prompt and anterior cervical decompression is the treatment of choice, as it directly address the problem and allows dura repair in spontaneous cervical disc herniation.
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Case Reports
Giant cell tumor of the thoracic spine completely removed by total spondylectomy after neoadjuvant denosumab therapy.
Denosumab, a novel monoclonal antibody that targets the receptor activator of nuclear factor-κB (RANK) ligand (RANKL), has recently been used to treat patients with giant cell tumor of bone (GCTB). However, few reports have described the clinical results of denosumab therapy for spinal GCTB and evaluated treatment efficacy with respect to the entirety of the resected vertebra after denosumab therapy. ⋯ These findings support that GCTB stromal cells survived around the newly formed woven bone after long-term denosumab treatment and total surgical resection of such primary spinal lesions as the gold-standard treatment, even following administration of denosumab. Surgeons should note that prolonged adjuvant denosumab therapy may increase the difficulty of performing a posterior-approach total en bloc spondylectomy.
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To discuss whether radiologic parameters are closely related to posterior ligamentous complex (PLC) injury identified by magnetic resonance imaging (MRI). ⋯ Our data may prove useful in a preliminary assessment of the PLC integrity based on plain radiographic imaging. We show that radiologic indications, such as AEIEA <70°, BFOFV, LK >25°, and increased AED, are correlated with ISL or SSL rupture, while RA, CA, SI, A/P ratio, and AVH ratio are not.
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Our objective was to use an open weight-bearing MRI to identify the effects of different loading conditions on the inter-vertebral anatomy of the lumbar spine in a post-discectomy recurrent lumbar disc herniation patient. ⋯ We observed that with weight-bearing, measurements indicative of spinal canal narrowing could be detected. These findings suggest that further research is warranted to determine the potential utility of weight-bearing MRI in clinical decision-making.
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Besides a patient reported outcome measure, the AOSpine Knowledge Forum Trauma aims to develop a new concept of a surgeon reported outcome measure (SROM) for spine trauma patients. This study aims to identify parameters that spine surgeons consider relevant to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients. ⋯ Including a large and representative sample of spine trauma experts, this study identified parameters to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients. The results form the basis for the development of a SROM for this specific patient population.