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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Spontaneous intracranial hypotension (SIH) is a clinical syndrome in which absolute or relative hypovolemia of the cerebrospinal fluid (CSF) results in various neurological symptoms. The etiology of spontaneous CSF leaks often remains unknown. However, it is believed that the most common cause is the fragility of spinal meninges at the level of radicular nerve root sleeve. ⋯ Spinal pathologies can cause this tear with resultant CSF leak and SIH, which include spinal trauma, degenerative diseases and spinal surgery. Uncommonly, SIH is developed by osteophyte with disc herniation without any other pathology. In this article, we reported two cases of SIH secondary to spinal dural tear due to intradural thoracic osteophyte with superimposed disc herniation, with the absence of other pathologies, which were treated successfully with epidural blood patch (EBP).
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This study evaluates the short-term clinical outcome, radiological, histological and device retrieval findings of two patients with second generation lumbar total disc replacement (TDR). ⋯ Although wear was unrelated to the reason for revision, this study demonstrates the presence of UHMWPE particles and inflammatory cells in second generation TDR. Long-term follow-up after TDR is indicated for monitoring wear and implant status.
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Case Reports
Congenital kypho-scoliosis: a case of thoracic insufficiency syndrome and the limitations of treatment.
Congenital spinal vertebral anomalies may present with deformity resulting in congenital scoliosis and kyphosis. This leads to abnormal spinal growth. The latter when combined with associated rib fusions may impair normal thoracic cage development and resultant pulmonary hypoplasia. Most congenital scoliosis can be detected in utero by ultrasound scan or recognized in the neonatal period, but a few spinal defects can remain undetected. ⋯ This article highlights the features of congenital kypho-scoliosis and TIS. The difficulties of treating kyphosis when combined with TIS are discussed together with the limitations of current surgical techniques.
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Comparative Study
An in vitro biomechanical comparison of Cadisc™-L with natural lumbar discs in axial compression and sagittal flexion.
The elastomeric, monobloc disc prosthesis (Cadisc™-L, Ranier Technology, Cambridge, UK) aims to preserve biomechanics of an implanted spinal motion segment. ⋯ Implantation of Cadisc™-L caused a reduction in axial stiffness, but maintained disc height and flexion stiffness. IAR loci remained mobile without large displacement of the centroid from the intact spine position.
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We hypothesized that L5-S1 kinematics will not be affected by the lordosis distribution between the prosthesis endplates. ⋯ Further clinical and biomechanical studies are needed to assess the long-term impact of lordosis angle distribution on the fate of the facet joints.