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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We report a case of fatal evolution of neurofibromatosis in a young boy. A laminectomy was performed when he was 9 years old. A secondary hyperkyphosis led to many surgeries resulting in recurrent malunions. ⋯ NF1 is characterised by neurofibromas that have a possibility of malign degeneration and conversion to a sarcoma. However, the chronology, rapidity of evolution and the exceptional volume of the tumour made us wonder whether the BMP had a part of responsibility as osteoinductor in the malignant degeneration, in this particular case, of neurofibromatosis. It seemed important to point out this case to the medical community.
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Since the rarefaction of neurosyphilis, axial neuroarthropathy is mostly secondary to spinal cord pathologies. Peripheral manifestations of neuroarthropathy resulting from Guillain-Barré syndrome have already been reported but to our knowledge, this is the first case of a patient diagnosed with axial involvement. After the acute phase, a 47-year-old woman suffered of paraparesia with a partial loss of sensibility under the tenth thoracic vertebra. ⋯ Natural evolution of Charcot spine remains unknown. Surgical treatment is recommended but even with circumferential fusion, failures do frequently occur. This observation allows us to report an original case and to discuss the etiology of axial neuroarthropathy, the classical radiographic findings, and the inherent difficulties of its treatment.
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Review Meta Analysis
Transforaminal endoscopic surgery for lumbar stenosis: a systematic review.
Transforaminal endoscopic techniques have become increasingly popular in surgery of patients with lumbar stenosis. The literature has not yet been systematically reviewed. A comprehensive systematic literature review up to November 2009 to assess the effectiveness of transforaminal endoscopic surgery in patients with symptomatic lumbar stenosis was made. ⋯ The reported re-operation rate varied from 0 to 20%. At present, there is no valid evidence from randomized controlled trials on the effectiveness of transforaminal endoscopic surgery for lumbar stenosis. Randomized controlled trials comparing transforaminal endoscopic surgery with other surgical techniques are direly needed.
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A novel rat model was used to investigate the effect of nitric oxide synthase inhibition in posterior spinal fusion augmented with recombinant human bone morphogenetic protein-2. Nitric oxide (NO) has important physiological functions including the modulation of fracture healing. Recombinant human BMP-2 (rhBMP-2) enhances spinal fusion. ⋯ Biomechanically, the rhBMP-2 groups were stiffer at all time points compared to the NOS inhibited groups. Decalcified histology demonstrated that there was a delay in graft incorporation whenever NOS was inhibited (AL and ALB groups) as assessed by a 5 point histological maturation score. In a novel model of rat intertransverse process fusion, nitric oxide synthase modulates rhBMP-2 induced corticocancellous autograft incorporation.
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Ineffective erythropoiesis in patients with thalassemia intermedia drives extramedullary hematopoietic tumor formation in several parts of the body. Paraspinal involvement has received increasing attention due to the associated morbidity secondary to spinal cord compression. Although the history and physical examination may help narrow the differential diagnosis, radiographic imaging remains essential to confirm the existence of hematopoietic tissue. ⋯ Several treatment options have been described, including transfusion therapy, laminectomy, radiotherapy, and the use of fetal hemoglobin inducing agents that decrease the hematopoietic drive. However, the ideal management scheme remains controversial. Until large prospective trials evaluate the efficacy and safety of the available treatment options, both in single and in combination therapy, an individualized approach should be entertained.