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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Tuberculosis of the craniovertebral region is very rare. Neural deficit in this region is reported in between 24% and 64% of cases, and mainly takes the form of quadriparesis. Hemiplegic and monoplegic presentation among this set of patients is rarer. ⋯ Hemi/monoplegic presentation is extremely rare; no author in the literature is able to give reason for the rarity or the pathomechanics of the condition. We believe that if medullary cervical junctional involvement extends slightly higher (in rare circumstances), with involvement of one of the branches of the vertebral or lower basilar artery, medial medullary syndrome will occur, sparing medial lemniscus and emerging hypoglossal nerve fibres. Thus the pyramids will be involved, causing contralateral hemiparesis, and if the pyramids are selectively involved, it will cause contralateral monoparesis.
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In internal posterior fixation of thoracolumbar fractures combined with transpedicular cancellous bone graft and posterior fusion of the intervertebral facet joints at the level of the destroyed end plate it is still uncertain as to whether significant vertebral body collapse and loss of correction of the regional angle (RA) and the intervertebral angle (IVA) occur (after removal of the implants). These questions were investigated in a retrospective study of 183 consecutive patients, 18-65 years old, with a spinal fracture between the 9th thoracic and the 5th lumbar vertebral body (inclusive), treated operatively between 1988 and 1996 (27% had objective neurological deficit, 37% had multiple injuries). According to the Comprehensive Classification, 128 type A, 32 type B and 21 type C fractures were identified preoperatively. ⋯ Correction of the RA was statistically significant before implant removal, but the RA 2 years after surgery had become almost the same as the preoperative values. Changes at the level of the intervertebral space, occurring after implant removal, contributed to the loss in the RA. Broken pedicle screws (10.9% of the patients) resulted in significant changes in the AWA and RA before implant removal, but did not influence the IVA.
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Paralysis following scoliosis correction is a catastrophic situation. We report an unusual metabolic cause of neurological deficit after anterior thoracic release. A 15-year-old female developed proximal leg paralysis 1 day after surgery. ⋯ After intravenous potassium substitution the neurological status completely normalized within a few hours. We assume that the condition was a manifestation of hypokalaemic paralysis since no further abnormalities could be disclosed. Spinal surgeons should bear in mind hypokalaemia as a benign and easily correctable cause of paresis following surgical scoliosis correction.
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Clinical Trial
Fluorine-18 fluorodeoxyglucose positron emission tomography findings in spondylodiscitis: preliminary results.
Nuclear medicine procedures can be helpful in diagnosing spine infections. The purpose of the study was to evaluate the findings of positron emission tomography with fluorine-18 fluorodeoxyglucose (FGD-PET) in the detection of spondylodiscitis. We performed FDG-PET in 16 patients with suspected spondylodiscitis. ⋯ The PET scans depicted the paravertebral soft tissue involvement in cases of spondylodiscitis. Our first results showed that FDG-PET is a very sensitive imaging procedure in the detection of spondylodiscitis. Compared to other nuclear medicine procedures, PET enables a rapid imaging with acceptable radiation dose and high spatial resolution.
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Scoliosis among children and adolescents is a persistent problem. Worldwide, it afflicts between 0.3 to 15.3% of the population. One of the treatment methods of this disorder is to administer lateral electrical surface stimulation (LESS) for 9 h/day; unfortunately, however, this results in side-effects. ⋯ The degree of scoliotic deformity (according to the Cobb method) ranged from 21 degrees to 410 degrees (mean, 31.2 degrees) and from 23 degrees to 330 degrees (mean, 30 degrees) in groups 1 and 2, respectively. LESS resulted in spinal deformity to a similar degree in the rabbits treated for either 9 or 2 h/day over a 3-month period. Short LESS therapy (2 h/day) significantly reduced detrimental effects associated with the treatment on internal organs of laboratory animals.