Neurochirurgie
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To report an unusual and asymptomatic cause of cord compression treated surgically with good clinical outcome. ⋯ Given its infrequency, the diagnosis of arachnoid cyst should be suspected when a cystic lesion causes cord compression. Surgery is the treatment of choice, providing good clinical outcome.
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Two cases of Brown-Sequard syndrome following a stab wound of the cervical spinal cord are reported. Spinal cord hemisection was confirmed by magnetic resonance imaging and surgical exploration. Both patients presented leakage of the cerebrospinal fluid and underwent surgical repair. ⋯ Outcome at ten and two years follow up was good in both patients who were able to walk. One of them returned to work. The contribution of surgical repair of spinal cord stab wounds and mechanisms of recovery are discussed.
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Neurostimulation is now a well-accepted treatment for neuropathic pain. The system is composed of an electrode and a battery-powered stimulator generally implanted in the abdominal wall or subclavicular space according to the location of electrodes. One of the complaints of the patients is the discomfort due to the site and the volume of the battery, particularly with the largest model used for dual channel stimulation. To reduce the frequency of this discomfort we propose an alternative site of implantation of the generator. ⋯ Ninety-four percent of our patients were very satisfied with this alternative site. One of the 17 patients complained of pain when he was in a reclining position. Otherwise, this technique enable us to perform simultaneously the implantation of the electrodes and the generator facilitating the surgery.
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Review Case Reports
[Surgical management of cervical radiculopathy in Forestier's disease. Case report and review].
Forestier's disease now called DISH (diffuse idiopathic skeletal hyperostosis) is a non inflammatory enthesopathy ossifying the anterolateral spine and sparing the disc and joint space in elderly men, mostly at thoracic levels. Radiology performed for minor trauma or to explore a stiff neck provides the diagnosis. The main differential diagnosis is ankylosing spondylitis presenting an inflammatory profile as well as previously existing alterations of the sacroiliac joint. ⋯ Surgery in DISH is mainly indicated for dysphagia and rarely after cervical trauma. Of note are associated lesions such as OPLL (ossification of the posterior longitudinal ligament) or synovial cysts responsible for the exceptional and severe myelopathy presentation. The neurosurgical community should become better aware of Forestier's disease.
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Multicenter Study
[Cost-benefit evaluation of spinal cord stimulation treatment for failed-back surgery syndrome patients].
Spinal cord stimulation is a well-known treatment of rigorously selected failed-back surgery syndrome patients. Efficacy levels over 50% of pain relief have been reported in long-term studies. The objective of this multicenter prospective evaluation was to analyze the cost to benefit ratio of spinal cord stimulation treatment for failed back surgery syndrome patients. ⋯ This study confirms a clear analgesic effect on neuropathic sciatalgia, and moderate attenuation of low-back pain. One particular interest of this study is the medico-economic prospective evaluation showing that the initial cost of the implanted device is compensated by a significant, early, and stable reduction in the cost of associated pain therapies.