Journal of spinal disorders
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Case Reports
Nonglucocorticoid-induced lumbar epidural lipomatosis: a case report and review of literature.
A case of nonglucocorticoid-induced lumbar epidural lipomatosis in a middle-aged black woman with neurogenic claudication is presented. The etiology, diagnosis, management, and outcome are discussed in detail.
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A new classification of flexion-distraction injuries of the spine is described based on the bony and soft tissue injuries to the posterior complex and the anterior column. In addition, the classification includes the status of the vertebral body, that is, the association of a wedge-compression fracture or a burst injury. The soft tissue component provides a rationale for surgical intervention. Most injuries were treated by compression instrumentation, but it is recommended that those injuries associated with a burst component require distraction instrumentation.
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We are reporting our experience in 23 patients with tumors of the thoracic or lumbar vertebrae treated via surgical anterior decompression and stabilization. Seventeen patients had metastatic disease and were treated with vertebral body resection followed by stabilization with anterior polymethylmethacrylate and threaded Harrington rods with sacral distraction hooks. Six patients had primary tumors and, following tumor resection and partial vertebral body resection, had autogenous bone graft struts placed anteriorly as well as posterior instrumentation. ⋯ Tumor recurrence with neurologic deterioration occurred in two patients. We are very encouraged by these results, and we recommend that patients with tumors of the vertebral body with neurologic deficit or severe unremitting pain be studied with MRI and/or myelography and CT. The patients with gross vertebral destruction and greater than 50% collapse of the vertebral body, those in need of a tissue diagnosis, or those with major neurologic deficit can be effectively treated by anterior decompression and stabilization.