The spine journal : official journal of the North American Spine Society
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Postoperative delirium is a great concern in the treatment of hip fracture. However, there have been no reports regarding the postoperative delirium in spine surgery. ⋯ Low concentrations of hemoglobin and hematocrit 1 day after surgery were risk factors for postoperative delirium. As delirium is thought to represent not only brain dysfunction, but also impaired general physical condition, careful observation is necessary for the management of patients with postoperative delirium.
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Selective lumbar nerve blocks (SLNBs) are a popular, minimally invasive treatment and diagnostic tool for lumbar radiculopathy. It is therefore relevant to determine the complication rate for SLNBs, as well as examine the association between needle-tip position and complication rates in order to improve safety. ⋯ Our results suggest that SLNBs performed with fluoroscopic guidance have a low incidence of complications. All of our complications were minor. The specific needle-tip position within or adjacent to the lumbar neural foramen does not appear to be associated with the incidence of complications.
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Although thoracic disc herniations are rare, misdiagnosis is an undesirable situation, as it results not only in unnecessary diagnostic studies and surgical procedures, but also in progressive myelopathy and paralysis. Therefore, it is important to be aware of patients with thoracic disc herniations presenting with unusual or atypical symptoms mimicking other non-spinal disorders. ⋯ Thoracic disc herniation should be considered in the differential diagnosis of patients with pain likely caused by nonspinal disorders, especially if basic diagnostic studies do not reveal the cause.
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A pedicle subtraction osteotomy can be considered as part of the surgical treatment of a symptomatic sagittal imbalance. The literature on the use of this technique is limited and thus far not applied to a rigid thoracolumbar hyperkyphosis. ⋯ A pedicle subtraction osteotomy is a technically demanding but well tolerated operative procedure for the correction of a kyphotic deformity. This technique can also be considered as an adjunctive tool in the surgical treatment of a rigid thoracolumbar (Scheuermann's) kyphosis.
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Case Reports
Intradural, extramedullary spinal sarcoidosis: report of a rare case and review of the literature.
Spinal sarcoidosis represents a rare subgroup of neurosarcoidosis. Most spinal sarcoid lesions are intramedullary, and only eight cases of intradural, extramedullary sarcoid lesions have been reported hitherto. We describe the complete entity of intradural, extramedullary spinal sarcoidosis. ⋯ An extramedullary sarcoid lesion is rare. Unlike intramedullary sarcoid lesions, it can be totally removed. Even if systemic sarcoidosis is present, the patient can have an excellent recovery. From a review of the literature, we can hypothesize that intradural extramedullary spinal sarcoidosis may represent a very early stage of spinal sarcoidosis progressing to intramedullary intradural spinal sarcoidosis. The intradural extramedullary spinal sarcoidosis can be subdivided into a peripheral and a central subtype. Positive histological examination is required to establish the diagnosis since other diagnostic tests are unspecific.