Pub Date : 2023-10-31DOI: 10.21129/nerve.2023.00409
Solji Jung, Dongho Kang, Donghwan Kim, Sang Hyub Lee
Approximately 50% of patients with neurofibromatosis type 1 (NF1) develop orthopedic complications, and spinal deformities are common manifestations. Cervical kyphosis is comparatively rare in NF1; however, it results in spinal cord compression associated with paralysis and respiratory dysfunction, requiring surgical correction. Pediatric patients with NF1 usually have small and defective pedicles or lateral masses, and surgery with a single approach is limited to ensure sufficient spinal cord decompression and deformity correction. However, no reliable treatment guidelines are available for this challenging condition. This case report presents a 7-year-old patient with NF1 who had severe cervical kyphosis with intradural extramedullary neurofibromas. The tumors were removed before correcting the deformity to decompress the spinal cord and reduce the risk of spinal cord injury. Moreover, we effectively corrected and stabilized the kyphosis using the anterior-posterior-anterior approach.
{"title":"Surgical Management of Recurrent Plexiform Neurofibroma in a Pediatric Patient with Severe Cervical Kyphotic Deformity: A Case Report","authors":"Solji Jung, Dongho Kang, Donghwan Kim, Sang Hyub Lee","doi":"10.21129/nerve.2023.00409","DOIUrl":"https://doi.org/10.21129/nerve.2023.00409","url":null,"abstract":"Approximately 50% of patients with neurofibromatosis type 1 (NF1) develop orthopedic complications, and spinal deformities are common manifestations. Cervical kyphosis is comparatively rare in NF1; however, it results in spinal cord compression associated with paralysis and respiratory dysfunction, requiring surgical correction. Pediatric patients with NF1 usually have small and defective pedicles or lateral masses, and surgery with a single approach is limited to ensure sufficient spinal cord decompression and deformity correction. However, no reliable treatment guidelines are available for this challenging condition. This case report presents a 7-year-old patient with NF1 who had severe cervical kyphosis with intradural extramedullary neurofibromas. The tumors were removed before correcting the deformity to decompress the spinal cord and reduce the risk of spinal cord injury. Moreover, we effectively corrected and stabilized the kyphosis using the anterior-posterior-anterior approach.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135930588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.21129/nerve.2023.00430
Rae Hyung Kim, Sung Bae Park
Myotonic dystrophy (MD) is a genetic disorder that causes progressive muscle weakness and atrophy, often leading to spinal deformities and decreased quality of life. While the surgical correction of spinal deformities is not absolutely contraindicated in MD patients, a comprehensive pre-anesthetic evaluation is crucial, particularly considering cardiovascular and respiratory health. We present a case of a 50-year-old woman with MD who underwent spinal deformity surgery to correct kyphosis and alleviate severe back pain. Despite the absence of significant events during surgery and preoperative risk factors, the patient experienced postoperative respiratory failure, hypotension, aggravated weakness, and mental deterioration in the intensive care unit. The patient received long-term ventilator support during hospitalization for respiratory muscle weakness. She demonstrated significant improvements in strength, mobility, and respiratory function with multidisciplinary support and rehabilitation, achieving functional independence within 6 months postoperatively. The authors discuss the possible etiological mechanisms underlying these complications and highlight the need for preoperative evaluations and multidisciplinary care for patients with MD.
{"title":"Catastrophic Complications Following Spinal Deformity Surgery in a Patient with Myotonic Dystrophy","authors":"Rae Hyung Kim, Sung Bae Park","doi":"10.21129/nerve.2023.00430","DOIUrl":"https://doi.org/10.21129/nerve.2023.00430","url":null,"abstract":"Myotonic dystrophy (MD) is a genetic disorder that causes progressive muscle weakness and atrophy, often leading to spinal deformities and decreased quality of life. While the surgical correction of spinal deformities is not absolutely contraindicated in MD patients, a comprehensive pre-anesthetic evaluation is crucial, particularly considering cardiovascular and respiratory health. We present a case of a 50-year-old woman with MD who underwent spinal deformity surgery to correct kyphosis and alleviate severe back pain. Despite the absence of significant events during surgery and preoperative risk factors, the patient experienced postoperative respiratory failure, hypotension, aggravated weakness, and mental deterioration in the intensive care unit. The patient received long-term ventilator support during hospitalization for respiratory muscle weakness. She demonstrated significant improvements in strength, mobility, and respiratory function with multidisciplinary support and rehabilitation, achieving functional independence within 6 months postoperatively. The authors discuss the possible etiological mechanisms underlying these complications and highlight the need for preoperative evaluations and multidisciplinary care for patients with MD.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"139 36","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135808287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.21129/nerve.2023.00346
Yong Min Lee, Dong Wuk Son, Bu Kwang Oh, Su Hung Lee, Jun Seok Lee, Young Ha Kim, Soon Ki Sung, Sang Weon Lee, Geun Sung Song
Objective: As Korea has become a super-aging society, the number of elderly patients with degenerative spinal disease has steadily increased. This study aimed to evaluate the usefulness of oblique lumbar interbody fusion (OLIF) by comparing the results and complications between OLIF and open spinal fusion in elderly patients with degenerative spinal disease.Methods: Thirty-one patients underwent one-level posterior lumbar interbody fusion (PLIF), and 35 patients underwent one-level indirect decompression OLIF. The clinical outcomes of the two patient groups were analyzed using the visual analog scale (VAS) and Oswestry Disability Index (ODI). Through a comparative analysis of pre- and post-operative images, we measured changes in disc height (DH) and foraminal height (FH), and investigated the occurrence of subsidence in each patient group. The cross-sectional area was measured using magnetic resonance imaging pre- and post-operatively in OLIF.Results: The pre-operative VAS and ODI scores were similar between the two groups and tended to improve post-operatively. In the OLIF group, the estimated blood loss (EBL) was significantly lower, DH and FH gains were more frequent, DH and FH maintenance was better, and cage subsidence occurred less frequently. In OLIF, psoas paresis and approach-site hematoma occurred; however, all patients with psoas paresis recovered without further treatment before discharge. In the PLIF group, dural tears occurred in four patients who recovered without revision surgery. Conclusion: OLIF enables indirect decompression, reduced EBL, shorter hospitalization, and lesser subsidence. OLIF is considered a beneficial, minimally invasive surgical method for elderly patients.
{"title":"Outcomes and Complications of Oblique Lateral Interbody Fusion as a Surgical Option in Elderly Patients (Over 70 Years Old) with Degenerative Spinal Disease","authors":"Yong Min Lee, Dong Wuk Son, Bu Kwang Oh, Su Hung Lee, Jun Seok Lee, Young Ha Kim, Soon Ki Sung, Sang Weon Lee, Geun Sung Song","doi":"10.21129/nerve.2023.00346","DOIUrl":"https://doi.org/10.21129/nerve.2023.00346","url":null,"abstract":"Objective: As Korea has become a super-aging society, the number of elderly patients with degenerative spinal disease has steadily increased. This study aimed to evaluate the usefulness of oblique lumbar interbody fusion (OLIF) by comparing the results and complications between OLIF and open spinal fusion in elderly patients with degenerative spinal disease.Methods: Thirty-one patients underwent one-level posterior lumbar interbody fusion (PLIF), and 35 patients underwent one-level indirect decompression OLIF. The clinical outcomes of the two patient groups were analyzed using the visual analog scale (VAS) and Oswestry Disability Index (ODI). Through a comparative analysis of pre- and post-operative images, we measured changes in disc height (DH) and foraminal height (FH), and investigated the occurrence of subsidence in each patient group. The cross-sectional area was measured using magnetic resonance imaging pre- and post-operatively in OLIF.Results: The pre-operative VAS and ODI scores were similar between the two groups and tended to improve post-operatively. In the OLIF group, the estimated blood loss (EBL) was significantly lower, DH and FH gains were more frequent, DH and FH maintenance was better, and cage subsidence occurred less frequently. In OLIF, psoas paresis and approach-site hematoma occurred; however, all patients with psoas paresis recovered without further treatment before discharge. In the PLIF group, dural tears occurred in four patients who recovered without revision surgery. Conclusion: OLIF enables indirect decompression, reduced EBL, shorter hospitalization, and lesser subsidence. OLIF is considered a beneficial, minimally invasive surgical method for elderly patients.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"7 29","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135765876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.21129/nerve.2023.00437
Jonggu Lee, Ho Jin Lee, Jae-Hyeok Heo, Jung Hee Kim
Guillain–Barré syndrome (GBS) is a rare immune-mediated polyneuropathy that rapidly leads to symmetric, ascending progressive weakness. Although GBS is typically associated with various infectious diseases, such as upper respiratory infections or gastroenteritis, it has also been reported following spine surgery. In this report, the authors present a case of GBS in an elderly patient after spinal fusion surgery and emphasize the importance of evaluating new-onset weakness in such cases. A 79-year-old man with diabetes mellitus and hypertension presented with weakness of the lower extremities and neurogenic claudication with chronic radicular pain. Magnetic resonance imaging revealed anterolisthesis at the L4-L5 level and disc protrusions with central and lateral recess spinal stenosis at L3-L4-L5. Following surgery, the patient complained of weakness and paresthesia in both upper extremities, prompting further investigation. An electrophysiologic study confirmed demyelinating neuropathy and cerebrospinal fluid (CSF) analysis showed elevated viral immunoglobulin levels and albumin-cytological dissociation despite negative bacterial and antiganglioside antibody tests. The patient received intravenous immunoglobulin infusion treatment and showed significant improvement, with full motor function recovery in all extremities after 6 weeks. The authors emphasize the importance of considering GBS in patients experiencing deteriorating neurological symptoms after spine surgery and suggest that electrophysiologic studies and CSF analysis are needed for an accurate diagnosis. Additionally, this report highlights the need for increased vigilance regarding the rapid onset of GBS symptoms in elderly patients following spinal surgery.
{"title":"Guillain-Barré Syndrome Following Spinal Fusion Surgery in an Elderly Patient: A Case Report","authors":"Jonggu Lee, Ho Jin Lee, Jae-Hyeok Heo, Jung Hee Kim","doi":"10.21129/nerve.2023.00437","DOIUrl":"https://doi.org/10.21129/nerve.2023.00437","url":null,"abstract":"Guillain–Barré syndrome (GBS) is a rare immune-mediated polyneuropathy that rapidly leads to symmetric, ascending progressive weakness. Although GBS is typically associated with various infectious diseases, such as upper respiratory infections or gastroenteritis, it has also been reported following spine surgery. In this report, the authors present a case of GBS in an elderly patient after spinal fusion surgery and emphasize the importance of evaluating new-onset weakness in such cases. A 79-year-old man with diabetes mellitus and hypertension presented with weakness of the lower extremities and neurogenic claudication with chronic radicular pain. Magnetic resonance imaging revealed anterolisthesis at the L4-L5 level and disc protrusions with central and lateral recess spinal stenosis at L3-L4-L5. Following surgery, the patient complained of weakness and paresthesia in both upper extremities, prompting further investigation. An electrophysiologic study confirmed demyelinating neuropathy and cerebrospinal fluid (CSF) analysis showed elevated viral immunoglobulin levels and albumin-cytological dissociation despite negative bacterial and antiganglioside antibody tests. The patient received intravenous immunoglobulin infusion treatment and showed significant improvement, with full motor function recovery in all extremities after 6 weeks. The authors emphasize the importance of considering GBS in patients experiencing deteriorating neurological symptoms after spine surgery and suggest that electrophysiologic studies and CSF analysis are needed for an accurate diagnosis. Additionally, this report highlights the need for increased vigilance regarding the rapid onset of GBS symptoms in elderly patients following spinal surgery.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"26 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135930528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.21129/nerve.2023.00395
Jeong-Ju Hong, Cheolsu Jwa, Jae Hoon Kim, Hee In Kang, In-Suk Bae, Hyungjoo Kwon
We report two uncommon cases of non-traumatic, acute cervical disc herniation presented with sudden paralysis of the limbs. First, a 61-year-old man presented with sudden quadriplegia while resting on the bed 2 hr ago. He had motor weakness of grade 3 in the upper arms and grade 0 in the lower legs. Magnetic resonance imaging (MRI) of the cervical spine showed severe spinal cord compression caused by huge soft central disc herniation at the C6-7 level. After surgery, the paralysis of the upper arms improved, but the paralysis of the lower legs and sphincter functions did not improve. Second, a 65-year-old woman presented with acute right hemiparesis just after waking up in the morning 3 hr ago. She had motor weakness of grade 3 of the right upper arm and grade 2 of the right lower leg. MRI of the cervical spine showed severe cord compression by the right-sided, superiorly migrated soft disc herniation at the C6-7 level. After surgery, she recovered completely and could walk independently.
{"title":"Non-Traumatic Cervical Disc Herniation Presented as Sudden Paralysis of the Limbs: Two Case Reports","authors":"Jeong-Ju Hong, Cheolsu Jwa, Jae Hoon Kim, Hee In Kang, In-Suk Bae, Hyungjoo Kwon","doi":"10.21129/nerve.2023.00395","DOIUrl":"https://doi.org/10.21129/nerve.2023.00395","url":null,"abstract":"We report two uncommon cases of non-traumatic, acute cervical disc herniation presented with sudden paralysis of the limbs. First, a 61-year-old man presented with sudden quadriplegia while resting on the bed 2 hr ago. He had motor weakness of grade 3 in the upper arms and grade 0 in the lower legs. Magnetic resonance imaging (MRI) of the cervical spine showed severe spinal cord compression caused by huge soft central disc herniation at the C6-7 level. After surgery, the paralysis of the upper arms improved, but the paralysis of the lower legs and sphincter functions did not improve. Second, a 65-year-old woman presented with acute right hemiparesis just after waking up in the morning 3 hr ago. She had motor weakness of grade 3 of the right upper arm and grade 2 of the right lower leg. MRI of the cervical spine showed severe cord compression by the right-sided, superiorly migrated soft disc herniation at the C6-7 level. After surgery, she recovered completely and could walk independently.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"37 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135808304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.21129/nerve.2023.00416
Sum Kim, Chang Kyung Kang, Hangeul Park, Young Rak Kim, Jun-Hoe Kim, Chang-Hyun Lee, Chun Kee Chung, Chi Heon Kim
The surgical treatment of spondylitis involves potential risks, especially when dealing with infected tissues that may be fragile and susceptible to injury from surgical trauma and inflammation. In cases where spondylitis is not controlled even after the initial surgery, unexpected situations can arise if an unusual change in infected tissues around the spine is misinterpreted. The present case involves a 62-year-old who underwent laminectomy, debridement, and stabilization from T12 to L2 due to medically intractable spondylitis caused by methicillin-resistant Staphylococcus aureus. No major bleeding or vascular injury occurred during surgery. However, despite some improvement in pain and weakness, inflammation markers remained elevated and back pain recurred. A computed tomography (CT) scan taken 15 days after surgery showed a round-enhancing lesion inside the L1 vertebra. Although the primary imaging diagnosis suggested a loculated abscess, a round-enhancing lesion raised suspicion of an unusual pseudoaneurysm. A CT angiography confirmed a pseudoaneurysm from the L1 segmental artery, successfully treated with endovascular embolization. After embolization, the patient’s back pain improved, and inflammation markers further decreased with oral antibiotics. This case highlights the possibility of a pseudoaneurysm occurring in cases of spondylitis, emphasizing the importance of considering this entity in the differential diagnosis to ensure proper treatment.
{"title":"An Intravertebral Pseudoaneurysm Formed after Infective Spondylitis","authors":"Sum Kim, Chang Kyung Kang, Hangeul Park, Young Rak Kim, Jun-Hoe Kim, Chang-Hyun Lee, Chun Kee Chung, Chi Heon Kim","doi":"10.21129/nerve.2023.00416","DOIUrl":"https://doi.org/10.21129/nerve.2023.00416","url":null,"abstract":"The surgical treatment of spondylitis involves potential risks, especially when dealing with infected tissues that may be fragile and susceptible to injury from surgical trauma and inflammation. In cases where spondylitis is not controlled even after the initial surgery, unexpected situations can arise if an unusual change in infected tissues around the spine is misinterpreted. The present case involves a 62-year-old who underwent laminectomy, debridement, and stabilization from T12 to L2 due to medically intractable spondylitis caused by methicillin-resistant Staphylococcus aureus. No major bleeding or vascular injury occurred during surgery. However, despite some improvement in pain and weakness, inflammation markers remained elevated and back pain recurred. A computed tomography (CT) scan taken 15 days after surgery showed a round-enhancing lesion inside the L1 vertebra. Although the primary imaging diagnosis suggested a loculated abscess, a round-enhancing lesion raised suspicion of an unusual pseudoaneurysm. A CT angiography confirmed a pseudoaneurysm from the L1 segmental artery, successfully treated with endovascular embolization. After embolization, the patient’s back pain improved, and inflammation markers further decreased with oral antibiotics. This case highlights the possibility of a pseudoaneurysm occurring in cases of spondylitis, emphasizing the importance of considering this entity in the differential diagnosis to ensure proper treatment.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135871318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-25DOI: 10.21129/nerve.2023.00451
Ho Che Jung, Dong Hyun Seo, Woo Jin Choe
Multiple occurrences of spinal tumors are a rare phenomenon that usually results from underlying genetic diseases. Schwannoma and meningioma are well-known benign spinal tumors commonly found in the intradural extramedullary (IDEM) space with different cellular origins. We present an extremely rare case of neighboring concurrence of meningioma and schwannoma in the lumbar spine in a patient without an underlying genetic disease. Pathological studies regarding the concurrent IDEM tumors are demonstrated, along with a literature review. Key words: Lumbar vertebrae; Neurilemmoma; Meningioma
{"title":"Concurrence of Schwannoma and Meningioma Neighboring in the Lumbar Spine: A Case Report","authors":"Ho Che Jung, Dong Hyun Seo, Woo Jin Choe","doi":"10.21129/nerve.2023.00451","DOIUrl":"https://doi.org/10.21129/nerve.2023.00451","url":null,"abstract":"Multiple occurrences of spinal tumors are a rare phenomenon that usually results from underlying genetic diseases. Schwannoma and meningioma are well-known benign spinal tumors commonly found in the intradural extramedullary (IDEM) space with different cellular origins. We present an extremely rare case of neighboring concurrence of meningioma and schwannoma in the lumbar spine in a patient without an underlying genetic disease. Pathological studies regarding the concurrent IDEM tumors are demonstrated, along with a literature review. Key words: Lumbar vertebrae; Neurilemmoma; Meningioma","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"76 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135112751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-25DOI: 10.21129/nerve.2023.00479
Jun Hyeong Park, Chang Kyu Lee, Se Hoon Kim, Jong Hee Chang, Dong Ah Shin, Seong Yi, Yoon Ha, Keung Nyun Kim
Rosai-Dorfman disease (RDD) is an exceptionally rare medical condition, with spinal cord involvement even more infrequent. It is frequently misidentified as another malignancy or infectious disease. In this report, we present two cases of RDD with spinal cord involvement. Each patient presented with spinal intradural extramedullary masses within the thoracic and cervical levels, respectively. The differential diagnoses remained uncertain, with the potential for pachymeningitis and meningiomatosis due to the shared nature of nonspecific imaging findings and clinical symptoms in both conditions. Given the presence of neurologic symptoms and spinal cord compression, the individual lesions were surgically excised. Subsequent pathological analysis definitively confirmed the diagnosis of RDD. As an adjunctive therapeutic measure, both patients were orally administered prednisolone. Both patients exhibited favorable neurologic improvement. These cases highlight the diagnostic challenges of RDD when solely relying on imaging studies. Surgical intervention, in conjunction with a meticulous pathologic examination, is imperative for a precise diagnosis and guides appropriate treatment strategies. The multifaceted spatial manifestation of this disease further underscores the potential for multifocal occurrences within the central nervous system, providing an avenue for improved comprehension of the underlying mechanisms contributing to its dissemination. Key words: Histiocytosis, sinus; Meningioma; Meningitis; Spinal cord neoplasms
{"title":"Diagnostic Challenges of Rosai-Dorfman Disease Presenting as Pachymeningitis and Meningiomatosis: A Report of Two Unusual Cases Involving the Spinal Cord","authors":"Jun Hyeong Park, Chang Kyu Lee, Se Hoon Kim, Jong Hee Chang, Dong Ah Shin, Seong Yi, Yoon Ha, Keung Nyun Kim","doi":"10.21129/nerve.2023.00479","DOIUrl":"https://doi.org/10.21129/nerve.2023.00479","url":null,"abstract":"Rosai-Dorfman disease (RDD) is an exceptionally rare medical condition, with spinal cord involvement even more infrequent. It is frequently misidentified as another malignancy or infectious disease. In this report, we present two cases of RDD with spinal cord involvement. Each patient presented with spinal intradural extramedullary masses within the thoracic and cervical levels, respectively. The differential diagnoses remained uncertain, with the potential for pachymeningitis and meningiomatosis due to the shared nature of nonspecific imaging findings and clinical symptoms in both conditions. Given the presence of neurologic symptoms and spinal cord compression, the individual lesions were surgically excised. Subsequent pathological analysis definitively confirmed the diagnosis of RDD. As an adjunctive therapeutic measure, both patients were orally administered prednisolone. Both patients exhibited favorable neurologic improvement. These cases highlight the diagnostic challenges of RDD when solely relying on imaging studies. Surgical intervention, in conjunction with a meticulous pathologic examination, is imperative for a precise diagnosis and guides appropriate treatment strategies. The multifaceted spatial manifestation of this disease further underscores the potential for multifocal occurrences within the central nervous system, providing an avenue for improved comprehension of the underlying mechanisms contributing to its dissemination. Key words: Histiocytosis, sinus; Meningioma; Meningitis; Spinal cord neoplasms","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"16 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135112914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-24DOI: 10.21129/nerve.2023.00339
Jae Woong Lee, Hyung Ki Park
Intracranial hypotension is a rare cause of cervical myelopathy. Cerebrospinal fluid (CSF) shunt surgery, which belongs to the broader category of ventriculoperitoneal shunt surgery, is commonly chosen as the primary treatment option for hydrocephalus. However, such surgery can potentially lead to CSF overdrainage, resulting in the occurrence of intracranial hypotension. In the present case, spinal surgery was performed twice for cervical myelopathy; however, there was no improvement in symptoms such as gait disturbance. After the readjustment of the shunt valve pressure, the symptoms improved. Key words: Intracranial hypotension; Spinal cord diseases; Ventriculoperitoneal shunt
{"title":"Cervical Myelopathy Caused by a Ventriculoperitoneal Shunt: A Case Report","authors":"Jae Woong Lee, Hyung Ki Park","doi":"10.21129/nerve.2023.00339","DOIUrl":"https://doi.org/10.21129/nerve.2023.00339","url":null,"abstract":"Intracranial hypotension is a rare cause of cervical myelopathy. Cerebrospinal fluid (CSF) shunt surgery, which belongs to the broader category of ventriculoperitoneal shunt surgery, is commonly chosen as the primary treatment option for hydrocephalus. However, such surgery can potentially lead to CSF overdrainage, resulting in the occurrence of intracranial hypotension. In the present case, spinal surgery was performed twice for cervical myelopathy; however, there was no improvement in symptoms such as gait disturbance. After the readjustment of the shunt valve pressure, the symptoms improved. Key words: Intracranial hypotension; Spinal cord diseases; Ventriculoperitoneal shunt","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"408 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135265922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-24DOI: 10.21129/nerve.2023.00388
Joonseo Kang, Young-Joon Kwon
Objective Minimally invasive (MI) surgery for the treatment of spinal stenosis is currently a topic of substantial interest. One such technique is the unilateral biportal endoscopic (UBE) method, becoming popular among spine surgeons as a MI alternative to decompressive lumbar laminectomy without fusion. The purpose of this study was to present a description of the surgical technique and early clinical and radiological outcomes following the author's adoption of the UBE surgical technique for decompression of spinal stenosis. Methods Between 2019 and 2021, surgery was performed on 47 patients with lumbar spinal stenosis. Clinical and radiological data were retrospectively analyzed through electronic medical records and imaging software reviews. Questionnaires and radiologic images were prospectively collected at scheduled times. The surgical technique used two corridors: one for endoscopic viewing and the other for handling surgical instruments during the procedure. Clinical outcomes were measured using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI), while radiological outcomes were evaluated using X-rays to assess instability. Outcomes after UBE surgery were evaluated in terms of changes in clinical and radiological parameters from the baseline. A mixed-effects model with random effects for patients and surgical levels was used to test for differences in repeatedly measured clinical and radiological parameters. Results During the early postoperative period, there were few complications, and all patients had a smooth recovery. Patients reported minimal postoperative wound discomfort. Back and leg VAS scores improved significantly in the early postoperative period (at 3, 6, and 12 months) compared to the baseline preoperative scores (p<0.001). The ODI also showed significant improvement post-operatively (p<0.001). The X-ray parameters were well maintained and did not show any progression of instability during the follow-up period. Conclusion UBE surgery is a safe and effective MI technique for treating lumbar stenosis, with good early results and few complications during the early learning curve period. Key words: Endoscopy; Lumbosacral region; Minimally invasive surgical procedures; Spinal stenosis
{"title":"The Unilateral Biportal Endoscopic Technique for Treatment of Lumbar Spinal Stenosis: Early Surgical Results","authors":"Joonseo Kang, Young-Joon Kwon","doi":"10.21129/nerve.2023.00388","DOIUrl":"https://doi.org/10.21129/nerve.2023.00388","url":null,"abstract":"Objective Minimally invasive (MI) surgery for the treatment of spinal stenosis is currently a topic of substantial interest. One such technique is the unilateral biportal endoscopic (UBE) method, becoming popular among spine surgeons as a MI alternative to decompressive lumbar laminectomy without fusion. The purpose of this study was to present a description of the surgical technique and early clinical and radiological outcomes following the author's adoption of the UBE surgical technique for decompression of spinal stenosis. Methods Between 2019 and 2021, surgery was performed on 47 patients with lumbar spinal stenosis. Clinical and radiological data were retrospectively analyzed through electronic medical records and imaging software reviews. Questionnaires and radiologic images were prospectively collected at scheduled times. The surgical technique used two corridors: one for endoscopic viewing and the other for handling surgical instruments during the procedure. Clinical outcomes were measured using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI), while radiological outcomes were evaluated using X-rays to assess instability. Outcomes after UBE surgery were evaluated in terms of changes in clinical and radiological parameters from the baseline. A mixed-effects model with random effects for patients and surgical levels was used to test for differences in repeatedly measured clinical and radiological parameters. Results During the early postoperative period, there were few complications, and all patients had a smooth recovery. Patients reported minimal postoperative wound discomfort. Back and leg VAS scores improved significantly in the early postoperative period (at 3, 6, and 12 months) compared to the baseline preoperative scores (p<0.001). The ODI also showed significant improvement post-operatively (p<0.001). The X-ray parameters were well maintained and did not show any progression of instability during the follow-up period. Conclusion UBE surgery is a safe and effective MI technique for treating lumbar stenosis, with good early results and few complications during the early learning curve period. Key words: Endoscopy; Lumbosacral region; Minimally invasive surgical procedures; Spinal stenosis","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"156 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135219451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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