Pub Date : 2017-11-09DOI: 10.4172/2325-9701.1000282
M. Wu, Chih-Hsiang Chiu, C. Su, K. Y. Hsieh
Background: Pisa syndrome, defined as more than 10 degrees tonic lateral flexion in upright spine without any significant associated vertebral rotation resembled the leaning tower of Pisa, is considered to be related to neuroleptics. Unfamiliarity of this disease, many neuro- and orthopedic surgeons can lead to unnecessary diagnostic and interventions. Method: We report an extremely rare case of neurosyphillis presenting with PISA syndrome in order to assess the clinical presentation and treatment. Results: A 49-year-old man, who has neurosyphillis and psychotic disorder due to general medical condition, treated by valproic acid 500 mg twice and quetiapine 200 mg once daily for as an unchanged regimen for the past 1 year. Five days after treatment with clozapine for poor controlled psychosis, he was noted leaned to one side. Physical examinations revealed a severe right truncal shift associated with left cervical tilt. We discontinued all medication except adding an anticholinergic drug (2 mg biperiden twice daily). After 7 days, the deformity disappeared with normal body posture. His psychosis flared up and we rechallenged clozapine 25mg daily. He was noticed leaned to one side again. Conclusions: orthopedic and neurological surgeons visiting patients with abnormal postures of the trunk need to evaluate medications especially with neuropsychiatric disease. Even drugs with a minimum risk of extrapyramidal symptoms, such as clozapine, can cause Pisa syndrome in even short duration and low dosage.
{"title":"Pisa Syndrome and Neurosyphilis: A Case Report in Taiwan","authors":"M. Wu, Chih-Hsiang Chiu, C. Su, K. Y. Hsieh","doi":"10.4172/2325-9701.1000282","DOIUrl":"https://doi.org/10.4172/2325-9701.1000282","url":null,"abstract":"Background: Pisa syndrome, defined as more than 10 degrees tonic lateral flexion in upright spine without any significant associated vertebral rotation resembled the leaning tower of Pisa, is considered to be related to neuroleptics. Unfamiliarity of this disease, many neuro- and orthopedic surgeons can lead to unnecessary diagnostic and interventions. \u0000Method: We report an extremely rare case of neurosyphillis presenting with PISA syndrome in order to assess the clinical presentation and treatment. \u0000Results: A 49-year-old man, who has neurosyphillis and psychotic disorder due to general medical condition, treated by valproic acid 500 mg twice and quetiapine 200 mg once daily for as an unchanged regimen for the past 1 year. Five days after treatment with clozapine for poor controlled psychosis, he was noted leaned to one side. Physical examinations revealed a severe right truncal shift associated with left cervical tilt. We discontinued all medication except adding an anticholinergic drug (2 mg biperiden twice daily). After 7 days, the deformity disappeared with normal body posture. His psychosis flared up and we rechallenged clozapine 25mg daily. He was noticed leaned to one side again. \u0000Conclusions: orthopedic and neurological surgeons visiting patients with abnormal postures of the trunk need to evaluate medications especially with neuropsychiatric disease. Even drugs with a minimum risk of extrapyramidal symptoms, such as clozapine, can cause Pisa syndrome in even short duration and low dosage.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":"2017 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2017-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41894904","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 : 2017-11-06DOI: 10.4172/2325-9701.1000274
P. Issack
We present the case of a 50-year-old lady with progressive neck pain, cervical myelopathy and dysphagia. Cervical spine radiographs and MRI demonstrated a large anterior cervical osteophyte complex impinging on the esophagus as well as cervical stenosis. Surgical treatment with anterior resection of osteophytes and anterior cervical discectomy with fusion relieved the patient’s dysphagia and neck pain. While there are several reports in the literature documenting resection of anterior osteophytes for dysphagia, most of these cases are secondary to DISH and do not present with neurologic symptoms (radiculopathy or myelopathy). To our knowledge, this is the first case presented where the patient presented with both dysphagia and clinical myelopathy, and required both resection of anterior osteophytes and cervical discectomy with fusion.
{"title":"Esophageal Impingement from Anterior Cervical Osteophytes Associated with Cervical Spondylosis","authors":"P. Issack","doi":"10.4172/2325-9701.1000274","DOIUrl":"https://doi.org/10.4172/2325-9701.1000274","url":null,"abstract":"We present the case of a 50-year-old lady with progressive neck pain, cervical myelopathy and dysphagia. Cervical spine radiographs and MRI demonstrated a large anterior cervical osteophyte complex impinging on the esophagus as well as cervical stenosis. Surgical treatment with anterior resection of osteophytes and anterior cervical discectomy with fusion relieved the patient’s dysphagia and neck pain. While there are several reports in the literature documenting resection of anterior osteophytes for dysphagia, most of these cases are secondary to DISH and do not present with neurologic symptoms (radiculopathy or myelopathy). To our knowledge, this is the first case presented where the patient presented with both dysphagia and clinical myelopathy, and required both resection of anterior osteophytes and cervical discectomy with fusion.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46994012","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 : 2017-11-06DOI: 10.4172/2325-9701.1000279
A. Rahimizadeh, A. Rahimizadeh, Valiolah Hassani, Shaghayegh Rahimizadeh
Lumbar discectomy is being done in increasing frequency worldwide where formation of epidural scar formation has been known as a common cause of its failure. Application of a free fat graft despite controversies has been widely used to prevent further adhesion and post-laminectomy scarring. Single nerve root compression and cauda equina syndrome due to compressive effect of free fat graft with a few days to weeks after laminectomy is well known early complication of lumbar discectomy. However, late neurological deficit as the result of significant increase of fat graft volume has been not addressed previously in the literature. Herein, the authors present a middle-age man who was admitted with cauda equina syndrome for one day duration developing 11 years after a redo laminectomy for recurrent disc herniation and local stenosis. The MRI obtained urgently revealed significant overgrowth of the free fat graft that had been already used for prevention of scar formation. Piecemeal surgical removal of fat with clearance of the theca and the corresponding nerve roots result in steady but good recovery within a few weeks. To our knowledge, although overgrowth of fat has been reported in other locations, but this is the first example occurring after its application at the site of laminectomy. Therefore, overgrowth of free fat graft should be added to all previously describe unusual complication of lumbar discectomy.
{"title":"Remote Cauda Equina Syndrome Due to Overgrowth of Epidural Free Fat Graft: Case Report","authors":"A. Rahimizadeh, A. Rahimizadeh, Valiolah Hassani, Shaghayegh Rahimizadeh","doi":"10.4172/2325-9701.1000279","DOIUrl":"https://doi.org/10.4172/2325-9701.1000279","url":null,"abstract":"Lumbar discectomy is being done in increasing frequency worldwide where formation of epidural scar formation has been known as a common cause of its failure. Application of a free fat graft despite controversies has been widely used to prevent further adhesion and post-laminectomy scarring. Single nerve root compression and cauda equina syndrome due to compressive effect of free fat graft with a few days to weeks after laminectomy is well known early complication of lumbar discectomy. However, late neurological deficit as the result of significant increase of fat graft volume has been not addressed previously in the literature. Herein, the authors present a middle-age man who was admitted with cauda equina syndrome for one day duration developing 11 years after a redo laminectomy for recurrent disc herniation and local stenosis. The MRI obtained urgently revealed significant overgrowth of the free fat graft that had been already used for prevention of scar formation. Piecemeal surgical removal of fat with clearance of the theca and the corresponding nerve roots result in steady but good recovery within a few weeks. To our knowledge, although overgrowth of fat has been reported in other locations, but this is the first example occurring after its application at the site of laminectomy. Therefore, overgrowth of free fat graft should be added to all previously describe unusual complication of lumbar discectomy.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":"2017 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41766306","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 : 2017-11-06DOI: 10.4172/2325-9701.1000277
Michael J DeRogatis, M. Shenouda, G. Hinika, P. Issack, A. Loo, A. Salem
We present the case of a 20-year-old man with an initial Glasgow Coma Scale (GCS) of 4 secondary to traumatic brain injury. Computed tomography of the head demonstrated diffuse cerebral edema, an acute right frontal subdural hematoma with a right-toleft midline shift, and subarachnoid hemorrhage. Surgical treatment with early decompressive craniectomy (DC) and duraplasty improved the patient’s GCS score to 15 by postoperative day 3. While there are several reports on early DC for traumatic brain injury, there has been as to date no level 1 evidence proving it to be superior to medical management alone or other neurosurgical techniques including routine temporparietal craniectomy.
{"title":"Early Decompressive Craniectomy in Conjunction with Medical Management in the Treatment of Severe Traumatic Brain Injury: A Case Report","authors":"Michael J DeRogatis, M. Shenouda, G. Hinika, P. Issack, A. Loo, A. Salem","doi":"10.4172/2325-9701.1000277","DOIUrl":"https://doi.org/10.4172/2325-9701.1000277","url":null,"abstract":"We present the case of a 20-year-old man with an initial Glasgow Coma Scale (GCS) of 4 secondary to traumatic brain injury. Computed tomography of the head demonstrated diffuse cerebral edema, an acute right frontal subdural hematoma with a right-toleft midline shift, and subarachnoid hemorrhage. Surgical treatment with early decompressive craniectomy (DC) and duraplasty improved the patient’s GCS score to 15 by postoperative day 3. While there are several reports on early DC for traumatic brain injury, there has been as to date no level 1 evidence proving it to be superior to medical management alone or other neurosurgical techniques including routine temporparietal craniectomy.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43195096","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 : 2017-11-06DOI: 10.4172/2325-9701.1000276
Yanqun Huang, Yangyang Zhao, Caiyou Hu, Zhixin Wu, Li Lian, Heinz Lowis, Mingsheng Zhang, Y. Jianrong, Mingming Zhao
Core Muscle mainly including the rectus abdominis, the oblique muscle, the lower back muscle and shaft sma, which located around the abdomen. It is an important muscle group responsible for protecting the stability of the spine. At present, core muscle group training is mainly aimed at Athletes, Stroke, Lumbar disc herniation and Parkinson’s Disease. However, quite few people did the research about the effects of exercise training on cardiopulmonary function in Parkinson’s patients. Therefore, this review summarized the effects of Core Muscle Training on cardiopulmonary function from its evaluating the parameters.
{"title":"The Effect of Core Muscle Training on Cardiopulmonary Function in Parkinson disease","authors":"Yanqun Huang, Yangyang Zhao, Caiyou Hu, Zhixin Wu, Li Lian, Heinz Lowis, Mingsheng Zhang, Y. Jianrong, Mingming Zhao","doi":"10.4172/2325-9701.1000276","DOIUrl":"https://doi.org/10.4172/2325-9701.1000276","url":null,"abstract":"Core Muscle mainly including the rectus abdominis, the oblique muscle, the lower back muscle and shaft sma, which located around the abdomen. It is an important muscle group responsible for protecting the stability of the spine. At present, core muscle group training is mainly aimed at Athletes, Stroke, Lumbar disc herniation and Parkinson’s Disease. However, quite few people did the research about the effects of exercise training on cardiopulmonary function in Parkinson’s patients. Therefore, this review summarized the effects of Core Muscle Training on cardiopulmonary function from its evaluating the parameters.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43595121","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 : 2017-11-06DOI: 10.4172/2325-9701.1000281
M. Stephens, E. King, Tuong Vy Dang, L. Nagy, G. Racz
Chiari 0 malformation is a disorder within the spectrum of Arnold- Chiari malformations characterized by cerebellar changes present during fetal development and early childhood. Specifically, Chiari 0 is classified by characteristics that include either lack of protrusion of the cerebellar tonsils into the foramen magnum or protrusion less than 5 millimeters, which is the current minimum cutoff for Chiari I classification. Due to the subtle changes in the cerebellar region regarding Chiari 0, patients with this malformation often present with neck and occipital pain along with occipital headaches. It is suggested that this may be due to abnormal blockage of cerebrospinal fluid (CSF) that causes entrapment and impingement of the occipital nerve. In the cases of two teenage patients, both were referred to Pediatric Neurosurgery in Lubbock, Texas for complaints of chronic headaches and neck pain. After previous pain remedies proved to be unsuccessful in providing lasting relief, the patients were deemed candidates to receive an innovative treatment option to manage their chronic headaches and neck pain. The patients were referred to receive epidural lysis of adhesions (LOA) which would provide the lasting relief that the patients were seeking. LOA is a procedure that includes using a needle, Racz catheter, and injectable contrast guided with fluoroscopy to locate the entrapment of the occipital nerve. LOA utilizes the injection of hyaluronidase dissolved in normal saline to free the entrapped nerve so that a local anesthetic/steroid solution can be injected to provide pain relief. Lysis of adhesions should be considered as a minimally invasive treatment for Chiari 0 malformations, whose primary symptoms are intractable occipital headaches.
{"title":"Innovative Treatment for Pre- Operative Occipital Nerve Pain Associated with Chiari 0 Malformation","authors":"M. Stephens, E. King, Tuong Vy Dang, L. Nagy, G. Racz","doi":"10.4172/2325-9701.1000281","DOIUrl":"https://doi.org/10.4172/2325-9701.1000281","url":null,"abstract":"Chiari 0 malformation is a disorder within the spectrum of Arnold- Chiari malformations characterized by cerebellar changes present during fetal development and early childhood. Specifically, Chiari 0 is classified by characteristics that include either lack of protrusion of the cerebellar tonsils into the foramen magnum or protrusion less than 5 millimeters, which is the current minimum cutoff for Chiari I classification. Due to the subtle changes in the cerebellar region regarding Chiari 0, patients with this malformation often present with neck and occipital pain along with occipital headaches. It is suggested that this may be due to abnormal blockage of cerebrospinal fluid (CSF) that causes entrapment and impingement of the occipital nerve. In the cases of two teenage patients, both were referred to Pediatric Neurosurgery in Lubbock, Texas for complaints of chronic headaches and neck pain. After previous pain remedies proved to be unsuccessful in providing lasting relief, the patients were deemed candidates to receive an innovative treatment option to manage their chronic headaches and neck pain. The patients were referred to receive epidural lysis of adhesions (LOA) which would provide the lasting relief that the patients were seeking. LOA is a procedure that includes using a needle, Racz catheter, and injectable contrast guided with fluoroscopy to locate the entrapment of the occipital nerve. LOA utilizes the injection of hyaluronidase dissolved in normal saline to free the entrapped nerve so that a local anesthetic/steroid solution can be injected to provide pain relief. Lysis of adhesions should be considered as a minimally invasive treatment for Chiari 0 malformations, whose primary symptoms are intractable occipital headaches.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41718769","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 : 2017-11-06DOI: 10.4172/2325-9701.1000280
N. Aydın
Spinal cord injuries continue to be a significant problem due to its high prevalence in young and productive people, the magnitude of the impact on physical, psychosocial and economic aspects, and lack of a treatment protocol widely accepted in the literature. Spinal cord injury (SCI) is an important cause of mortality and morbidity that has been the focus of research for many years.
{"title":"Clinical Analysis of Thoracic Pathologies Accompanying Thoracic Spine Fractures Occurring after Spinal Cord Injury","authors":"N. Aydın","doi":"10.4172/2325-9701.1000280","DOIUrl":"https://doi.org/10.4172/2325-9701.1000280","url":null,"abstract":"Spinal cord injuries continue to be a significant problem due to its high prevalence in young and productive people, the magnitude of the impact on physical, psychosocial and economic aspects, and lack of a treatment protocol widely accepted in the literature. Spinal cord injury (SCI) is an important cause of mortality and morbidity that has been the focus of research for many years.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43282546","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 : 2017-07-11DOI: 10.4172/2325-9701.1000275
N. Tadokoro
Objective: The transient suppression of voluntary muscle contraction after nociceptive stimulation is termed the cutaneous silent period (CSP), and is thought to be a spinal inhibitory reflex mediated by A-delta fibers. In CSP testing using the abductor pollicis brevis (APB) muscle (C8-T1 myotome) and the index finger (C6-C7 dermatome), the intramedullary CSP circuit is thought to be localized to the C6-T1 spinal segments. Notably, CSPs are altered or abolished in cervical cord disorders. However, the association between the site of cord lesion and CSP changes is not clearly defined. Methods: We prospectively reviewed the onset latency and duration of preoperative CSPs in 40 hands from 22 patients with cervical compression myelopathy (CCM) and single-level cord compression. CCM patients were divided into 2 groups: those with compression involving the C6-T1 spinal segments (CCM at the middle and lower cervical spine, the ML group; 10 hands) or other segments (CCM at the upper cervical spine; the U group, 30 hands). Results: Onset latency was significantly delayed in the ML group compared to the U group (P = 0.0001), whereas duration was not significantly different between groups (P = 0.9). Conclusion: Changes in the CSP onset latency were influenced by the CCM lesion site. The results of this study inform the evaluation of patients with cervical cord disorders when using CSP testing.
{"title":"Relationship between Cutaneous Silent Period Characteristics and Lesion Site in the Cervical Spinal Cord","authors":"N. Tadokoro","doi":"10.4172/2325-9701.1000275","DOIUrl":"https://doi.org/10.4172/2325-9701.1000275","url":null,"abstract":"Objective: The transient suppression of voluntary muscle contraction after nociceptive stimulation is termed the cutaneous silent period (CSP), and is thought to be a spinal inhibitory reflex mediated by A-delta fibers. In CSP testing using the abductor pollicis brevis (APB) muscle (C8-T1 myotome) and the index finger (C6-C7 dermatome), the intramedullary CSP circuit is thought to be localized to the C6-T1 spinal segments. Notably, CSPs are altered or abolished in cervical cord disorders. However, the association between the site of cord lesion and CSP changes is not clearly defined. \u0000Methods: We prospectively reviewed the onset latency and duration of preoperative CSPs in 40 hands from 22 patients with cervical compression myelopathy (CCM) and single-level cord compression. CCM patients were divided into 2 groups: those with compression involving the C6-T1 spinal segments (CCM at the middle and lower cervical spine, the ML group; 10 hands) or other segments (CCM at the upper cervical spine; the U group, 30 hands). \u0000Results: Onset latency was significantly delayed in the ML group compared to the U group (P = 0.0001), whereas duration was not significantly different between groups (P = 0.9). \u0000Conclusion: Changes in the CSP onset latency were influenced by the CCM lesion site. The results of this study inform the evaluation of patients with cervical cord disorders when using CSP testing.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47259349","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 : 2017-07-06DOI: 10.4172/2325-9701.1000273
A. Rahimizadeh
Lumbar discectomy is done in increasing frequency worldwide. A rare event associated with this procedure is breaking of the disc forceps blade during discectomy. In majority the broken part of the disc forceps can be removed during the initial surgery. But, rarely, the surgeon’s attempts might be unsuccessful, resulting in intradiscal retained foreign body. Literature regarding this issueis scarce, although there might be cases that have been never reported because of the medico legal consequences. Furthermore, until recently, there have been no guidelines to address this complication. Herein, a middle age woman in whom the blade of disc forceps was broken during L5-S1 discectomy is presented. Her surgeon could not remove the broken blade, so it was retained. .Once the patient and her family became aware about this event, began to seek medical advice .In our institute, retrieval of the broken blade of the disc forceps became possible via transforaminal corridor. Thereafter, posterior screw rod fixation and L5-S1 interbody fusion was done. To our knowledge, the reports about the broken surgical instruments being retained in the disc space are extremely rare complication of lumbar discectomy. Moreover, xtraforaminal or transforaminal corridor might an appropriate alternative option instead of anterior or anterolateral approaches.
{"title":"Intradiscal Retained Broken Blade Of A Disc Rongeur","authors":"A. Rahimizadeh","doi":"10.4172/2325-9701.1000273","DOIUrl":"https://doi.org/10.4172/2325-9701.1000273","url":null,"abstract":"Lumbar discectomy is done in increasing frequency worldwide. A rare event associated with this procedure is breaking of the disc forceps blade during discectomy. In majority the broken part of the disc forceps can be removed during the initial surgery. But, rarely, the surgeon’s attempts might be unsuccessful, resulting in intradiscal retained foreign body. Literature regarding this issueis scarce, although there might be cases that have been never reported because of the medico legal consequences. Furthermore, until recently, there have been no guidelines to address this complication. Herein, a middle age woman in whom the blade of disc forceps was broken during L5-S1 discectomy is presented. Her surgeon could not remove the broken blade, so it was retained. .Once the patient and her family became aware about this event, began to seek medical advice .In our institute, retrieval of the broken blade of the disc forceps became possible via transforaminal corridor. Thereafter, posterior screw rod fixation and L5-S1 interbody fusion was done. To our knowledge, the reports about the broken surgical instruments being retained in the disc space are extremely rare complication of lumbar discectomy. Moreover, xtraforaminal or transforaminal corridor might an appropriate alternative option instead of anterior or anterolateral approaches.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2017-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48471709","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 : 2017-05-11DOI: 10.4172/2325-9701.1000265
T. Funayama, T. Tsukanishi
Primitive neuroectodermal tumors (PNET) are rare, and are even rarer when they arise from the spinal cord tissue. Therefore, we report a case of peripheral PNET that arose from the sacral spinal nerve root. The patient was a 30-year-old woman who presented with left lower extremity pain, and MRI revealed a neoplastic lesion in the left S1 nerve root canal of the sacral region. Subsequent imaging and testing were not able to confirm a diagnosis, although we suspected a benign tumor as a candidate for the differential diagnosis. We performed surgery to remove the tumor, and confirmed total resection. Our subsequent pathological testing confirmed a diagnosis of peripheral PNET, and we elected to treat the patient using concurrent radiotherapy and the standard chemotherapy for Ewing’s sarcoma. The treatment was successful, and the patient was free from recurrence at the 27-month follow-up. Although it may be impossible to achieve a preoperative imaging diagnosis in similar cases, we believe that imaging remains an important part of the differential diagnosis to facilitate successful treatment.
{"title":"Primary Extradural Peripheral Primitive Neuroectodermal Tumor (Extraskeltal Ewing’s Sarcoma) Arising from the Sacral Spinal Nerve Root: A Case Report and Review of the Literature","authors":"T. Funayama, T. Tsukanishi","doi":"10.4172/2325-9701.1000265","DOIUrl":"https://doi.org/10.4172/2325-9701.1000265","url":null,"abstract":"Primitive neuroectodermal tumors (PNET) are rare, and are even rarer when they arise from the spinal cord tissue. Therefore, we report a case of peripheral PNET that arose from the sacral spinal nerve root. The patient was a 30-year-old woman who presented with left lower extremity pain, and MRI revealed a neoplastic lesion in the left S1 nerve root canal of the sacral region. Subsequent imaging and testing were not able to confirm a diagnosis, although we suspected a benign tumor as a candidate for the differential diagnosis. We performed surgery to remove the tumor, and confirmed total resection. Our subsequent pathological testing confirmed a diagnosis of peripheral PNET, and we elected to treat the patient using concurrent radiotherapy and the standard chemotherapy for Ewing’s sarcoma. The treatment was successful, and the patient was free from recurrence at the 27-month follow-up. Although it may be impossible to achieve a preoperative imaging diagnosis in similar cases, we believe that imaging remains an important part of the differential diagnosis to facilitate successful treatment.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49288763","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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