髓圆锥硬膜内椎间盘突出：1例报告，强调患者体位和神经监测。

Q4 Medicine JBJS case connector Pub Date : 2024-11-22 eCollection Date: 2024-10-01 DOI:10.2106/JBJS.CC.24.00235

Michael J Kelly, Marco D Burkhard, Franziska C S Altorfer, Ronald G Emerson, Andrew A Sama

{"title":"髓圆锥硬膜内椎间盘突出：1例报告，强调患者体位和神经监测。","authors":"Michael J Kelly, Marco D Burkhard, Franziska C S Altorfer, Ronald G Emerson, Andrew A Sama","doi":"10.2106/JBJS.CC.24.00235","DOIUrl":null,"url":null,"abstract":"Case: A 73-year old man who underwent previous L2-S1 decompression presenting with new right radicular leg pain. Imaging suggests a large central disk herniation at L1-2 with possible intrathecal extension requiring surgical decompression. When positioned prone on a Jackson frame, neuromonitoring motor signals became diminished, and thus, the case was aborted. On returning to the operating room 2 days later, careful positioning in a more neutral/flexed position facilitated normal neuromonitoring signals, allowing for an uneventful intradural approach and discectomy.Conclusion: With conus-level intrathecal disk herniation, consider using prepositional neuromonitoring and avoid hyperextension with positioning to ensure neurological safety.","PeriodicalId":14748,"journal":{"name":"JBJS case connector","volume":"14 4","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581431/pdf/","citationCount":"0","resultStr":"{\"title\":\"Intradural Disk Herniation at the Conus Medullaris: A Case Report With Emphasis on Patient Positioning and Neuromonitoring.\",\"authors\":\"Michael J Kelly, Marco D Burkhard, Franziska C S Altorfer, Ronald G Emerson, Andrew A Sama\",\"doi\":\"10.2106/JBJS.CC.24.00235\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Case: A 73-year old man who underwent previous L2-S1 decompression presenting with new right radicular leg pain. Imaging suggests a large central disk herniation at L1-2 with possible intrathecal extension requiring surgical decompression. When positioned prone on a Jackson frame, neuromonitoring motor signals became diminished, and thus, the case was aborted. On returning to the operating room 2 days later, careful positioning in a more neutral/flexed position facilitated normal neuromonitoring signals, allowing for an uneventful intradural approach and discectomy.Conclusion: With conus-level intrathecal disk herniation, consider using prepositional neuromonitoring and avoid hyperextension with positioning to ensure neurological safety.\",\"PeriodicalId\":14748,\"journal\":{\"name\":\"JBJS case connector\",\"volume\":\"14 4\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-11-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581431/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JBJS case connector\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2106/JBJS.CC.24.00235\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS case connector","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.CC.24.00235","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

病例：一名73岁男性，先前进行了L2-S1减压，表现为新的右腿神经根性疼痛。影像学提示L1-2处大的中央椎间盘突出，可能伴有鞘内延伸，需要手术减压。当俯卧在Jackson框架上时，神经监测运动信号减弱，因此，该病例流产。2天后返回手术室时，小心地将患者置于更中性/弯曲的体位，以促进正常的神经监测信号，从而顺利地进行硬膜内入路和椎间盘切除术。结论：对于圆锥水平椎间盘突出症，可考虑采用前置式神经监测，避免过伸伴定位，确保神经系统安全。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

Intradural Disk Herniation at the Conus Medullaris: A Case Report With Emphasis on Patient Positioning and Neuromonitoring.

Case: A 73-year old man who underwent previous L2-S1 decompression presenting with new right radicular leg pain. Imaging suggests a large central disk herniation at L1-2 with possible intrathecal extension requiring surgical decompression. When positioned prone on a Jackson frame, neuromonitoring motor signals became diminished, and thus, the case was aborted. On returning to the operating room 2 days later, careful positioning in a more neutral/flexed position facilitated normal neuromonitoring signals, allowing for an uneventful intradural approach and discectomy.

Conclusion: With conus-level intrathecal disk herniation, consider using prepositional neuromonitoring and avoid hyperextension with positioning to ensure neurological safety.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

JBJS case connector Medicine-Medicine (all)

CiteScore

0.60

自引率

0.00%

发文量

319

期刊介绍： JBJS Case Connector helps improve patient care by providing the medical community with a journal that harnesses technology to provide information tools for discovery and reporting of unusual musculoskeletal problems, findings, treatment, and outcomes. Co-edited by Thomas W. Bauer, MD, PhD, and Ronald W. Lindsey, MD, JBJS Case Connector assists orthopaedic surgeons in the search for precedents, connections, and trends in their efforts to improve patient care. Using this unique journal, surgeons can find the commonalities between cases, benefit from the experience of their peers, and filter case information by many important variables in order to provide the best possible care for orthopaedic patients. This cross-referenced online journal includes thousands of orthopaedic case reports. It compiles symptoms, conditions, and demographic details to empower surgeons to find cases similar to theirs. Surgeons can mine the database to reveal emerging trends and identify patterns, distinguishing between truly rare cases and repeated, related single instances of a larger problem. The JBJS Case Connector Image Quiz feature provides interactive quizzes based on images from content published by JBJS and includes a discussion area for further exploration of ideas and concepts. The JBJS Image Quiz app for iPad and iPhone is available in the App Store. Contributions to JBJS Case Connector are welcomed from anywhere in the world and are considered on their merits. Articles must be written in English and should be submitted as outlined in the Instructions to Authors. All authors must abide by the JBJS ethics policies and all submissions to JBJS Case Connector are covered by the JBJS embargo policy.