[Diagnosis of cauda equina syndromes].
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The authors report a child who was involved in an automobile accident. The patient was restrained by a rear seat lap belt. Radiological examination revealed an L4 Chance-type fracture and ligamentous disruption at the L4-L5 interval. During superficial dissection of the paraspinal muscles for a spinal fusion procedure, the cauda equina and the lower spinal cord (several centimeters) were visible, completely transected and herniated into the extraspinal space through a disrupted thoracolumbar fascia. The clinician should be aware of the potentially devastating results following a lap-belt injury in which a Chance fracture is produced.
Diffuse idiopathic skeletal hyperostosis (DISH) has long been regarded as a benign asymptomatic clinical entity with an innocuous clinical course. Precise information is lacking in the world literature. Authors report the results of a retrospective analysis of 74 cases of DISH. Eleven patients presented with progressive spinal cord or cauda equina compression. In nine cases ossified posterior longitudinal ligament (OPLL) and in two cases ossified ligamentum flavum (OLF) were primarily responsible. Surgically treated patients (eight) had far better outcome as compared to the patients managed conservatively, as they had refused surgery. 'DISH' is neither a benign condition, nor it always runs a innocuous clinical course. In fact, in about 15% of the cases, serious neurological manifestations occur, which may require a major neurosurgical intervention.
The authors report a case of arachnoid cyst of cauda equina with severe chronic coccygodynia. The value of radioculography in the diagnosis of this condition is pointed out. Resection of the cyst abolished coccygodynia completely and permanently. No case of arachnoid cyst causing coccygodynia has been found in the available literature.
Severe dysuria, due to insufficiency of the perineal floor associated during micturition with a posterior tilting of the prostate-bladder block in lower or in associated upper and lower motor neuron lesions, can be treated surgically by a prostato cytso pexy. Since 1971, eight patients with post-traumatic conus and/or cauda equina lesions have been treated by this intervention. On the follow-up the satisfactory results appear to remain stable. An alternative surgical technique using the abdominal pyramidalis muscle is described so as to fix the prostate, associated with a bladder-pexy. The recurrence of dysuria, after the intervention, has always been caused by an additional lower urinary tract pathology. The comfort of the patients has been greatly improved.
STUDY DESIGN: Case report and literature review. OBJECTIVE: Intradural-extramedullary cavernoma is a rare condition with only 23 cases reported in the literature. Most cases described adhere to spinal root or spinal cord. We report an example of this rare entity located within the sheets of one cauda equina nerve root. SETTING: Rome, Italy. METHODS: The authors report clinical, radiological, surgical, and pathological features of intraroot cavernoma with a literature review. RESULTS: Patient was operated. One year after surgery, he was healthy. CONCLUSION: Lumbar intradural cavernous angioma may present with sciatalgia, low-back pain, neurological deficit, or, more rarely with subarachnoid hemorrhage or hydrocephalus. They are treated successfully with surgical resection but preoperative status is a predicting factor for outcome. Sometimes the sacrifice of the spinal root is inevitable because, as in present case, the cavernous angioma is included in the nerve root. These lesions are rare and benign lesions. It is important for neurosurgeons to be aware of the existence of this entity to avoid preoperative misdiagnosis with tumor.
Meningiomas are unusual in childhood, and the intraspinal location is very uncommon. Those arising from lumbar dura matter are the most rare among spinal neoplasms of meningeal origin. We present the case of a 12-years-old girl with a cauda equina meningioma. As in previously reported cases, the initial complain was back pain with radicular irradiation. The girl had few neurological findings, with pyramidal signs of both lower limbs as single neurological impairment. She underwent surgical treatment through an open door laminoplasty and the tumour was completely removed without neurological deficit. After 2-year of follow-up she remains asymptomatic.
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