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A patient with recurrent carcinoma of the proximal esophagus after radiotherapy presented with bacterial meningitis. Esophagography and CT of the chest disclosed an esophagosubarachnoidal fistula extending between the ulcerated tumor, posterior mediastinum, and the thoracic spine.
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Explore the source record for details and available documents.
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Cervical vertebral columns (214) of South African black and white cadaver populations were examined and measured to determine the mean midsagittal and transverse diameters of cervical vertebral foramina. Findings reveal that blacks have significantly narrower midsagittal and transverse diameters of their cervical vertebral foramina than do whites. The significance of the findings with particular regard to spondylosis is discussed in some detail. In a discussion on the causes of differences in canal size in the two ethnic groups, the role of heredity and environment was addressed and attention was drawn to the importance and pervasive influence of socioeconomic factors during the early growing years of the child.
The intraspinal endoscopy was carried out by means of a recently developed Selfoc-endoscope. The optical principle of the Selfoc-glass rod was described. The endoscopic observations in the preliminary experiment on dogs and in 6 clinical cases were reported. Our experiences showed the usefulness of Selfoc-endoscope for the clinical spinaloscopy.
In a patient wounded by a gunshot in the abdomen, the bullet was radiologically located intradurally at S1 level. Although she had no neurological deficit at admission, she developed pain and motor weakness a few days later. At operation the bullet was found at L4 level and its removal resulted in complete neurological recovery.
The process of distractive regenerates of the vertebral arch was studied histologically in mature outbred dogs in modelling of vertebral canal by G. A. Ilizarov technique. During the process of distraction regenerate was shown to have a zonal structure i.e. to include 2 bone regions and connective tissue layering. Its growth is based on the fibers of that layering. The possibility of the increase of vertebral canal sagittal diameter up to 90-100% within 2-2,5 months due to the formation of vertebral arch distractive regenerates is supported by the results of present study and opens the perspective of this technique use in clinical practice.
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Thoracic spondylotic myelopathies are exceptional, only 29 observations could be found in the literature; we intend to describe three new cases here. The patients, two women and one man, 64, 69 and 72 years old, complained of weakness of the lower limbs, more marked on one side, which had been progressing slowly from several months to eight years. Examination revealed asymmetrical paraparesis with distal sensitivity deficits without thoracic sensory level. In the first case, the myelography remained virtually unchanged in front of T11, T12; in the second and third cases, there was slight extradural compression at T9 and T10 respectively. Magnetic Resonance Imaging (M.R.I.) performed in two patients was evocative of a thoracic disk herniation. A chest CT scan enabled us to establish correct diagnosis: in the three cases irregular hypertrophy of the posterior elements was evident at T11 and T12, T9 and T10, T10 and T11 respectively, with osteophytes originating in the articular process and deeply embedded in the spinal canal. Decompressive laminectomy associated with medial facetectomy resulted in the gradual improvement of walking in all three patients. Myelography and MRI are both useful in demonstrating the level compression, usually situated in the low thoracic spine, however only the CT allows differential diagnosis with other etiologies, especially anterior compression such as disk herniation.
The authors described a 22-year-old female patient in whom a neurofibroma had been removed at the age of 13 years (laminectomy L1, 2, 3), and 9 years later psammoma was removed by laminectomy Th7, 8, 9). Both tumours developed outside the cord and were removed radically. The patient without complaints and without neurological deficit returned to work.
STUDY DESIGN: This study is a prospective, clinical study assessing the efficacy of selective decompression of the responsible level in two-level stenosis in accordance with neurologic findings defined by the gait load test, and functional diagnosis based on selective nerve root block. OBJECTIVE: To clarify the clinical features of two-level stenosis regarding the neurologic level responsible for the symptoms, neurogenic intermittent claudication, and the outcome of selective decompression. SUMMARY OF BACKGROUND DATA: Experimental studies have indicated that double-level compression of the cauda equina induces a more severe impairment of nerve function than does single-level compression. However, few studies have focused on the clinical importance of two-level stenosis. The clinical effects of two-level stenosis on the cauda equina and nerve roots are unknown. METHODS: A total of 81 patients with lumbar spinal canal stenosis due to spondylosis and degenerative spondylolisthesis were divided into two groups, two-level stenosis at L3-L4 and L4-L5, and one-level stenosis at L4-L5, based on myelography. The types of neurogenic intermittent claudication, the level responsible for neurologic findings, and the postsurgical outcome were compared between both groups. The level responsible for the symptoms in two-level stenosis was determined in accordance with neurologic findings on the gait load test and functional diagnosis based on a selective nerve root block. All patients underwent a prospective, selective decompression at the neurologically responsible level only. The average follow-up period was 4.6 years (range, 1-8 years). RESULTS: The patients with two-level stenosis more frequently had cauda equina symptoms than those with one-level stenosis, except patients with degenerative spondylolisthesis. It was therefore assumed that two-level stenosis was associated with cauda equina impairment, Changes in neurologic condition before and after the gait test were observed in four patients with two-level stenosis. Finally, for 28 patients with two-level stenosis, the levels responsible for the neurologic symptoms were the caudal level (L4-L5) in 22 patients, the cranial level (L3-L4) in 1 patient, and both cranial and caudal levels (L3-L4 and L4-L5) in 5 patients. All stenotic levels on the myelogram were not always symptomatic in two-level stenosis. However, in one-level stenosis, all of the responsible levels completely corresponded to the myelogram. Selective decompression only at the neurologically responsible level improved neurogenic intermittent claudication in all patients. The asymptomatic levels at which the stenotic condition was left unchanged at surgery did not become symptomatic at follow-up; in addition, there was no significant difference in the postoperative outcome between two-level stenosis and one-level stenosis. CONCLUSIONS: Two-level stenosis in patients with lumbar spondylosis is associated with production of cauda equina lesions. The gait load test provides information regarding changes in symptoms and neurologic condition during exercise. The responsible levels should be determined based on neurologic findings after the gait load test and a selective nerve root block. It is uncommon for both stenotic levels to be symptomatic in patients with two-level stenosis. Less invasive surgery such as selective decompression for the responsible level in patients with two-level stenosis is a useful technique with a good potential for long-term success.
Villonodular synovitis is believed to be an inflammatory, proliferative reaction of synovial tissues. The case of a 65-year-old woman with a cervical epidural mass is presented in which histological examination showed that the lesion was villonodular synovitis, an extremely rare occurrence. Because of its cellularity and occasional multinucleated giant cells, villonodular synovitis may be confused with metastatic malignancies or giant-cell tumor of bone.
Kyphosis, anterior subluxation, and instability of the spine are reported as postoperative complications of multiple level laminectomies in children. The surgical procedure of multiple level laminotomies is proposed as an alternative. Indications in infants and children, the surgical technique, and the postoperative management are presented. The goal is preservation of the normal architecture of the spine in patients who are still developing.
Hemophilic pseudotumor is an uncommon complication among hemophiliacs. Most of these lesions are located in the long bones and the pelvis. The authors describe a case of hemophilic pseudotumor in a patient who presented with symptoms of L-5 radiculopathy and evidence of a destructive lesion on computerized tomography scans. Histologically, the lesion consisted of an organizing hematoma with reactive fibrosis. The diagnosis requires a high index of suspicion. Surgery is recommended for symptomatic patients.
PURPOSE: To show that retrovertebral extension of neoplastic and infectious disease proceeds in a predictable manner, with the anatomic superstructure determining the shape of the advancing process. METHODS: We examined 58 patients who had neoplastic (n = 44) and infectious (n = 14) processes that caused canal compromise. In total, 140 levels were examined by means of MR imaging only (48 patients), CT only (1 patient), CT plus MR imaging (3 patients), and MR imaging plus CT myelography (6 patients). RESULTS: At 136 levels, the retrovertebral disease process took the shape of a smoothly marginated, bilobulated mass that was broad-based against the posterior surface of the vertebra. Various degrees of mass effect were observed: symmetric on 108 levels and asymmetric on 28 levels; on 4 levels, expansion of the anterior epidural space was unilobar, reflecting unilateral canal invasion. With advanced stages of canal invasion, this bilobulated pattern was maintained but there was a tendency toward detachment of the midline septum (20 levels). CONCLUSION: The observed patterns are determined by the particular anatomy of the anterior epidural space. The shape of the mass is imposed by the posterior longitudinal ligament and by the attached lateral membranes, with the central tether produced by the attached midline septum. The two compartments expand independently.
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The authors present a case of cauda equina paraparesis due to compression by tabetic osteo-arthropathy. Diagnosis was confirmed by the typical clinical picture of tabes and by the history of a chancre 53 years earlier. Radiography of the spine showed vertibral osteo-arthropathy. Opaque contrast myelography showed compression at the D 11/D 12 and L 4/L 5 levels, with poor contrast filling athe the L 1/L 3 level. Surgical treatment by decompressive laminectomies from D 12 to L 4 led to a satisfactory result with motor recovery and regression of the cauda equina syndrome.