[Conservative treatment of patients with stenosis of the spinal canal in the lumbar segment].
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Two cases are presented with the myelographic appearance of an intradural tumor believed to be neurilemoma. In one instance the defect was undoubtedly caused by a cicatrix which developed over a period of years, consequent to postoperative spinal fluid fistula. In the second case a herniated disk at the L2-3 level was mistaken as artifact and its true nature was revealed only at operation seven years later. It was suspected to be neurilemoma because of the myelographic appearance and persistence of the lesion.
The authors have seen 11 instances in which symptoms that could be related to arthrosis of the hip and treated by total hip replacement were associated with root involvement due to lumbar spinal stenosis of degenerative origin. At times the Surgeon had been misled and treated the hip first instead of the spine. The clinical signs of these associated lesions, which are not uncommon, are described. This paper aims to draw the attention of Surgeons to the frequency of symptoms originating from the spine in patients more than 70 years old.
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A case malignant pleural mesothelioma is presented. The initial CT scan of the chest showed a left paraspinal pleural mass at T6-T7 level. Subsequently the mass was partially resected by a left thoracotomy. The patient later developed spinal cord findings, and a followup CT scan showed partial destruction of the twelfth dorsal vertebra and intraspinal tumor at T11-T12 level. This is only the second case reporting spinal cord compression by mesothelioma and the first documented by computed tomography.
Seventy-two patients with compression fractures of the lower thoracic and lumbar spine who were treated by the Böhler method from 1972 to 1987 were followed up to compare the clinical signs and the results of conventional radiography and spinal computed tomography. There were 33 men and 39 women with an average age of 44.3 years (23-69 years). Treatment by the Böhler method is indicated for fractures between T12 and L5, which constitute 60% of all vertebral fractures. The main distribution in our patients was T12 (n = 26) and L1 (n = 33). Four patients primarily had neurological symptoms. The mean duration of hospitalization was 16 days (4-54). In our results, back pain is the most frequent complaint. A comparison with the findings on the day of the accident showed that the vertebral deformity decreased in all cases (index: mean accident = 0.64; mean follow-up = 0.82). In the CT scan we found spinal stenosis in up to 30% in 9 patients (12.5%) with no neurological symptoms. Based on these results, the authors recommend the Böhler method in lower thoracic and lumbar compression fractures without neurological symptoms. The main aim of the treatment must be reduction of the vertebral deformity to a minimum in order to maximize the biomechanical integrity of the vertebral column and prevent degenerative changes. The use of computed tomography is recommended even in these fractures because of possible spinal stenosis. CT is accurate, especially in evaluating the nature of facet joint failure.
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