SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
We describe a rare case of marked segmental stenosis of the axis secondary to developmental hypertrophy of the posterior neural arch causing severe neck pain and headache in the occipital region. The patient made a remarkable recovery following decompressive laminectomy and foraminal decompression.
We present the case of a 46-year-old female with a lumbar spine paraganglioma. The patient complained of a right-sided lumboischialgia. Preoperative MRI revealed an intradural tumour at the vertebra L3 level, located in the midline, 7 mm in diameter. The tumour was totally removed by laminectomy. Histopathological examination showed nests of chief cells (zellballen), surrounded by reticulin fibres. Immunohistochemistry showed a positive reaction for chromogranin A, neuronal specific protein, synaptophysin and cytokeratin in the chief cells. The sustentacular cells displayed immunopositivity for S-100 protein, single cells were also positive for GFAP. We found no proliferative activity in the tumour cells (Ki-67 index = 0%). In the two years follow-up the patient remains without clinical or radiological signs of recurrence. Spinal paraganglioma is a rare, surgically curable tumour with low proliferative potential. This entity should be taken into consideration in the differential diagnosis of extramedullary spinal lesions.
STUDY DESIGN: This report describes a case of successful surgical excision of an intrathoracic paraspinal desmoid tumor with an intraspinous extension causing scoliosis and paralysis in a 12-year-old girl. OBJECTIVES: The purpose of this report is to illustrate the potential spectrum of disease of a desmoid tumor and to make physicians aware of the rare possibility of an intraspinal extension of a paraspinal desmoid tumor. SUMMARY OF BACKGROUND DATA: Surgical excision of desmoid tumors in the pediatric population is the standard of care for initial treatment. There have been no clinical reports in the spine literature of a desmoid tumor causing scoliosis or of a desmoid tumor with an intraspinous extension causing paralysis. METHODS: The tumor was decompressed from a posterior approach followed by an anterior resection and an anterior spinal fusion. Two weeks later a posterior spinal fusion was performed to correct the spinal deformity. The patient also received radiation therapy after surgery for 5 weeks. RESULTS: The patient tolerated the procedure well, has been free of recurrence for 9 years, and is currently doing well. CONCLUSION: This case report should help expand the understanding of the spectrum of this uncommon tumor.
Symptoms suggestive of vascular origin, both venous and arterial, may be the presenting complaints in patients with lumbar spondylosis. Fourteen patients suspected of having vascular intermittent claudication were found to be free of vascular disease, but had cauda equina compromise from herniated disk, osteoarthritis, and hypertrophic ligaments. Complete follow-up data were available for seven patients. In three, claudication seemed typical; in four, atypical. At operation, herniated intervertebral disks, osteophytic bone, or hypertrophied ligamenta flava, or a combination, were found. All benefited from lumbar laminectomy. When patients with vascular-like symptoms are found to be free of arterial or venous disease, lumbar spondylosis (narrow lumbar canal syndrome) should be considered. Chronic incapacitation pain without vascular disease provides a clue, as does electromyography. Plain X-ray films of the lumbar spine do not show the abnormality; thus, myelography should be carried out even in the absence of neurologic signs.
The value of the physical therapy after the operation at the lumbar spine is unquestionable. But the treatment should be chosen individually, according to the kind of operation, the patient's age, the state of the spine, but also according to the social and familiar conditions. We present our criteria of choosing the adequate treatment. In times of sharp increase of the medical costs such frequently, rather costly treatment must only be prescribed when inevitably indicated.
Measurements of cast preparations of epidural cavities yielded data characterising the "internal silhouette" of the lumbar vertebral canal. Three groups of different shapes of lumbar vertebral canal were found to be statistically distinguishable from each other. These are determined by the constitution of the patient. The different spatial capacity of the three types and the different relations of the diameters modify the value of the isolated determined distance, for example of the sagittal diameter at L5, which is a clinically extremely relevant factor that must be taken into account.
The myelograms of 40 patients who had been operated on because of stenosis of the lumbar vertebral canal, were retrospectively assessed and measured. As was to be expected, the diameters were reduced, especially the sagittal diameter. Three configurations of the epidural space were seen representing different spatial capacities. The type occurring particularly often in lumbar osteogenic stenosis, which is conditioned by the patient's constitution, must be considered as a predisposing factor for the manifestation of a lumbar compression syndrome on account of its small capacity.
Two cases of symptomatic lumbar lateral recess stenosis are described in which the compressed nerve root became focally enhanced on magnetic resonance imaging (MRI) studies performed with gadolinium DTPA. Two men with low back pain and lumbar radiculopathy were examined with contrast-enhanced MRI studies, which showed intradural enhancement of the symptomatic nerve roots. In selected cases of lateral recess stenosis, focal radicular injury may be visualized on enhanced MRI as a result of a breakdown of the blood-brain barrier.
During a period of 4.5 years, 199 patients have been operated on by laminectomy because of narrow lumbar canal. The incidence in Geneva is about 11.5 case/100000/year and the ratio between male and female is 1.28. The disease is strongly related to aging, but men are affected earlier in their life than women. Heavy work, particularly for men, has a part to play in the genesis, like the body mass calculated by BMI (Body Mass Index). A comparison between the epidemiology of lumbar disc prolapse and lumbar stenosis shows the differences.
The present paper describes a tumour that developed like an hour-glass tumour, both intraspinally at lumbar level and retroperitoneally. At operation the tumour was diagnosed as a malignant neurinoma. The structure of the tumour, studied by light and electron microscopy, as well as the subsequent evolution of the case, showed it to be a leiomyoblastoma with a retroperitoneal origin, that gradually infiltrated the nerve root (L1) up to the dura mater, epidural and subdural space, where it took on the appearance of a primary tumour of these formations. The author discusses the existence of the so-called primary intracranial rhabdomyosarcoma and its relationship with medullomyoblastoma.
A 49-year-old man who had complained of back pain for 20 years presented with numbness and pain in his left leg persisting for 6 weeks. Magnetic resonance imaging demonstrated a peripherally enhanced intraspinal mass at the L-3 level. The mass was completely removed. The operative and histological findings revealed degenerated disc fragments surrounded by granulation tissue. His symptoms were completely relieved. Migrated disc should be included in the differential diagnosis of patients with a long history of back pain and an intraspinal mass.
Pituitary carcinoma with metastatic endocrine secreting tissue is rare. Eight cases of malignant, growth hormone-secreting tumours, all metastatic within the central nervous system have been previously described. Complete surgical resection was not possible and the patients died within 4 years of presentation with distant spread. Here we describe the first case of an apparent surgical cure of a somatotroph carcinoma metastatic to the cervical spine, documented by biochemical assessment and magnetic resonance and radioligand imaging. The possibility that intrathecal metastasis of somatotroph tumours may be responsible for some cases of treatment resistant acromegaly is discussed.
Aneurysmal bone cysts (ABC) are rare bone tumors of controversial pathogenesis. In 15% of cases, they are localized in the vertebrae. Despite the absence of anaplasia, their volume and localization are often responsible for incomplete surgical resection. The authors present 5 cases of primary vertebral ABC, 4 females and one male, localized in cervical (3 cases), dorsal (1 case) and lumbar (1 case) spine. Symptoms included rachialgia and torticollis. Radiological and histopathological examination disclosed the typical features of ABC. Pre-operative embolization (in 3 cases) and surgery (complete exeresis in all cases except one) were the therapeutic procedures. During a 39 month median period of follow-up, there was one local recurrence. The only case of incomplete exeresis show not did any evidence of progression until 36 months after operation.
Within a period of 27 years 62 patients were operated on because of glial tumours. In 30 cases these were ependymomas. In another 32 patients gliomas were identified histologically. In each case 31 men and 31 women were affected. At the time of the operation, almost two thirds of the patients were no longer able to walk without help. In 41 per cent of the patients the operation brought an improvement. A total of 33.9 per cent were able to walk on their own and 8.1 per cent could walk when given help. Fourteen patients (22.6%) became fit to work. Nine patients (14.5%) are in need of care. The total mortality within an after-observation period of three years amounted to 40.3 per cent (25 cases).
Eighty-eight patients (52 men, 36 women) were operated on for lateral recess syndrome, during the 1970-1986 period. 7 had priorly a disc excision; in 11 a chemonucleolysis had been performed. The pain affected one nerve root in 41 cases, two in 8, three in 1. In 33 patients the pain pattern was incomplete. Myelography was used in 77 cases, and was positive in 68. CT scan was used in 43 cases. A posterolateral fusion was added to the unroofing of the nerve in 9 patients, who had severe low back pain before surgery. The results were assessed with a special rating scale of 20 points. They were considered excellent or good in 70 per cent. 6 patients were reoperated from 3 months to 2 years post-operatively mainly for recurrent pain at another level or side.
To investigate the pathogenesis of hypertrophy of the ligamentum flavum, 45 cases of lumbar canal stenosis were evaluated by computed tomography scan and pathologic and immunohistochemical studies. The ligamentum flavum along with the medial one-third of the superior facet was obtained en bloc to include the enthesis. Statistically significant differences in transverse area and thickness of the ligamentum flavum were evident compared to the control group (P < 0.01). Pathogenesis of the hypertrophied ligamentum flavum was classified into three major groups: 1) fibrocartilage change due to proliferation of type II collagen, 2) ossification, and 3) calcium crystal deposition. It is stressed that marked proliferation of Type II collagen from the enthesis to the ligament side was revealed in the capsular portion of the hypertrophied ligament.
In a 64-year-old male with pain and weakness of the right lower limb, investigations disclosed a cervical tumor, several dorsal tumors, and tumoral infiltration of the lumbosacral area. Histological and, above all, immunohistochemical and ultrastructural features were suggestive of meningeal melanocytoma. Before the use of immunohistochemical and electron microscopy techniques, meningeal melanocytoma was designated by the term pigmented meningioma because its histological features bear some resemblance to those of meningioma. However, only a few cases of meningeal melanocytoma have been documented by immunohistochemistry and electron microscopy. Previously reported patients with meningeal melanocytoma had solitary tumors. In contrast, a review of the literature showed that multiple intraspinal or intraspinal and intracranial meningiomas are not exceptional, although meningiomatous infiltration is considerably less frequent. Treatment of such cases rests on surgery, radiotherapy, and chemoimmunotherapy.
A total of 102 patients were operated on in 134 levels because of an isolated spondylotic cervical stenosis in 6 years. A titanium implant coated with hydroxyapatite ceramic (HAC) was inserted. The average age of the patients was 53 years. The final clinical and radiological follow-up was performed after 15 months. The functional outcome was classified as good to excellent (Odoms's score) in 83.8% of the patients. Implant-related complications requiring revision surgery included two dislocated dowels and one vertebral collapse in a bisegmental operation. After 6 weeks beginning of bony growth around the implant was seen in 38% of all inserted titanium cages on roentgenograms. A complete solid bony incorporation was shown in 91.2% of the fused segments after 6 months and in 96% after 12 months or at follow-up, respectively. These results illustrate the efficacy of the easy to handle HAC titanium implant, demonstrating that this technique achieves good clinical outcome with the same complication rate as comparable techniques.