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At least 1,675 records · Page 93Linked to original sources
PubMed1998

[Delayed lumbar epidural hematoma. Discussion of the risk factors: hypertension, anticoagulation and spinal anesthesia].

This case report deals with the very rare complication of an intraspinal haematoma: a 70 year old male underwent anticoagulation because of supraventricular dysrhythmias followed by two transient ischaemic attacks. He accidentally received an intramuscular injection for tetanus prophylaxis and developed a deep intramuscular haematoma, which was operated upon, after normalisation of coagulation parameters, under spinal anaesthesia. No primary complication was noted. Heparin therapy was started perioperatively, on the day of the operation. Sixteen days postoperatively, the patient resumed oral anticoagulation; 3 months later he developed a progressive cauda-equina-syndrome due to an epidural haematoma at the level of L2 to L4. This could be diagnosed by magnetic resonance imaging, but not by computed tomography. Acute surgical decompression was performed. The haematoma showed various ages as suspected by the intraoperative morphology and proven by histological examination. The neurological findings improved, and 6 months after rehabilitation only slight neurological deficits remained. Hypertension, anticoagulants, and spinal anaesthesia are discussed as risk factors for this complication.

Aged↗
PubMed2002

[Intradural recurrence of multiple myeloma during the hematological complete remission].

In December 1997, a 55-year-old man presented with left-sided back and arm pain. Pretreatment examination revealed IgG-lambda type M-protein, Bence-Jones protein and the posterior mediastinum tumor. Bone marrow examination revealed hypercellular marrow with 73.6% plasma cells. He was diagnosed as having multiple myeloma with extramedullary lesion. As a result of VAD, MP, interferon and radiation therapy, he had a hematological complete remission. After 21 months, he developed intradural relapse at cauda equina and cerebrum. Many plasma cells and IgG-lambda type M-protein were detected in the cerebrospinal fluid. Laboratory examinations showed a complete remission except for cerebral and meningeal involvement. The myeloma cells might have infiltrated the intradural space at diagnosis and expanded in the central nervous system despite chemotherapy. Because reported cases with cerebral and meningeal myeloma are increasing according to the recent advance of treatment, we must pay attention to the meningeal myeloma.

Brain Neoplasms↗
PubMed1996

Spinal ependymomas--the value of postoperative radiotherapy for residual disease control.

Spinal ependymomas are rare intramedullary tumours, usually with a benign biological nature. They have, however, a known potential for recurrence and metastatic spread through the CSF pathways. Traditionally, radiotherapy has been employed as an adjuvant to surgery. Recently, however, this view has been increasingly questioned. Thirty-eight adult patients operated in the West Midlands between 1956 and 1994 were reviewed. Mean age at presentation was 37.8 years. Of all tumours 45% (17) were situated in the conus/cauda equina region, 26% (10) in the thoracic and 29% (11) in the cervical region. All patients underwent surgery as primary treatment. Postoperative mortality was 2.6% (one patient). Complete macroscopic excision of their tumours was performed in 14 patients; of these three received postoperative radiotherapy. Subtotal excision was performed in 18 patients, seven receiving adjuvant radiotherapy. Decompressive laminectomy and biopsy was performed in five patients with either no radiotherapy in one, radiotherapy in three or radiotherapy and chemotherapy in one. The overall survival rate was 87% at 5 years and 73% at 10 years for the whole series. In patients treated after the 1970s, the cumulative 10-year survival was 95%. Patients over the age of 40 years at diagnosis had a 10-year survival of 61% compared to 78% of those under the age of 40. Intramedullary tumours had a worse outcome with 68% survival at 10 years, compared to 89% of tumours at the cauda equina. Total excision carried 86% survival, subtotal excision 80% and biopsy only 25% at 10 years. In those patients treated by administration of postoperative radiotherapy the 10-year survival was 48%, compared to 96% in those in whom radiotherapy was not given postoperatively. Analysis of the recurrence and survival rates demonstrated that radiotherapy did not confer any significant protection against recurrence or disease progression. Whilst complete excision offers the maximal potential for cure, an expectant policy with possible repeat surgery may be appropriate when total excision is not achieved. The main conclusion to be drawn is that a randomized controlled trial of the value of adjuvant radiotherapy is greatly needed.

Adolescent↗
PubMed1991

Intraoperative recordings of spinal somatosensory evoked potentials to tibial nerve and sural nerve stimulation.

Somatosensory evoked potentials (SSEPs) to stimulation of the tibial nerve at the knee (TN-K) and ankle (TN-A), and the sural nerve at the ankle (SN-A), were recorded from 3 or 4 spinal levels during surgery for scoliosis in 11 neurologically normal subjects. With stimulation of all 3 nerves, the propagation velocity along the spine was nonlinear: it was faster over cauda equina and midthoracic cord than over caudal spinal cord. Over the mid-thoracic cord, TN-K SSEP propagation was faster than that of TN-A and SN-A SSEPs, whereas over the caudal spinal cord these values were similar on stimulation of all 3 nerves. These data suggest that fast conducting second order afferent fiber systems contribute to spinal cord SSEPs evoked by stimulating both mixed and cutaneous peripheral nerves.

Adolescent↗
PubMed1977

Radiation-induced nerve root degeneration and hypertrophic neuropathy in the lumbosacral spinal cord of rats: the relation with changes in aging rats.

Three-month-old WAG/Rij rats were irradiated with 300 kV X-rays on the lumbar region of the spinal column with doses below the level for causing paralysis due to radiation radiculomyelopathy. 8--9 months after irradiation, degeneration of predominantly the ventral nerve roots of the cauda equina was boserved. Three stages were distinguishable: I) Demyelination and proliferation of Schwann cells; II) Local swelling of ventral nerve roots, with concentric layers of Schwann cells resembling hypertrophic neuropathy; III) Malignant Schwannoma, invading roots and spinal cord. It is concluded that the degenerative and proliferative lesions represent a continuous series of stages of slowly progressive lesions. The ventral nerve root degeneration (1st stage) is similar to that observed in aging, unirradiated rats, normally developing at the age of 18--20 months.

Aging↗
PubMedDate not supplied

The Pennsylvania Plan. An algorithm for the management of lumbar degenerative disc disease.

An algorithm for the sequential management of the patient with low-back pain has been formulated from evaluation of treatment outcomes. Patients presenting with back pain complaints and cauda equina syndrome are evaluated with immediate myelography. Without this complication, back pain patients are treated with 6 weeks of conservative therapy. Those who fail to respond are evaluated with progressively more complex techniques. When sciatica predominates, treatment may ultimately include laminectomy. When back pain predominates, medical and psychosocial appraisal are recommended. Some with normal medical and psychosocial evaluations may become candidates for spine fusion. The remaining are treated according to the findings of such appraisals. Rigorous screening is mandatory prior to any surgery.

Algorithms↗
PubMedDate not supplied

[Spinal cord metastasis of a glioblastoma].

Two years after surgery followed by chemotherapy and radiotherapy of a temporal glioblastoma, a 51 year-old woman presented pluriradicular symptoms ascribed to compression of the left part of the cauda equina. The second operation confirmed the metastatic nature of the compression, and histological investigation proved the similarity of the neoplastic tissues taken from the medullary and cerebral regions. The authors stress the rarity of the clinical forms of medullary metastases of glioblastomas. The factors conducive to this fluid effusion are trauma and ventricular effraction by the original tumour. Neither screening nor prophylactic irradiation seem necessary in view of the low frequency of these metastases.

Brain Neoplasms↗
PubMed1987

Central nervous system neoplasm in a young man with Martin-Bell syndrome--fra(X)-XLMR.

A 17-year-old retarded male developed unilateral leg weakness with foot drop, pain, and incontinence. Workup disclosed a cauda equina tumor which, on surgical exploration, was demonstrated to merge with the conus medullaris. Pathological examination of the subtotally resected tumor led to a diagnosis of malignant ganglioglioma. Further evaluation of the patient documented marginal macro-orchidism, and chromosome studies showed fragile X. Since some neoplasms are known to be associated with chromosomal deletions and other abnormalities, we suggest that the occurrence of this tumor in this patient indicates a more than coincidental relationship between the two diagnoses.

Adolescent↗
PubMed1975

Electron-microscopie observations of a human schwannoma in organotypic culture.

A malignant Schwannoma of the cauda equina has been studied in long-term organotypic culture. Electron-microscopic observation demonstrates that, along with tissue organization, characteristic cell differentiation was retained in this type of culture, but with some morphological changes. As in the biopsy, the tumor cells were elongated and had abundant cell processes in vitro. An increase in the quantity of cytoplasmic filaments and changes in the form of cell processes were observed. Thus organotypic culture of human Schwann cell tumors provides a method of investigating factors which affect their development and differentiation.

Adolescent↗
PubMed2006

Peripheral primitive neuroectodermal tumor/Ewing's sarcoma of the craniospinal vault: case reports and review.

The peripheral primitive neuroectodermal tumor/Ewing's sarcoma family tumor (pPNET/ESFT) group includes small round cell tumors of the bone, soft tissue, and nerve with morphological attributes of the germinal neuroepithelium. Peripheral PNETs/ESFTs also occur within the craniospinal vault, a region including the central nervous system, the meninges, and the cranial and spinal nerve roots. Gene rearrangements between the EWS gene on chromosome 22q12 and members of the ETS gene family are common in and specific to pPNETs/ESFTs. Another defining characteristic of pPNETs/ESFTs is their membranous expression of the MIC2 gene product. We describe 2 cases of pPNETs within the craniospinal vault. An intradural tumor arising from the nerve roots of the cauda equina was discovered in a 32-year-old man presenting with radiculopathic back pain and lower-extremity weakness. An intracranial pPNET that mimicked a meningioma was found in a 21-year-old man presenting with headache and visual disturbances. MIC2 gene product expression and EWS/ETS gene rearrangement were detected in both case patients. The literature with regard to pPNETs/ESFTs arising within the craniospinal vault is reviewed.

12E7 Antigen↗
PubMed1975

[The role of surgery in the treatment of sciatica. An experience of more than 4000 operations].

Sciatica must always be first considered as a medical problem. Operation is indicated only for refractory cases. Analysis of more than 4 036 operations shows the best indications for surgery. These consist of typical disc sciatica, sciatica with excessive pain, with paralysis and with cauda equina syndrome. Myeloradiculography was not carried out routinely, being reserved for atypical forms. A negative radiculography is not necessarily a contraindication. The results of foraminotomy are less constant than after removal of a disc prolapse. It benefits 60 p. cent of patients, however. Some reserve applies to its use since it is not possible to predict those patients who will be relieved. There exist finally those cases in which the organic origin of the pain cannot be proved, at which time the surgeon should refuse operation which may be an aggravating factor.

Cauda Equina↗
PubMed1999

[Panorama ultrasound of the spinal canal with determination of the level of the conus medullaris in newborn infants and infants].

PURPOSE: To evaluate the utility of panoramic ultrasound in visualizing the spinal canal and the conus medullaris level in neonates and young infants. METHOD: 30 children (aged 2 days to 5 months, 2058-6660 g, 41-57 cm) underwent examination of the spinal canal. The children were examined by a single, continuous 9.0 MHz transducer movement from the cervico thoracic spine to the coccyx. A dedicated computer processor produced an extended field of view image in realtime mode. RESULTS: With panoramic ultrasound coverage of the thoracic, lumbar and sacral spinal canal on one extended image was possible. Visualization of the spinal cord, the conus medullaris level, the subarachnoid space, the cauda equina and the tip of the dural sac was easily accomplished in each child. An average of four trials was necessary to obtain an image of sufficient diagnostic quality. The conus level ranged from L1 to L3, the tip of the dural sac was localized at S1 to S3. CONCLUSIONS: Panoramic ultrasound offers nearly complete visualization of the spinal canal in children on one single extended field of view image. The conus medullaris level and the tip of the dural sac can easily be localized.

Cauda Equina↗
PubMedDate not supplied

Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment.

OBJECTIVE: To provide a qualitative systematic review of the risk of spinal manipulation in the treatment of lumbar disk herniations (LDH) and to estimate the risk of spinal manipulation causing a severe adverse reaction in a patient presenting with LDH. DATA SOURCES: Relevant case reports, review articles, surveys, and investigations regarding treatment of lumbar disk herniations with spinal manipulation and adverse effects and associated risks were found with a search of the literature. DATA SYNTHESIS: Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated. From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated. This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH. RESULTS: An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million. CONCLUSION: The apparent safety of spinal manipulation, especially when compared with other "medically accepted" treatments for LDH, should stimulate its use in the conservative treatment plan of LDH.

Cauda Equina↗
PubMed2000

Kinesin superfamily protein 3 (KIF3) motor transports fodrin-associating vesicles important for neurite building.

Kinesin superfamily proteins (KIFs) comprise several dozen molecular motor proteins. The KIF3 heterotrimer complex is one of the most abundantly and ubiquitously expressed KIFs in mammalian cells. To unveil the functions of KIF3, microinjection of function-blocking monovalent antibodies against KIF3 into cultured superior cervical ganglion (SCG) neurons was carried out. They significantly blocked fast axonal transport and brought about inhibition of neurite extension. A yeast two-hybrid binding assay revealed the association of fodrin with the KIF3 motor through KAP3. This was further confirmed by using vesicles collected from large bundles of axons (cauda equina), from which membranous vesicles could be prepared in pure preparations. Both immunoprecipitation and immunoelectron microscopy indicated the colocalization of fodrin and KIF3 on the same vesicles, the results reinforcing the evidence that the cargo of the KIF3 motor consists of fodrin-associating vesicles. In addition, pulse-labeling study implied partial comigration of both molecules as fast flow components. Taken together, the KIF3 motor is engaged in fast axonal transport that conveys membranous components important for neurite extension.

Animals↗
PubMedDate not supplied

[Lumbosacral tumors of the vertebral canal simulating prolapse of the nucleus pulposus].

The authors analyzed the signs and clinical data from the preoperative period in 39 patients with tumours of the conus terminalis and cauda equina. Most patients had been treated for a long time for lumbar discopathy with sciatic pains. Most symptoms and neurological signs were in many cases suggestive rather of lumbar disc prolapse than spinal tumour. Radiological examinations of the spine failed in a overwhelming majority of cases to provide clues for correct diagnosis, only the type of tendon jerks loss, results of Queckenstedt's test and protein level in the cerebrospinal fluid suggested spinal tumor as a cause of the disease. Contract radiological examination of the vertebral canal gave definite answer in all cases.

Adult↗
PubMed2002

Predictive power of motor unit potential parameters in anal sphincter electromyography.

The diagnostic utility of motor unit potential (MUP) parameters is usually based exclusively on their diagnostic sensitivity, disregarding specificity. In the present study, advanced statistical methods were used to determine MUP parameters with the highest predictive power for the separation of neuropathic and normal external anal sphincter (EAS) muscles. Using multi-MUP analysis, 3,720 MUPs from 138 muscles of 52 patients with cauda equina lesion and 2,526 from 112 muscles of 64 controls were obtained. Only two principal components (PCs), which put weight on the MUP area and amplitude, were needed to explain all the data variability. On logistic and probit regression analyses, MUP area, duration, and number of turns gave results identical to all MUP parameters. Our results suggest that only these three MUP parameters are needed, and that they are as effective as PCs, in MUP analysis of chronic neuropathic EAS muscles. Reduced number of MUP parameters is expected to simplify MUP analysis and increase its specificity.

Anal Canal↗
PubMed1978

[The diagnosis of lumbosacral lipomeningocele by computed tomography (author's transl)].

A case of 2-month-old girl with lumbosacral lipomeningocele was reported. She was admitted for evaluation of a large soft mass in the lumbosacral area, initially noted at birth. On examination, the tumor was 7 cm in diameter and 3 cm in height. The upper part of a mass was cystic. Plain X-ray films revealed bifid lower lumbar and sacal vertebra. Spinal CT scans revealed a mass and bifid spine. An area with EMI units, 2.4+/-4.2, at L4 level and another with EMI units, -52.9+/-5.5, at L5 level were seen extending from within the canal to the subcutaneous tissue. The former was identified as water and the latter as fat. The preoperative diagnosis of lipomeningocele was made. Operation was performed under the operating microscope. A meningocele sac contained no neural element and it's surface was adhesive to lipoma. Lipoma involved cauda equina and conus medullaris in the canal. We removed the extraspinal lipoma with meningeal sac and a part of the intraspinal lipoma to avoid neurological deficit. We consider, like many authors, that intraspinal lipoma should be operated as early as possible with the help of surgical microscope. Early diagnosis is necessary. Myelography is valuable but caution is needed at time of lumbar or cisternal puncture. But spinal computed tomography is noninvasive and allows for precise diagnosis without contrast myelography. CT scan is extremely useful in diagnosing congenital abnormality of the spine.

Cauda Equina↗
PubMed1976

Degenerative lumbar spondylolisthesis with an intact neural arch (pseudospondylolisthesis).

Twenty patients treated for degenerative spondylolisthesis with an intact neural arch principally at the L4-5 interspace had neural compression caused by dislocation of the vertebral bodies and intrusions of lamina and enlarged, arthrotic facets into a stenotic spinal canal. The resulting "pincer" effect caused complete or partial block demonstrable on myelography, with nerve root and cauda equina compression. Most of the patients were women aged 45-84 years. Seven had neurogenic claudication. The majority had unrestricted straight-leg raising, and no signs of acute neural entrapment were seen as in patients with a herniated disc. Absent ankle reflexes, and weakness and atrophy of the anterior tibial muscle group were common, while sensation was relatively undisturbed. Treatment consisted of liberal laminar decompression including foraminotomy and medial or total facetectomy. Good-to-excellent results were obtained, and no patient was made worse by the procedure.

Aged↗