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Lumbosacral osteochondrosis: radiological features and surgical management in 34 dogs.

Lumbosacral osteochondrosis has been diagnosed with increasing frequency over the past few years. Nevertheless, poor recognition of the condition continues to lead to frequent misdiagnosis. A study was therefore undertaken over a 12-year period (1986 to 1998) to describe the use of a variety of radiological studies to define the syndrome and the use of different surgical techniques for optimal treatment of the condition. Dogs with clinical signs of cauda equina neuropathy and radiological signs of lumbosacral osteochondrosis were older than 14 months (mean age 6.3 years). German shepherd dogs, boxers and rottweilers were heavily represented. Of the 34 dogs with osteochondrosis in this study, the lesion appeared to be related to the sacrum in 31 dogs (91 per cent) and the seventh lumbar vertebra in the remaining three dogs (9 per cent). Twenty-seven male and seven female dogs were affected (4:1). Out of the 34 dogs, six (18 per cent) were treated conservatively and the remaining 28 (82 per cent) were treated surgically. The outcome of surgical treatment was considered to be satisfactory in 24 (86 per cent) of these latter dogs.

Animals↗

[Corticosteroid-induced epidural lipomatosis. Efficacy of medical treatment].

We describe a further case of cauda equina compression secondary to steroid-induced epidural lipomatosis in a patient treated for IBD. The diagnosis was rapidly confirmed by MRI allowing conservative management by corticosteroid withdrawal as well as use of hygiene and dietary measures. Therapeutic efficacy was noted on a clinical basis and confirmed by repeated follow-up MRI exams which showed regression of fat accumulation. Symptomatic epidural lipomatosis is probably underestimated because physicians concerned by steroid treatment are not fully informed about this potentially severe and usually iatrogenic disease. Also, proper medical attention to the first neurological symptom in these patients might help limit therapeutic management to a medical measurer, before requiring surgical decompressive surgery.

Adult↗

[Morphological findings in MRI to be considered in perfoming spinal and epidural anesthesia].

The spinal cord and cauda equina move in the subarachnoid space by changing positions. The subarachnoid space is compressed from the dorsal side by epidural injection. At the end of gestation, the subarachnoid space is compressed from the ventral side by the engorged venous plexus. Idiopathic epidural lipomatosis is observed almost exclusively in the obese population. In the case of lipomatosis, the subarachnoid space is compressed by increased extradural fat around the thecal sac. We have had some severe cases of spinal canal stenosis in whom it is difficult to perform the spinal puncture. The authors showed some MR images and discussed morphological issues for spinal or epidural anesthesia.

Adult↗

Tissue culture, electron microscopic and enzyme histochemical investigations of extraadrenal paragangliomas.

Light and electromicroscopical as well as histochemical investigations were performed on three cases of extraadrenal paragangliomas. They were localized in the carotid body, tympanicum and cauda equina region. Tissue of two cases was cultivated in vitro in nutrient medium TCM 199. The tumours were classified as paragangliomas of the paraganglionic type with typical cell clusters, of the adenomatous and angiomatous type. The enzyme histochemistry showed a very high dehydrogenase activity. Ultrastructurally numerous typical osmiophilic granules could be observed in the cytoplasm of the tumour cells. In tissue culture only a minimal cellular proliferative activity could be detected. The few proliferating cell colonies showed mostly characteristics of epithelial tissue and sometimes a similar behaviour to cells of a ganglioneuroblastoma. The minimal proliferative activity in vitro is in good agreement with the proliferative behaviour of the extraadrenal paragangliomas in vivo.

Carboxylic Ester Hydrolases↗

Lumbar root stimulation for restoring leg function: stimulator and measurement of muscle actions.

We are studying the feasibility of restoring lower limb functions to paraplegics by stimulating their lumbar anterior roots (L2-S2). The potential advantages of placing electrodes at the roots, at the cauda equina, were set out by Rushton (1), and our results so far are in a companion paper by Rushton et al. In this paper, we describe briefly the stimulator system and a special apparatus we call the multimoment chair. The stimulator is a development from an earlier design of an implantable peripheral nerve stimulator (2) and has features that make it easier to use. The multimoment chair enables us to gather simultaneously isometric joint moments for 14 axes of the legs during stimulation while the body is fixed in a posture between sitting and full extension. Such rapid data collection is essential to discover the effects of multiple-root stimulation and its functional possibilities.

Cauda Equina↗

Spinal cord compression in multiple myeloma: who gets it?

Of 97 Chinese patients with multiple myeloma seen over a 12-year period, 23.7% were found to have cauda equina or spinal cord compression (SCC). Predictive features for SCC include paraprotein type, hemoglobin level, and the extent of bone lesion at initial hematological diagnosis. A discriminant function derived from this analysis can be used to predict the likelihood of SCC with 79% accuracy. It is postulated that when the cortex is more involved than the medulla in a vertebra, it will predispose to SCC while hemopoiesis is relatively preserved. Our patients presented late with advanced neurological deficit so that treatment was unsatisfactory. It is emphasised that early recognition of back pain and neurological symptoms is essential, as any delay would jeopardize the chance of neurological recovery.

Adult↗

Interdural cyst of the lumbosacral region.

The purpose of this report is to call attention to the clinical, myelographic, and computed tomographic appearance of a very rare type of dural cyst within the lumbosacral spinal canal. We report this condition in three unrelated boys who presented with symptoms of cauda equina compression. Our experience suggests that these cysts are congenital in origin. Anatomically, the cyst wall consisted of a dura-like layer without arachnoid. There was a small ventral defect allowing incomplete communication with the compressed subarachnoid space. Cerebrospinal fluid-like fluid accumulated within the interdural cyst as a result of this communication. Treatment consisted of obliteration of the point of entry between cyst and subarachnoid space in all cases and partial cyst wall excision in one case. After operation, the two patients who had presented with long-standing sphincter disturbance had partial improvement in function and the child with a pain syndrome was completely relieved of symptoms.

Cauda Equina↗

Impaction fracture of the lumbar vertebrae with dural tear.

The authors described a lumbar spine fracture that is characterized on anteroposterior x-ray views by separation of the pedicular shadows. It is almost invariably associated with posterior interlaminar herniation of the cauda equina through a dorsal dural split, and anterolateral entrapment or amputation of the nerve root. The fracture is unstable and requires internal fixation and fusion at the time of neurolysis. Fractures meeting these criteria should be explored as soon as the patients' condition permits. Myelography is usually unnecessary and may be contraindicated in some cases. The postulated mechanism of injury is hyperextension with vertical impaction and rupture of the ring made up of the lamina, pedicle, and vertebral body. The ring is fractured in several places in a manner similar to that seen in "Jefferson fracture" of C-1. The special anatomical relationships of the thoracolumbar junction and the plane of the lumbar facets are also discussed.

Cauda Equina↗

Criteria for neuropathic abnormality in quantitative anal sphincter electromyography.

For the external anal sphincter muscle, both normative values and an optimal set of motor unit potential (MUP) parameters have been defined. However, criteria for the diagnosis of neuropathic conditions have not yet been validated. Therefore, in this study, sensitivity was examined in 86 patients with cauda equina lesions (227 muscles), and specificity in 77 controls (119 muscles), using multi-MUP analysis. Six previously defined diagnostic criteria (mean values and outliers for MUP area, duration, and number of turns) were used. An increase in the number of diagnostic criteria required for muscle abnormality (two and three instead of one), and the application of more stringent normative limits resulted in a progressive increase in specificity from 74% to 99% (controls), and a decrease in sensitivity from 70% to 21% (patients). The data suggest that no single cut-off diagnostic criterion has both satisfactory sensitivity and specificity. Introduction of the diagnostic categories of "possible," "probable," and "definite" neuropathic abnormalities into quantitative electromyographic analysis is proposed.

Adult↗

Induction of experimental autoimmune neuritis with peripheral myelin protein-22.

Two myelin proteins, P2 basic protein and P0 glycoprotein, can induce experimental autoimmune neuritis (EAN), a model of human inflammatory neuropathy. We investigated whether peripheral nerve myelin protein-22 (PMP22), the gene for which is duplicated in hereditary motor sensory neuropathy type la, can also induce EAN. PMP22 cDNA produced by the reverse transcriptase-polymerase chain reaction from rat sciatic nerve was expressed in Escherichia coli as a fusion protein with glutathione-S-transferase (GST). Ten Lewis rats were immunized with purified PMP22 fusion protein (50-100 microg) and eight controls with the same amount of GST. Two additional animals were immunized with each of two peptides (250 microg) of the human PMP22 extracellular sequences. Animals were examined daily until 20 days following immunization, when they underwent neurophysiological examination. A serum sample was then taken, prior to perfusion with glutaraldehyde and removal of the sciatic nerves and cauda equina. PMP22-immunized animals developed antibodies to the fusion protein and five out of 10 developed limp tails. No changes were observed in controls immunized with GST or in animals immunized with peptide. The mean compound motor action potentials elicited in the foot muscles by stimulation of the sciatic nerve at the sciatic notch and of the tibial nerve at the ankle were significantly reduced in the PMP22-immunized group (P < 0.05). Spinal roots from the group of animals immunized with PMP22 showed sparse infiltration of mononuclear cells, oedema and demyelination. PMP22 now deserves consideration as an autoantigen in human acute inflammatory demyelinating polyradiculoneuropathy.

Action Potentials↗

[Clinical and electroencephalographic signs of side effects in patients after myelography using "amipaque"].

The authors present the results of own investigations on the occurrence of side effects following myelography with the contrast medium Amipaque administered usually by the lumbar route. Sixty patients aged 21-65 years with various diseases of the spinal cord and cauda equina were studied. Clinical and myelographic investigations were performed before and after myelography. In 6 out of 60 cases (10%) transient neurological disturbances developed including epileptic seizures, speech disturbances of the type of aphasia and dysartria, visual disturbances and twitching of lower extremities. Other symptoms and signs included: headaches, vomiting, collapse. One patient with cardiorespiratory failure died hours after myelography with evidence of increased symptoms of cardiorespiratory failure. EEG changes appeared after myelography in 2/3 of cases and persisted for up to 12 days. The authors call attention to the high proportion of neurological complications and EEG changes which must be taken into account when indications to myelography are considered. Particular caution is necessary in cases with coexistent cardiorespiratory failure.

Adult↗

Magnetic resonance imaging in the management of suspected spinal canal disease in patients with known malignancy.

AIM: The aim of this study was to examine the spectrum of spinal canal disease in patients with known malignancy using magnetic resonance imaging (MRI). MATERIALS AND METHODS: One hundred and fifty-five patients underwent a total of 159 spinal MRI examinations over a three-year period. Patients were examined using a 1.0T magnet and a phased array surface spine coil. Sagittal T1 weighted spin echo and STIR sequences were routinely employed. Axial T1 and T2 weighted spin echo images were obtained at sites of identified pathology. Contrast enhanced sagittal and axial T1 weighted spin echo images were acquired when the unenhanced appearances did not correlate with the clinical findings or when the images suggested intradural or intramedullary disease. RESULTS: Malignant disease affecting the spinal cord or cauda equina was noted in 104/159 (65%) patients (extradural n= 78, intradural n= 20, intramedullary n= 7); one patient had evidence of both intradural and intramedullary deposits. Multiple levels of extradural cord/cauda equina compression were present in 18/78 patients (23%). The thoracic spine was the most frequently affected (74%). Bone elements were the major component of extradural compression in 11/78 patients (14%). Intradural metastases were multiple in 15/20 patients (75%). Four of the six solitary intramedullary metastases were situated in the conus medullaris. CONCLUSION: Magnetic resonance imaging of the entire spine is the investigation of choice in patients with known malignancy and suspected spinal canal disease. Contrast-enhanced images should be acquired when the unenhanced appearances do not correlate with the clinical findings or when they suggest intradural or intramedullary disease.Loughrey, G. J. (2000). Clinical Radiology55, 849-855.

Adolescent↗

The relationship of structural pathology to the nerve root.

Lumbar spinal nerves may be entrapped (a) at the back of the disc (b) laterally in the central canal, (c) in the cauda equina, (d) more laterally in the nerve canal, and (e) posteriorly in the zygapophyseal joints. There is a spectrum of degenerative change in both joints and disc. Changes at these three sites can produce (a) dysfunction, (b) disc herniation, (c) instability, (d) lateral entrapment, and (e) central stenosis. The clinical significance is that many patients become symptom free on nonoperative treatment. Some with nerve entrapment require decompression. Those with instability may need a fusion. The pain from a disc lesion or from stenosis may come from irritation and inflammation of the dura. The motor loss in these lesions may be due to reflex inhibition and vascular insufficiency rather than from nerve compression. It is vitally important to identify accurately the nerve that is entrapped.

Cauda Equina↗

Acute spinal subdural hematoma: MR and CT findings with pathologic correlates.

PURPOSE: To determine the MR and CT findings that characterize acute spinal subdural hematoma (ASSH). METHODS: The MR, CT, and clinical findings in three patients with surgically proved ASSH were reviewed and also correlated with the postmortem MR, CT, and cryomicrotome findings in three other patients, two with ASSH and one with an acute spinal epidural hematoma. RESULTS: Imaging findings in ASSH included: (a) hyperdense lesions on plain CT within the dural sac, distinct from the adjacent low-density epidural fat and silhouetted against the lower-density spinal cord and cauda equina, which it compressed; (b) lack of direct continuity with the adjacent osseous structures; (c) clumping, loculation, and streaking of blood within the dural sac on both MR and Ct; and (d) an inhomogeneous and variable signal intensity to the ASSH on all MR pulse sequences, but, nevertheless, a striking low signal intensity on T2-weighted spin-echo or T2-weighted gradient-echo to a major part of the ASSH because of deoxyhemoglobin. Plain CT was most helpful in compartmentalizing the hematoma. CONCLUSION: When MR and plain CT are obtained as complementary studies, they provide characteristic findings that allow the prompt diagnosis of ASSH.

Adult↗

Lumbosciatic pain and coagulopathies.

Three cases of nerve compression causing lumbosciatic pain and/or cruralgia due to hematoma secondary to coagulopathies of varying etiology are described. The cases involved a multiple nerve root syndrome of the cauda equina due to extradural hematoma in coagulopathy resulting from the administration of dicumarol drugs, a neuropathy of the crural nerve caused by hematoma of the iliopsoas muscle in hemophilia B, and a neuropathy of the sciatic nerve caused by hematoma in the gluteus and thigh in coagulopathy resulting from the administration of dicumarol drugs. In all three of the cases the clinical picture resembled that of lumbar disc herniation, but a careful evaluation of each patient's history, objective picture, and laboratory and radiological testing allowed us to make a correct diagnosis. Medical therapy is based on the correction of the coagulopathy by means of suitable drugs or hemoderivates. Surgical treatment is reserved for the most severe cases.

Acute Disease↗

Isolation and culture of bovine endothelial cells of endoneurial origin.

Penetration of immunoglobulins and/or migration of activated lymphocytes into peripheral nervous system (PNS) parenchyma are the initial key steps to develop immunological disorders of PNS including Guillain-Barré syndrome, IgM neuropathy and chronic inflammatory demyelinating polyradiculoneuropathy. Hence, it is important to know the cellular property of endothelial cells of endoneurial tissue origin (PnMEC) because these cells constitute the bulk of the blood-nerve barrier (BNB). For this purpose, we developed a method to isolate and culture pure populations of PnMECs from bovine cauda equina. PnMECs were identified by their cobblestone appearance, immunoreactivity against Factor VIII/von Willebrand factor (vWF) antigen, and positive uptake of DiI-Ac-LDL. The glucose transporter type 1 (GLUT1) expression of these cells was rapidly down-regulated in vitro. Other than GM3(NeuAc) and GM3(NeuGc) as major glycosphingolipids, PnMECs comprise GM1, GD1a, GD1b and GT1b, which are shared by PNS parenchyma, and sialyl lactosaminyl paragloboside (SLPG) as minor species. Because bovine PnMECs proliferate rapidly and a large mass of cells could be obtained, this method should contribute to the biochemical analysis of surface molecules in PnMECs that might play a key role in the formation of BNB as well as in pathological conditions involving the PNS.

Animals↗

Pulmonary thromboembolism after spinal instrumentation surgery.

A 57-year-old woman was hospitalized because of gait disturbance and dysuria. Close examination revealed a cauda equina tumor at the level of L2 and L3. Tumor resection was performed, with posterolateral fusion and spinal instrumentation. On the eleventh day after the surgery, she experienced dyspnea and chest pain during standing and walking exercise. Pulmonary thromboembolism was diagnosed, based on: (1) blood gas analysis findings of hypoxemia and (2) defective images in both of the upper lobes on urgent pulmonary blood flow scintigram. Her clinical status improved with urgent thrombolytic therapy (with tisokinase and urokinase) and anticoagulation therapy (with heparin and warfarin), and her life was saved. When pulmonary thromboembolism occurs, early diagnosis by pulmonary blood flow scintigram and early thrombolytic and anticoagulative therapies are necessary. Special attention should be paid to symptoms of pulmonary thromboembolism in patients after spinal surgery.

Anticoagulants↗

Ependymal variations in the caudal spinal cord.

The lumbosacral spinal cord including the cauda equina was examined in 100 unselected autopsied cases of infants dying at or near term. A striking finding in 10% of these cases was the occurrence of bilateral collections of ependymal cells lying in rows on the surface of the lumbosacral cord. In another 25% the central canal was forked or duplicate. These foci were not associated with evidence of defective neural tube closure or spina bifida; the central canal was of normal length. There was no relationship between the ependymal structures and systemic clinical or pathological findings. The pathogenesis and significance of these lesions is unclear. Our observations suggest that they occur regularly and are not associated with neurological disturbances. The relationship of the ependymal cell collections to ependymomas of the caudal spinal cord is open to speculation.

Cauda Equina↗