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Ran Q, Li T, Kuang ZP, Guo XH. Percutaneous transforaminal endoscopic decompression combined with percutaneous vertebroplasty in treatment of lumbar vertebral body metastases: A case report. World J Clin Cases 2022; 10:7944-7949. [PMID: 36158475 PMCID: PMC9372846 DOI: 10.12998/wjcc.v10.i22.7944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/19/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PTED) is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis. Despite its less invasiveness, this surgery is rarely used to treat spinal metastases. Percutaneous vertebroplasty (PVP) has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.
CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms. She couldn't straighten her legs because of severe pain. Computed tomography (CT) showed a mass lesion in the lung and bone destruction in the L4 vertebrae. The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma. PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time. Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation. The incision was scaled up with the TESSY technology. The pain was obviously relieved following the operation and no serious complications occurred. Postoperative CT showed that the decompression around the nerve root was successful, polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed. During the 1-year follow-up period, the patient was in a stable condition.
CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms. Because of the small sample size and short follow-up time, the long-term clinical efficacy of this method needs to be further confirmed.
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Affiliation(s)
- Qiang Ran
- Department of Orthopaedics, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400010, China,
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China
| | - Tong Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China
| | - Zhi-Ping Kuang
- Department of Orthopaedics, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400000, China
| | - Xiao-Hong Guo
- Department of Pharmacy, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400000, China
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Shi YF, Chen YQ, Chen HF, Hu X. An atypical primary malignant melanoma arising from the cervical nerve root: A case report and review of literture. World J Clin Cases 2022; 10:381-387. [PMID: 35071542 PMCID: PMC8727269 DOI: 10.12998/wjcc.v10.i1.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/29/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary melanomas affecting the central nervous system are very rare, and melanomas originating in the spinal canal or origin of the spinal nerve root are even rarer. As a consequence, not much is known about this.
CASE SUMMARY Here we report a case of primary malignant melanoma originating in the cervical spinal cord nerve root. A 64-year-old woman presented with symptoms of numbness in the right side of the neck, pain, and hypoesthesia in the right upper limb which persisted for 1 year. Neurological examination showed that the superficial sensation in the right upper limb had decreased with muscle strength of grade 4. Magnetic resonance imaging examination revealed a mass (approximately 2.5 cm × 1.4 cm × 1 cm) in the right side of the spinal canal in the C-2 plane. Based on findings obtained during operation, perioperative examination, pathological diagnosis, and the diagnostic criteria of primary central melanoma proposed by Hayward, the mass was confirmed to be a melanoma of intraspinal nerve root origin.
CONCLUSION This is the first case of primary malignant melanoma originating from cervical spinal cord nerve roots and spread along the inside and outside of the spinal canal. The clinical relevance of this case is discussed to provide new insights into the differential diagnosis of intraspinal tumours. Further studies are needed to better understand the mechanisms driving the growth pattern and development of this type of tumour.
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Affiliation(s)
- Yi-Feng Shi
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Yu-Qi Chen
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Hai-Feng Chen
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
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Wilent WB, Tesdahl EA, Trott JT, Tassone S, Harrop JS, Klineberg EO, Sestokas AK. Impact of inhalational anesthetic agents on the baseline monitorability of motor evoked potentials during spine surgery: a review of 22,755 cervical and lumbar procedures. Spine J 2021; 21:1839-1846. [PMID: 34274500 DOI: 10.1016/j.spinee.2021.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/01/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT During spine surgery, motor evoked potentials (MEPs) are often utilized to monitor both spinal cord function and spinal nerve root or plexus function. While there are reports evaluating the impact of anesthesia on the ability of MEPs to monitor spinal cord function, less is known about the impact of anesthesia on the ability of MEPs to monitor spinal nerve root and plexus function. PURPOSE To compare the baseline monitorability and amplitude of MEPs during cervical and lumbar procedures between two cohorts based on the maintenance anesthetic regimen: a total intravenous anesthesia (TIVA) versus a regimen balanced with volatile inhalational and intravenous agents. STUDY DESIGN Baseline MEP data from a total of 16,559 cervical and 6,196 lumbar extradural spine procedures utilizing multimodality intraoperative neuromonitoring (IONM) including MEPs between January 2017 and March 2020 were obtained from a multi-institutional database. Two cohorts for each region of spine surgery were delineated based on the anesthetic regimen: a TIVA cohort and a Balanced anesthesia cohort. PATIENT SAMPLE Age 18 and older. Fellowship support for 65,000 for year 2021. OUTCOME MEASURES Percent monitorability and amplitudes of baseline MEPs. METHODS The baseline monitorability of each muscle MEP was evaluated by the IONM team in real-time and recorded in the patient's electronic medical record. The relation between anesthetic regimen and baseline monitorability was estimated using mixed effects logistic regression, with distinct models for cervical and lumbar procedures. Subsets of cervical and lumbar procedures from each anesthesia cohort in which all MEPs were deemed monitorable were randomly selected and the average peak-to-trough amplitude of each muscle MEP was retrospectively measured. Mixed-effects linear regression models were estimated (one each for cervical and lumbar procedures) to assess possible differences in average amplitude associated with anesthesia regimen. RESULTS At the time of surgery, baseline MEPs were reported monitorable from all targeted muscles in 86.8% and 83.0% of cervical and lumbar procedures, respectively, for the TIVA cohort, but were reported monitorable in just 59.3% and 61.0% of cervical and lumbar procedures, respectively, in the Balanced cohort, yielding disparities of 27.5% and 22.0%, respectively. The model-adjusted monitorability disparity between cohorts for a given muscle MEP ranged from 0.2% to 16.6% but was smallest for distal intrinsic hand and foot muscle MEPs (0.2%-1.1%) and was largest for proximal muscle MEPs (deltoid: 10.8%, biceps brachii: 8.8%, triceps: 13.0%, quadriceps: 16.6%, gastrocnemius: 7.8%, and tibialis anterior: 3.7%) where the monitorability was significantly decreased in the Balanced cohort relative to the TIVA cohort (p<.0001). Relative to the TIVA cohort, the model-adjusted amplitude of an MEP in the Balanced cohort was smaller for all muscles measured, ranging from 27.5% to 78.0% smaller. Relative to the TIVA cohort, the model-adjusted amplitude of an MEP was significantly decreased (p<.01) in the Balanced cohort for the most proximal muscles (Percent smaller: deltoid: 74.3%, biceps: 78.0%, triceps: 54.9%, quadriceps: 54.8%). CONCLUSIONS TIVA is the preferred anesthetic regimen for optimizing MEP monitoring during spine surgery. Inhalational agents significantly decrease MEP monitorability and amplitudes for most muscles, and this effect is especially pronounced for proximal limb muscles such as the deltoid, biceps, triceps, and quadriceps.
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Affiliation(s)
- W Bryan Wilent
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027.
| | - Eric A Tesdahl
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027
| | - Julie T Trott
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027
| | - Shakira Tassone
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027
| | - James S Harrop
- Jefferson University Hospital, 909 Walnut Street Clinical Office Building: 2nd Floor, Philadelphia, PA 19107
| | - Eric O Klineberg
- University of California Davis, 3301 C St., Suite 1500, Sacramento, CA 95816
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Ravindra VM, Karas PJ, Hartnett S, Patino I, North R, Tatsui CE, Gonda D, Schwabe A, Curry DJ. Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Palliative Rhizotomy: A Novel Technical Application. Oper Neurosurg (Hagerstown) 2021; 20:413-418. [PMID: 33377153 DOI: 10.1093/ons/opaa415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Spastic cerebral palsy is caused by an insult to the developing brain. Various medical and surgical procedures are used to reduce tone. OBJECTIVE To describe a novel method of magnetic resonance-guided laser interstitial thermal ablation for palliative rhizotomy. METHODS Patients treated at a single institution with percutaneous rhizotomy using magnetic resonance-guided laser interstitial thermal therapy were identified. Preoperative and postoperative Modified Ashworth Scale scores were collected as well as procedural information. RESULTS Two male children (7.8 and 19 yr, respectively) with spastic quadriparesis were treated using this technique. Neither patient experienced surgical or perioperative complications, and both were discharged from the hospital within 48 h. Each of them demonstrated improvement in his Modified Ashworth Scale score with no need for retreatment for spasticity at last follow-up. CONCLUSION These 2 cases illustrate a novel technique for treating spasticity in the setting of cerebral palsy. Further study of this technique in additional patients, and comparison with traditional methods of surgical tone reduction, are warranted.
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Affiliation(s)
- Vijay M Ravindra
- Division of Pediatric Neurosurgery, Texas Children's Hospital Baylor College of Medicine, Houston, Texas.,Division of Pediatric Neurosurgery, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - Patrick J Karas
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Sara Hartnett
- Department of Neurosurgery, University of South Florida, Tampa, Florida
| | - Ilana Patino
- Division of Pediatric Neurosurgery, Texas Children's Hospital Baylor College of Medicine, Houston, Texas
| | - Robert North
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Claudio E Tatsui
- Department of Neurosurgery, Division of Surgery, MD Anderson Cancer Center, Houston, Texas
| | - David Gonda
- Division of Pediatric Neurosurgery, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - Aloysia Schwabe
- Department of Physical Medicine and Rehabilitation Medicine, Baylor College of Medicine, Section of Pediatric Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, Texas
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Texas Children's Hospital Baylor College of Medicine, Houston, Texas.,Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Lohman Bonfiglio CM, Gilbert KK, Brismée JM, Sobczak S, Hixson KM, James CR, Sizer PJ. Upper limb neurodynamic testing with radial and ulnar nerve biases: An analysis of cervical spinal nerve mechanics. Musculoskelet Sci Pract 2021; 52:102320. [PMID: 33513560 DOI: 10.1016/j.msksp.2021.102320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical research supports a combination of upper limb neurodynamic testing (ULNT) strategies to rule out upper limb and cervical neurogenic pathology; however, knowledge of the biomechanical response of spinal nerves during ULNT is lacking for radial and ulnar nerve biases. OBJECTIVE To assess whether radial and ulnar nerve biased strategies of ULNT elicit significant displacement and strain of cervical spinal nerves. STUDY DESIGN Cross-sectional. METHODS Radiolucent markers were implanted into spinal nerves C5-C8 proximal and distal to the intervertebral foramen in nine unembalmed cadavers (six male; three female) age 80.1 ± 13.2 years. Fluoroscopic images were captured during ULNT with radial and ulnar nerve biases. Images at rest and maximum tension were digitized and displacement and strain were measured. All data were analyzed using one sample t-tests and a generalized linear mixed models approach. RESULTS Upper limb neurodynamic testing with radial nerve bias resulted in displacement (2.44-3.04 mm) and strain (7.99-11.98%) and ULNT with ulnar nerve bias resulted in displacement (2.16-4.41 mm) and strain (7.12 and 12.95%). Significant extraforaminal displacement occurred during radial and ulnar nerve biases for all spinal nerves (all P < 0.05) whereas significant strain occurred during ulnar nerve biases for all spinal nerves but only in C6-C8 during radial nerve bias. CONCLUSION Upper limb neurodynamic testing using both radial and ulnar nerve biases resulted in cervical spinal nerve displacement and strain. Such techniques could be used to tension load or mobilize or cervical spinal nerves to evaluate for pathology.
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Affiliation(s)
- Chelsea M Lohman Bonfiglio
- Department of Cellular and Developmental Biology, School of Medicine, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Aurora, CO, 80045, USA.
| | - Kerry K Gilbert
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, 3601 4th St. Lubbock, Texas, 79430, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, 3601 4th St. Lubbock, Texas, 79430, USA
| | - Stéphane Sobczak
- Département D'anatomie, Université Du Québec à Trois-Rivières, 3513, Léon-Provancher 3986, Québec, Canada
| | - Krista M Hixson
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Cir Mesa, Arizona, 85206, USA
| | - C Roger James
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, 3601 4th St. Lubbock, Texas, 79430, USA
| | - Phillip J Sizer
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, 3601 4th St. Lubbock, Texas, 79430, USA
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6
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Rotter J, Mueller K, MacConnell A, McGowan J, Spitz S. Isolated cervical extraosseous intradural chordoma attached to the C5 nerve root: a case report. Chin Neurosurg J 2020; 5:22. [PMID: 32922921 PMCID: PMC7398216 DOI: 10.1186/s41016-019-0170-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background As chordomas are slow growing and locally invasive with high recurrence rates, initial recommendations include complete surgical resection with or without radiation therapy. A large proportion of recurrences occur years after initial resection necessitating lengthy follow-up. The novel biomarker brachyury and the repurposing of pharmaceutical products have the potential to substantially impact long-term recurrence rates. Case presentation A 43-year-old woman presented with an isolated, cervical extraosseous intradural extramedullary chordoma attached to a nerve root underwent a C3-5 laminectomy, C3-5 lateral mass screw instrumentation, and mass resection. All symptoms resolved by the 12-month postoperative follow-up visit. Conclusions This is the first report of an isolated, cervical extraosseous intradural extramedullary chordoma attached to a nerve root, and this case adds to the previous six Type IV chordomas in the literature. Unfortunately, the very rare form of extraosseous intradural chordoma is poorly understood: the lack of detailed knowledge in how they are differentiated from other forms of chordoma confounds the development of optimal treatment strategies and follow-up guidelines.
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Affiliation(s)
- Juliana Rotter
- Georgetown University School of Medicine, 3700 Reservoir Rd, Washington, DC 20007 USA
| | - Kyle Mueller
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd, Washington, DC 20007 USA
| | - Ashley MacConnell
- Georgetown University School of Medicine, 3700 Reservoir Rd, Washington, DC 20007 USA
| | - Jason McGowan
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St. Ste B400, Pittsburg, PA 15213 USA
| | - Steven Spitz
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd, Washington, DC 20007 USA
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7
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Pang JY, Tan F, Chen WW, Li CH, Dou SP, Guo JR, Zhao LY. Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation. World J Clin Cases 2020; 8:2942-2949. [PMID: 32775376 PMCID: PMC7385604 DOI: 10.12998/wjcc.v8.i14.2942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/24/2020] [Accepted: 05/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lumbar disc herniation is a common disease. Endoscopic treatment may have more advantages than traditional surgery. AIM To compare the clinical efficacy and safety of microendoscopic discectomy (MED) and open discectomy with lamina nucleus enucleation in the treatment of single-segment lumbar intervertebral disc herniation. METHODS Ninety-six patients who were operated at our hospital were selected for this study. Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group. The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy. Surgical effects were compared between the two groups. RESULTS In terms of surgical indicators, the observation group had a longer operation time, shorter postoperative bedtime and hospital stay, less intraoperative blood loss, and smaller incision length than the control group (P < 0.05). The excellent recovery rate did not differ significantly between the observation group (93.75%) and the control group (91.67%). Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d, 3 d, 1 mo, and 6 mo after surgery (P < 0.05). The incidence of complications was significantly lower in the observation group than in the control group (6.25% vs 22.92%, P < 0.05). CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation, but MED is associated with less trauma, less bleeding, and a lower incidence of complications.
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Affiliation(s)
- Jiu-Ya Pang
- Department of Traumatology, The Second Hospital of Tangshan, Tangshan 0630000, Hebei Province, China
| | - Fei Tan
- Intensive Care Unit, The Second Hospital of Tangshan, Tangshan 0630000, Hebei Province, China
| | - Wei-Wei Chen
- Intensive Care Unit, The Second Hospital of Tangshan, Tangshan 0630000, Hebei Province, China
| | - Cui-Hua Li
- Department of Nursing, The Second Hospital of Tangshan, Tangshan 0630000, Hebei Province, China
| | - Shu-Ping Dou
- Department of Hand Surgery, The Second Hospital of Tangshan, Tangshan 0630000, Hebei Province, China
| | - Jing-Ran Guo
- Department of Spinal Surgery, The Second Hospital of Tangshan, Tangshan 0630000, Hebei Province, China
| | - Li-Ying Zhao
- Hospital Office, The Second Hospital of Tangshan, Tangshan 0630000, Hebei Province, China
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Mehta GU, Montgomery BK, Maggio DM, Chittiboina P, Oldfield EH, Lonser RR. Functional Outcome After Resection of Von Hippel-Lindau Disease-Associated Cauda Equina Hemangioblastomas: An Observational Cohort Study. Oper Neurosurg (Hagerstown) 2019; 13:435-440. [PMID: 28838111 DOI: 10.1093/ons/opx019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 01/28/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cauda equina hemangioblastomas in von Hippel-Lindau (VHL) disease can cause significant neurological signs and symptoms. Despite their associated morbidity, the management of these tumors remains incompletely defined. OBJECTIVE To determine optimal management, we analyzed the functional outcomes after resection of these tumors. METHODS VHL patients who underwent surgical resection of cauda equina hemangioblastomas at the National Institutes of Health and the University of Virginia were included. Clinical and radiological follow-up was performed at 6- to 12-month intervals after surgery. RESULTS Fifteen patients underwent 18 operations for 21 cauda equina hemangioblastomas (median follow-up 5.9 years). Patients often presented with multiple symptoms, including pain (67%), numbness (50%), urinary complaints (33%), and weakness (11%). Median preoperative tumor volume was 1.2 cm 3 . Four tumors at 3 operations were not resected due to a motor nerve root origin. Gross total resection was achieved in 14 surgeries (93% of operations when resection was attempted). New mild (non-function limiting) neurological symptoms were noted after 11 operations (61%), which most often (64%) resolved within 2 weeks of surgery. At 6-month follow-up, 15 patients (83%) were stable, 2 (11%) were improved, and 1 (6%) was worse. Histological analysis revealed that all tumors originated from within the involved nerve fascicle. CONCLUSIONS VHL-associated cauda equina hemangioblastomas have an intrafascicular origin and require interruption of the rootlet of origin for complete resection. Motor nerve root involvement may preclude complete resection but strategies including bony decompression and/or interruption of vascular supply may provide a therapeutic option. Nevertheless, most VHL patients with symptom-producing lesions improve with resection.
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Affiliation(s)
- Gautam U Mehta
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurosurgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
| | - Blake K Montgomery
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Dominic M Maggio
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurosurgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
| | - Prashant Chittiboina
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Edward H Oldfield
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurosurgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia
| | - Russell R Lonser
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Yin M, Ma J, Ye J, Xu H, Mo W. 8-Year Follow-up for Woman with Spinal Meningeal Melanocytoma in S1 Nerve Root: Case Report and Literature Review. World Neurosurg 2019; 129:143-147. [PMID: 31426249 DOI: 10.1016/j.wneu.2019.05.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Primary melanocytic neoplasms in the central nervous system are rare lesions arising from leptomeningeal melanocytes. These lesions produce neural deficits that resemble those of a meningioma or a schwannoma radiologically. CASE DESCRIPTION A tumor around the left S1 root with an extension into the left paraspinal compartment was identified in a 32-year-old female with persistent left leg pain for 6 months. The tumor was hyperintense on T1-weighted image and hypointense on T2-weighted image with a homogeneous enhancement. The clinical features, radiologic presentations, treatment choice, and pathologic characteristic were illustrated. The treatment outcome was compared with those reported in the previous literature. The tumor was en-bloc resected with the S1 nerve root reserved. Grossly, the tumor was a soft, capsulated, well-circumscribed, black pigmented lesion. Immunohistochemistry revealed that the tumor cells were positive for HMB-45, S-100 protein, and vimentin. The patient's symptoms were greatly relieved postoperatively. No signs of local recurrence were observed. CONCLUSIONS Spinal meningeal melanocytoma inside the nerve root is rare and benign. It is difficult to diagnose and often misdiagnosed as schwannoma or meningioma. HMB-45 has been suggested as a significant marker for the diagnosis of meningeal melanocytoma. Complete surgical resection is recommended as the primary treatment. Radiotherapy, chemotherapy, and other treatments can be selected as adjuvant therapies, but their effects are controversial. The recurrence and metastasis rates also remain unclear.
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Affiliation(s)
- Mengchen Yin
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junming Ma
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Ye
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hua Xu
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Mo
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Zhang KH, Zhang WH, Xu BS, Dong XM, Guo L, Du LL, Xu HW. CT-based Morphometric Analysis of Approach of Percutaneous Transforaminal Endoscopic Lumbar Interbody Fusion. Orthop Surg 2019; 11:212-220. [PMID: 30895721 PMCID: PMC6594482 DOI: 10.1111/os.12434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES A radiographic study was designed to measure the relationship of the exiting nerve root and its surroundings to the corresponding intervertebral disc for percutaneous transforaminal endoscopic lumbar interbody fusion to better understand the regional anatomy and to improve clinical applications. METHODS A retrospective study from January 2017 to October 2017 was conducted at Tianjin Hospital. CT images were obtained from patients presenting low back pain (110 patients), and analysis was performed bilaterally from L2-3 to L5 S1 . In the rotating coronal plane we analyzed: the nerve root-dural sac distance at the superior and inferior margins of the disc (Js, Ji); the nerve root-pedicle distance at the medial, middle, and lateral borders of the pedicle (Pa, Pb, Pc); the pedicle width (W); and the safe working zone, defined as a trapezoid bounded by the inferior pedicle and the exiting nerve root (S). In the transverse plane, the nerve root-articular process and the shortest distance for the nerve root-articular process joint surface were analyzed at the superior and inferior margins of the disc (Gs, Gi), respectively. The groups were analyzed using ANOVA, and paired t-tests were used to compare the left and right sides. RESULTS From L2-3 to L5 S1 , the distance of the nerve root to the dural sac was larger at the inferior margin of the disc. From L2-3 to L5 S1 , each segment of the vertebral nerve root-pedicle distance gradually decreased from medial to lateral. From L2-3 to L5 S1 , the distance from the exiting nerve root to the middle and lateral margins of the pedicle gradually decreased, with L5 S1 being the minimum. Some significant differences were observed between the left and right sides for L4-5 and L5 S1 . The pedicle width of the vertebral body and the mean area for the safe working zone gradually increased from L2-3 to L5 S1 . In the axial plane, the shortest distance between the nerve root and articular process joint surface at the inferior margin of the disc was greater than the distance for the nerve root to the articular process at the superior margin of the disc from L2-3 to L5 S1 . There were no significant differences between the two sides. CONCLUSIONS It is more difficult to implant a cage with a width of 10 mm above the L3-4 level. By removing part of the superior articular process, the safe working area can be expanded, and damage to the nerve or other structures can be avoided when implanting a cage.
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Affiliation(s)
- Kai-Hui Zhang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Wei-Hao Zhang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Bao-Shan Xu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Xiao-Man Dong
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Lin Guo
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Li-Long Du
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Hai-Wei Xu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China
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Kim HS, Singh R, Adsul NM, Oh SW, Noh JH, Jang IT. Management of Root-Level Double Crush: Case Report with Technical Notes on Contralateral Interlaminar Foraminotomy with Full Endoscopic Uniportal Approach. World Neurosurg 2018; 122:505-507. [PMID: 30476660 DOI: 10.1016/j.wneu.2018.11.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Double crush of a nerve at the root level is not common. We describe here a double crush of the right L4 nerve with foramina to far lateral disk (ventral) and extraforaminal (dorsal) compression. The double crush was managed by endoscopy with a contralateral uniportal approach from the left interlaminar space. Right lateral recess stenosis at the same level was subsequently managed with the same approach. CASE DESCRIPTION A 79-year-old lady presented to our clinic with a low backache, right leg pain, and weakness. On her right side, the straight leg raise test was 70 degrees, great toe dorsiflexion was grade 3/5, and hypoesthesia was present in the L4 dermatome. Her preoperative visual analog scale score was 9. Magnetic resonance imaging showed right lateral recess stenosis and a double compression of L4 nerve root from the dorsal and ventral sides. A diagnosis of right lateral recess stenosis with double crush of the right L4 nerve root was made. The patient was managed with percutaneous endoscopic contralateral interlaminar foraminotomy from the left interlaminar approach. She got relief for the symptoms and her postoperative visual analog scale score was 2. Magnetic resonance imaging and computed tomography showed nerve root decompression and well-preserved facet joints. CONCLUSIONS We conclude that the management of double crush at the nerve root level with interlaminar contralateral approach endoscopy (percutaneous endoscopic contralateral interlaminar foraminotomy) can deal with the issue effectively with facet joint preservation and other benefits of the minimally invasive spine procedure.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea.
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea
| | | | - Sung Woon Oh
- Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea
| | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea
| | - Il Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea
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Lin JH, Chen CC. Current challenges in diagnosis of lumbar radiculopathy. World J Anesthesiol 2018; 7:20-23. [DOI: 10.5313/wja.v7.i3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/23/2018] [Accepted: 10/13/2018] [Indexed: 02/06/2023] Open
Abstract
Lumbar radiculopathy (LR) is a term used to describe a pain syndrome caused by compression or irritation of nerve roots in the lower back. The surgery cost for LR increased by 23% annually during 1992-2003 in the developed country. Although it is one of most common complaints in clinical practice, the diagnosis for LR is still very challenging. Here we discuss the current tools of LR diagnosis and highlight the needs to develop new diagnosis tools for LR.
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Affiliation(s)
- Jiann-Her Lin
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chih-Cheng Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Taiwan Mouse Clinic, National Comprehensive Mouse Phenotyping and Drug Testing Center, Academia Sinica, Taipei, Taiwan
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Joswig H, Neff A, Ruppert C, Hildebrandt G, Stienen MN. The value of short-term pain relief in predicting the long-term outcome of 'indirect' cervical epidural steroid injections. Acta Neurochir (Wien) 2018; 160:935-43. [PMID: 29541886 DOI: 10.1007/s00701-018-3511-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The predictive value of short-term arm pain relief after 'indirect' cervical epidural steroid injection (ESI) for the 1-month treatment response has been previously demonstrated. It remained to be answered whether the long-term response could be estimated by the early post-interventional pain course as well. METHODS Prospective observational study, following a cohort of n = 45 patients for a period of 24 months after 'indirect' ESI for radiculopathy secondary to a single-level cervical disk herniation (CDH). Arm and neck pain on the visual analog scale (VAS), health-related quality of life with the Short Form-12 (SF-12), and functional outcome with the Neck Pain and Disability (NPAD) Scale were assessed. Any additional invasive treatment after a single injection (second injection or surgery) defined treatment outcome as 'non-response'. RESULTS At 24 months, n = 30 (66.7%) patients were responders and n = 15 (33.3%) were non-responders. Non-responders exited the follow-up at 1 month (n = 10), at 3 months (n = 4), and at 6 months (n = 1). No patients were injected again or operated on between the 6- and 24-month follow-up. Patients with favorable treatment response at 24 months had significantly lower VAS arm pain (p < 0.05) than non-responders at days 6, 8-11, and at the 3-month follow-up. The previously defined cut-off of > 50% short term pain reduction was not a reliable predictor of the 24-month responder status. SF-12 and NPAD scores were better among treatment responders in the long term. CONCLUSIONS Patients who require a second injection or surgery after 'indirect' cervical ESI for a symptomatic CDH do so within the first 6 months. Short-term pain relief cannot reliably predict the long-term outcome.
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Farshad M, Sutter R, Hoch A. Severity of foraminal lumbar stenosis and the relation to clinical symptoms and response to periradicular infiltration-introduction of the "melting sign". Spine J 2018; 18:294-299. [PMID: 28739476 DOI: 10.1016/j.spinee.2017.07.176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/25/2017] [Accepted: 07/17/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Nerve root compression causing symptomatic radiculopathy can occur within the intervertebral foramen. Sagittal magnetic resonance imaging (MRI) sequences are reliable in detection of nerve root contact to intraforaminal disc material, but a clinically relevant classification of degree of contact is lacking. PURPOSE This study aimed to investigate a potential relation of amount of contact between intraforaminal disc material and nerve root to clinical findings and response after periradicular corticosteroid infiltration. STUDY DESIGN A post hoc analysis of a prospective cohort was carried out. PATIENT SAMPLE Patients who underwent computed tomography (CT)-guided periradicular corticosteroid infiltration (L1-L5) at our institution (January 2014 to May 2016) were included. OUTCOME MEASURES The medical records and radiographic imaging were reviewed. METHODS T2-weighted MRI of the lumbar spine of patients with single-level symptomatic radiculopathy with (responders, n=28) or without (non-responders, n=14) pain relief after periradicular infiltration with corticosteroids were measured and compared by two independent readers to determine the amount of intraforaminal nerve root contact with the intervertebral disc ("melting" of the T2-hypointense signal). Pain relief was defined with a pain level decrease of >50% on a visual analogue scale and lack of pain relief with a pain level decrease of <25%, respectively. The amount of T2-hypointensity melting of disc and nerve root was categorized to 0%, 1%-25%, and over 25%. RESULTS Reader one identified 0% T2-melting in none of the responders, 1%-25% melting in 13 patients (46.4%), 26%-50% in 15 of the 28 patients (53.6%) with pain relief after periradicular corticosteroid infiltration (responders), with a mean amount of T2-melting of 5.9±2.1 mm, whereas the non-responder group had 0% T2-melting in 2 patients (14.3%), 1%-25% T2-melting in 11 patients (78.6%), and 26%-50% in 1 patient (7.1%), with a mean amount of T2-melting of 2.6±1.9 mm (p<.05). Reader two identified 0% T2-melting in none, 1%-25% T2-melting in 15 (53.6%) patients, and 26%-50% in 13 of the 28 responders (46.4%), with mean amount of 6.3±1.9 mm. In the non-responder group 0% T2-melting was seen in 3 patients (21.4%), 1%-25% T2-melting in 10 patients (71.4%), and 26%-50% in 1 patient (7.1%), with a mean amount of T2-melting of 2.7±1.9 mm (p<.05). None of the MRI showed T2-melting in over 50% of the circumference of the intraforaminal nerve root. A T2-melting of >25% had a high specificity of 93% but a sensitivity of 50%, thus a positive likelihood ratio of 7.5, to identify those with a pain relief of more than 50% after infiltration. CONCLUSION The amount of T2-melting of disc material and nerve root on sagittal MRI (>25%) predicts the amount of pain relief by periradicular infiltration in patients with intraforaminal nerve root irritation.
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Affiliation(s)
- Mazda Farshad
- Division of Spine Surgery and Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - Reto Sutter
- Division of Spine Surgery and Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Armando Hoch
- Division of Spine Surgery and Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
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Sadeghian H, Motiei-Langroudi R. Sonography guided lumbar nerve and facet blocks: The first report of clinical outcome from Iran. Radiography (Lond) 2018; 24:52-6. [PMID: 29306376 DOI: 10.1016/j.radi.2017.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Nerve root block (NRB) and facet block (FB) are viable options for pain arising from facet and lumbar disc herniation (LDH) not responding to conservative therapy but still not suitable for surgery. Classically, they are performed under fluoroscopy and computed tomography (CT) guidance, which have the disadvantages of radiation exposure and limited accessibility. The aim of this study was to assess the effectiveness of US guided FB and NRB in patients suffering from facet arthropathy and LDH. METHODS 14 patients were involved in the study. After defining nerve root (for NRB) or facet joints (for FB) under a standard US investigation, real-time injection of methylprednisolone and bupivacaine was performed. Pain was measured before and after procedure by VAS. RESULTS Ten patients underwent FBs (8 bilateral and 2 unilateral) and 4 underwent NRBs (2 bilateral and 2 unilateral). 11/14 (79%) patients improved after the block (8 in FB, 3 in NRB) and the VAS had significantly decreased 1 week after procedure (mean [range] -1.7 [-6 to 0]). For the 11 patients that improved after FB or NRB, the effect lasted for a mean of 59 days (range: 30-130 days). Analysis showed that neither block procedure (NRB vs. FB) nor block level (L4L5 vs. L5S1) had an effect on result. CONCLUSIONS Results of our preliminary study shows that in appropriately selected patients, nerve root and facet blocks can be effectively performed under ultrasonography guidance without notable complications, with effects lasting for a mean 2 months.
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Joswig H, Neff A, Ruppert C, Hildebrandt G, Stienen MN. The value of short-term pain relief in predicting the 1-month outcome of 'indirect' cervical epidural steroid injections. Acta Neurochir (Wien) 2017; 159:291-300. [PMID: 27796650 DOI: 10.1007/s00701-016-2997-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/13/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical management after epidural steroid injections (ESI) of patients with radiculopathy secondary to a cervical disc herniation (CDH) is uncertain. This study aims to determine whether short-term arm pain alleviation following computed tomography-guided 'indirect' cervical ESI can predict the 1-month outcome. METHODS We conducted a prospective observation of 45 consecutive patients at a tertiary radiological department. Study components were visual analog scale arm and neck pain at baseline, 15, 30, and 45 min, 1, 2, and 4 h, on days 1-14, 1 month, and at 1 year. Health-related quality of life and functional impairment were assessed using the short form-12 and Neck Pain and Disability Scale. Patients who reported ≥80 % persisting arm pain, as well as patients who underwent a second injection or an operation within 1 month were defined as 'non-responders'. Logistic regression was used to analyze the effect size of the relationship between >50 % pain relief at any given study visit and responder status. RESULTS Patients experiencing a >50 % pain reduction 4 h after the injection were four times as likely to be responders as those experiencing ≤50 % pain reduction (OR 4.04, 95 % CI 1.10-14.87). The effect was strongest on days 5-6 (OR 18.37, 95 % CI 3.39-99.64) and remained significant until day 14. CONCLUSIONS The results of this study can guide physicians in managing patients with CDH: a ≤50 % arm pain relief within 1 week after an 'indirect' cervical ESI predicts an unfavorable 1-month outcome and suggests that other treatment options may be considered at an earlier point in time.
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Affiliation(s)
- Holger Joswig
- Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
| | - Armin Neff
- Department of Radiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Gerhard Hildebrandt
- Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
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Mori A, Nodera H, Takamatsu N, Maruyama-Saladini K, Osaki Y, Shimatani Y, Kaji R. Sonographic evaluation of peripheral nerves in subtypes of Guillain-Barré syndrome. J Neurol Sci 2016; 364:154-9. [PMID: 27084237 DOI: 10.1016/j.jns.2016.03.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/25/2016] [Accepted: 03/22/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sonography of peripheral nerves can depict alteration of nerve sizes that could reflect inflammation and edema in inflammatory and demyelinating neuropathies. Guillain-Barré syndrome (GBS). Information on sonographic comparison of an axonal subtype (acute motor [and sensory] axonal neuropathy [AMAN and AMSAN]) and a demyelinating subtype (acute inflammatory demyelinating polyneuropathy [AIDP]) has been sparse. MATERIAL AND METHODS Sonography of peripheral nerves and cervical nerve roots were prospectively recorded in patients with GBS who were within three weeks of disease onset. RESULTS Five patients with AIDP and nine with AMAN (n=6)/AMSAN (n=3) were enrolled. The patients with AIDP showed evidence of greater degrees of demyelination (e.g., slower conduction velocities and increased distal latencies) than those with AMAN/AMSAN. The patients with AIDP tended to show enlarged nerves in the proximal segments and in the cervical roots, whereas the patients with AMAN/AMSAN had greater enlargement in the distal neve segment, especially in the median nerve (P = 0.03; Wrist-axilla cross-sectional ratio). CONCLUSION In this small study, two subtypes of GBS showed different patterns of involvement that might reflect different pathomechanisms.
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Affiliation(s)
- Atsuko Mori
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - Hiroyuki Nodera
- Department of Neurology, Tokushima University, Tokushima, Japan.
| | - Naoko Takamatsu
- Department of Neurology, Tokushima University, Tokushima, Japan
| | | | - Yusuke Osaki
- Department of Neurology, Tokushima University, Tokushima, Japan
| | | | - Ryuji Kaji
- Department of Neurology, Tokushima University, Tokushima, Japan
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18
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Gilbert KK, Smith MP, Sobczak S, James CR, Sizer PS, Brismée JM. Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: an unembalmed cadaveric investigation. J Man Manip Ther 2016; 23:239-45. [PMID: 26955255 DOI: 10.1179/2042618615y.0000000009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Manual and physical therapists incorporate neurodynamic mobilisation (NDM) to improve function and decrease pain. Little is known about the mechanisms by which these interventions affect neural tissue. The objective of this research was to assess the effects of repetitive straight leg raise (SLR) NDM on the fluid dynamics within the fourth lumbar nerve root in unembalmed cadavers. METHODS A biomimetic solution (Toluidine Blue Stock 1% and Plasma) was injected intraneurally, deep to the epineurium, into the L4 nerve roots of seven unembalmed cadavers. The initial dye spread was allowed to stabilise and measured with a digital calliper. Once the initial longitudinal dye spread stabilised, an intervention strategy (repetitive SLR) was applied incorporating NDMs (stretch/relax cycles) at a rate of 30 repetitions per minute for 5 minutes. Post-intervention calliper measurements of the longitudinal dye spread were measured. RESULTS The mean experimental posttest longitudinal dye spread measurement (1.1 ± 0.9 mm) was significantly greater (P = 0.02) than the initial stabilised pretest longitudinal dye spread measurement. Increases ranged from 0.0 to 2.6 mm and represented an average of 7.9% and up to an 18.1% increase in longitudinal dye spread. DISCUSSION Passive NDM in the form of repetitive SLR induced a significant increase in longitudinal fluid dispersion in the L4 nerve root of human cadaveric specimen. Lower limb NDM may be beneficial in promoting nerve function by limiting or altering intraneural fluid accumulation within the nerve root, thus preventing the adverse effects of intraneural oedema.
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Affiliation(s)
- Kerry K Gilbert
- Center for Rehabilitation Research and Department of Rehabilitation Sciences, School of Allied Health Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Michael P Smith
- Anatomical Simulation and Research, Patient Safety, and Competency Center, Albany Medical College, Albany, New York, USA
| | - Stéphane Sobczak
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medecine, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - C Roger James
- Center for Rehabilitation Research and Department of Rehabilitation Sciences, School of Allied Health Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Phillip S Sizer
- Center for Rehabilitation Research and Department of Rehabilitation Sciences, School of Allied Health Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jean-Michel Brismée
- Center for Rehabilitation Research and Department of Rehabilitation Sciences, School of Allied Health Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Plata-Bello J, Pérez-Lorensu PJ, Brage L, Hernández-Hernández V, Dóniz A, Roldán-Delgado H, Febles P, García-Conde M, Pérez-Orribo L, García-Marín V. Electrical stimulation threshold in chronically compressed lumbar nerve roots: Observational study. Clin Neurol Neurosurg 2015; 139:1-5. [PMID: 26342804 DOI: 10.1016/j.clineuro.2015.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/20/2015] [Accepted: 08/23/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Intraoperative neuromonitoring (IONM) is a common practice in spinal surgery, mostly during pedicle screw placement. However, there is not enough information about the factors that can interfere with IONM data. One of these factors may be existing damage of the nerve root whose function must be preserved. The main purpose of the present study is to evaluate the effect of chronic compression in lumbar nerve roots in terms of stimulation thresholds during direct nerve stimulation. PATIENTS AND METHODS Direct electrical stimulation was performed in 201 lumbar nerve roots during lumbar spinal procedures under general anaesthesia in 80 patients with different lumbar spinal pathologies. Clinical and radiological data were reviewed in order to establish the presence of chronic compression. RESULTS Chronically compressed nerve roots showed a higher stimulation threshold than non compressed nerve roots (11.93 mA vs. 4.33 mA). This difference was confirmed with intra-subject comparison (paired sample t test, p=0.012). No other clinical factors were associated with this higher stimulation threshold in lumbar nerve roots. CONCLUSION A higher stimulation threshold is present in compressed lumbar nerve roots than non compressed roots. This needs to be taken into consideration during pedicle screw placement, where intraoperative neurophysiological monitoring is being used.
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Nourbakhsh A, Yang J, Ziran B, Garges KJ. An unusual course of the vertebral artery posterior to the nerve root in the inter-transverse space: a cadaveric study. Patient Saf Surg 2015; 9:19. [PMID: 25972925 PMCID: PMC4430022 DOI: 10.1186/s13037-015-0072-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/29/2015] [Indexed: 11/17/2022] Open
Abstract
Background The V2 segment of the vertebral artery is very vulnerable to injury during cervical spine surgery. The incidence of vertebral artery injury during anterior cervical spine procedures is reported to be 0.22–2.77 %. This is partially due to its variable course while running in the transverse foramens of the cervical vertebrae. Case presentation The course of the vertebral artery in the dissected cadaver of a 79 year old female is presented. Dissection of the left vertebral artery showed that the 5th nerve root passes in front of the vertebral artery in the 4th intertransverse space. Further exploration showed that although vertebral artery at first passed at the back of the nerve root it curved downwards again and after passing underneath the 5th nerve root entered the 4th vertebral body. After making a loop in the left half of the vertebrae, vertebral artery ran anterior to the nerve root and after entering the 4th transverse foramen showed up in the 3rd intertransverse space. The shortest distance of the vertebral artery to the midline at the 4th vertebrae level was 4.78 mm. Conclusions To our knowledge this case is the first report of a nerve root lying anterior to the vertebral artery in the intertransverse space of the cervical spine. Additionally vertebral artery has never been reported to be so close to the midline. This report signifies the importance of obtaining MRI or contrast enhanced CT scan prior to any cervical spine surgery in the vicinity of the vertebral artery including corpectomies and also careful approach to the intertransverse space during the operation.
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Affiliation(s)
- Ali Nourbakhsh
- Atlanta Medical Center, 303 Parkway Dr. NE, 30312 Atlanta, GA USA
| | - Jinping Yang
- Department of Orthopaedic Surgery & Rehabilitation, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX USA
| | - Bruce Ziran
- Gwinnett Medical Center, 575 Professional Dr., Suite 360, 30046 Lawrenceville, GA USA
| | - Kim J Garges
- Houston Physician's Hospital, 333 North Texas Avenue, 77598 Webster, TX USA
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Ohnishi Y, Iwatsuki K, Ohkawa T, Ninomiya K, Moriwaki T, Yoshimine T. Differences between Cervical Schwannomas of the Anterior and Posterior Nerve Roots in Relation to the Incidence of Postoperative Radicular Dysfunction. Asian Spine J 2015; 9:263-70. [PMID: 25901239 DOI: 10.4184/asj.2015.9.2.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/28/2014] [Accepted: 08/03/2014] [Indexed: 12/14/2022] Open
Abstract
Study Design A retrospective study. Purpose To assess the case files of patients who underwent surgery for cervical dumbbell schwannoma for determining the differences between schwannomas of the anterior and posterior nerve roots with respect to the incidence of postoperative radicular dysfunction. Overview of Literature The spinal roots giving origin to schwannoma are frequently nonfunctional, but there is a risk of postoperative neurological deficit once these roots are resected during surgery. Methods Fifteen patients with cervical dumbbell schwannomas were treated surgically. Ten men and 5 women, who were 35-79 years old (mean age, 61.5 years), presented with neck pain (n=6), radiculopathy (n=10), and myelopathy (n=11). Results Fourteen patients underwent gross total resection and exhibited no recurrence. Follow-ups were performed for a period of 6-66 months (mean, 28 months). Preoperative symptoms resolved in 11 patients (73.3%) but they persisted partially in 4 patients (26.7%). Six patients had tumors of anterior nerve root origin, and 9 patients had tumors of posterior nerve root origin. Two patients who underwent total resection of anterior nerve root tumors (33.3%) displayed minor postoperative motor weakness. One patient who underwent total resection of a posterior nerve root tumor (11.1%) showed postoperative numbness. Conclusions Appropriate tumor removal improved the neurological symptoms. In this study, the incidence of radicular dysfunction was higher in patients who underwent resection of anterior nerve root tumors than in patients who underwent resection of posterior nerve root tumors.
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Kamogawa J, Kato O, Morizane T, Hato T. Virtual pathology of cervical radiculopathy based on 3D MR/CT fusion images: impingement, flattening or twisted condition of the compressed nerve root in three cases. Springerplus 2015; 4:123. [PMID: 25793153 PMCID: PMC4359697 DOI: 10.1186/s40064-015-0898-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/20/2015] [Indexed: 11/21/2022]
Abstract
Background There have been several imaging studies of cervical radiculopathy, but no three-dimensional (3D) images have shown the path, position, and pathological changes of the cervical nerve roots and spinal root ganglion relative to the cervical bony structure. The objective of this study was to introduce a technique that enables the virtual pathology of the nerve root to be assessed using 3D magnetic resonance (MR)/computed tomography (CT) fusion images that show the compression of the proximal portion of the cervical nerve root by both the herniated disc and the preforaminal or foraminal bony spur in patients with cervical radiculopathy. Findings MR and CT images were obtained from three patients with cervical radiculopathy. 3D MR images were placed onto 3D CT images using a computer workstation. The entire nerve root could be visualized in 3D with or without the vertebrae. The most important characteristic evident on the images was flattening of the nerve root by a bony spur. The affected root was constricted at a pre-ganglion site. In cases of severe deformity, the flattened portion of the root seemed to change the angle of its path, resulting in twisted condition. Conclusions The 3D MR/CT fusion imaging technique enhances visualization of pathoanatomy in cervical hidden area that is composed of the root and intervertebral foramen. This technique provides two distinct advantages for diagnosis of cervical radiculopathy. First, the isolation of individual vertebra clarifies the deformities of the whole root groove, including both the uncinate process and superior articular process in the cervical spine. Second, the tortuous or twisted condition of a compressed root can be visualized. The surgeon can identify the narrowest face of the root if they view the MR/CT fusion image from the posterolateral-inferior direction. Surgeons use MR/CT fusion images as a pre-operative map and for intraoperative navigation. The MR/CT fusion images can also be used as educational materials for all hospital staff and for patients and patients’ families who provide informed consent for treatments.
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Affiliation(s)
- Junji Kamogawa
- Spine & Sports Center, Shiraishi Hospital, 1-5-9 Matsumoto Town, Imabari City, Ehime 794-0041 Japan
| | - Osamu Kato
- Department of Radiology, Shiraishi Hospital, 1-5-9 Matsumoto Town, Imabari City, Ehime 794-0041 Japan
| | - Tatsunori Morizane
- Department of Radiology, Shiraishi Hospital, 1-5-9 Matsumoto Town, Imabari City, Ehime 794-0041 Japan
| | - Taizo Hato
- Spine & Sports Center, Shiraishi Hospital, 1-5-9 Matsumoto Town, Imabari City, Ehime 794-0041 Japan
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Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. World J Orthop 2014; 5:134-45. [PMID: 24829876 PMCID: PMC4017306 DOI: 10.5312/wjo.v5.i2.134] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/17/2013] [Accepted: 03/03/2014] [Indexed: 02/06/2023] Open
Abstract
Spinal nerve roots have a peculiar structure, different from the arrangements in the peripheral nerve. The nerve roots are devoid of lymphatic vessels but are immersed in the cerebrospinal fluid (CSF) within the subarachnoid space. The blood supply of nerve roots depends on the blood flow from both peripheral direction (ascending) and the spinal cord direction (descending). There is no hypovascular region in the nerve root, although there exists a so-called water-shed of the bloodstream in the radicular artery itself. Increased mechanical compression promotes the disturbance of CSF flow, circulatory disturbance starting from the venous congestion and intraradicular edema formation resulting from the breakdown of the blood-nerve barrier. Although this edema may diffuse into CSF when the subarachnoid space is preserved, the endoneurial fluid pressure may increase when the area is closed by increased compression. On the other hand, the nerve root tissue has already degenerated under the compression and the numerous macrophages releasing various chemical mediators, aggravating radicular symptoms that appear in the area of Wallerian degeneration. Prostaglandin E1 (PGE1) is a potent vasodilator as well as an inhibitor of platelet aggregation and has therefore attracted interest as a therapeutic drug for lumbar canal stenosis. However, investigations in the clinical setting have shown that PGE1 is effective in some patients but not in others, although the reason for this is unclear.
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Nodera H, Takamatsu N, Shimatani Y, Mori A, Sato K, Oda M, Terasawa Y, Izumi Y, Kaji R. Thinning of cervical nerve roots and peripheral nerves in ALS as measured by sonography. Clin Neurophysiol 2014; 125:1906-11. [PMID: 24657162 DOI: 10.1016/j.clinph.2014.01.033] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/20/2013] [Accepted: 01/11/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Progressive atrophy and loss of motor axons is a hallmark of amyotrophic lateral sclerosis (ALS). Limited sonographic data are available on potential detection of atrophy of peripheral nerves and nerve roots in ALS. METHODS Patients with either definite or probable ALS and control subjects underwent sonographic evaluation of the cervical roots (C5, C6, and C7) and peripheral nerves (median and ulnar nerves) on the right. These diameters and cross-sectional areas (C6, median, and ulnar nerves) were compared. RESULTS The diameters and cross-sectional areas were consistently smaller in ALS than in controls. No correlation was present between the sonographic parameters and the disease severity, disease duration, age, or gender. The overall sensitivity and specificity tended to be greater in the cervical nerve roots than in the peripheral nerves. CONCLUSIONS This study shows atrophy of cervical nerve roots and peripheral nerves in ALS detected by sonography. Cervical nerve roots might be more appropriate to detect motor axon loss than peripheral nerves. SIGNIFICANCE Sonographic evaluation of nerve roots and peripheral nerves may be a useful disease marker in ALS to confirm the diagnosis and to potentially monitor the disease progression.
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Affiliation(s)
- Hiroyuki Nodera
- Department of Neurology, Tokushima University, Tokushima, Japan.
| | - Naoko Takamatsu
- Department of Neurology, Tokushima University, Tokushima, Japan; Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan
| | | | - Atsuko Mori
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - Kenta Sato
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - Masaya Oda
- Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan
| | - Yuka Terasawa
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Tokushima University, Tokushima, Japan; Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan.
| | - Ryuji Kaji
- Department of Neurology, Tokushima University, Tokushima, Japan
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Strong C, Yanamadala V, Khanna A, Walcott BP, Nahed BV, Borges LF, Coumans JVCE. Surgical treatment options and management strategies of metastatic renal cell carcinoma to the lumbar spinal nerve roots. J Clin Neurosci 2013; 20:1546-9. [PMID: 23931936 DOI: 10.1016/j.jocn.2013.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/19/2013] [Indexed: 11/19/2022]
Abstract
Spinal nerve root metastasis of renal cell carcinoma is a rare occurrence. In addition to treatment of the primary lesion, surgical resection of the nerve root metastasis, occasionally with sacrifice of the involved nerve, is the accepted standard of treatment. Resection often resolves presenting motor and pain symptoms due to relief of neural compression. We describe two patients with nerve root metastasis of renal cell carcinoma and their management. While locally advanced and metastatic renal cell carcinoma has been shown to be chemo- and radio-resistant, immunotherapy is a promising treatment. Given the high prevalence of systemic disease in patients with intradural metastases, systemic (and possibly intracranial) imaging can be used to identify other potential areas of disease.
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Affiliation(s)
- Christian Strong
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02115, USA
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Cabrilo I, Burkhardt K, Schaller K, Tessitore E. Renal carcinoma relapse presenting as a peripheral nerve sheath tumor: A case report and brief review of the literature. Neurochirurgie 2013; 59:128-32. [PMID: 23806763 DOI: 10.1016/j.neuchi.2013.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/02/2013] [Accepted: 04/11/2013] [Indexed: 11/20/2022]
Abstract
We report a rare case of renal carcinoma metastasis involving a lumbar nerve root. Metastases to nerve roots are rare occurrences, and to our knowledge, only six cases have been reported so far in the literature. The patient in this report presented with weakness in the right lower limb and intractable pain irradiating along the L5 dermatome. MRI findings revealed a right-sided L5 nerve root mass, suggestive of a schwannoma, involving the spinal ganglion and its extraforaminal region. Complete macroscopic resection of this mass was performed, and histopathologic analysis confirmed the lesion to be a metastasis of a renal clear cell carcinoma. Local radiotherapy was given and tyrosine kinase inhibitors administered. At 5 months, the patient was pain-free and his right limb weakness had completely resolved. A tumoral recurrence could be observed on the control MRI 5 months after surgery. This report presents the first case of a patient with a renal clear cell carcinoma metastasis to a L5 nerve root, as well as a brief review of previous cases of metastases to peripheral nerve roots.
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Ohnishi Y, Yuguchi T, Iwatsuki K, Yoshimine T. Entrapment of the fifth lumbar spinal nerve by advanced osteophytic changes of the lumbosacral zygapophyseal joint: a case report. Asian Spine J 2012; 6:291-3. [PMID: 23275815 DOI: 10.4184/asj.2012.6.4.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 07/08/2011] [Accepted: 07/25/2011] [Indexed: 11/08/2022] Open
Abstract
A 54-year-old female patient had a 6-year history of backache and left sciatica. Five years earlier, she had undergone surgery in another hospital for left L4-5 disc herniation. Computed tomography revealed the ossified wall that enclosed the left L5 nerve root. There were also osteophytic changes in the left L5-S zygapophyseal joint. These osteophytes developed rostrally, along the left L5 nerve root, throug h the intervertebral foramina. We performed decompression surgery for the left L5 nerve root, and surgery resulted in symptomatic relief. We experienced a rare clinical presentation of osteophytic formation, with a specific configuration in relation to the nerve root. Surgeons should be aware of entrapment of the lumbar spinal nerve by advanced osteophytic changes occurring in the zygapophyseal joint after lumbar surgery.
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Kim SH, Lee JH, Kim JH, Chun KS, Doh JW, Chang JC. Anatomical morphometric study of the cervical uncinate process and surrounding structures. J Korean Neurosurg Soc 2012; 52:300-5. [PMID: 23133716 PMCID: PMC3488636 DOI: 10.3340/jkns.2012.52.4.300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/10/2012] [Accepted: 10/04/2012] [Indexed: 11/28/2022] Open
Abstract
Objective The purpose of this study is to elucidate the anatomic relationships between the uncinate process and surrounding neurovascular structures to prevent possible complications in anterior cervical surgery. Methods Twenty-eight formalin-fixed cervical spines were removed from adult cadavers and were studied. The authors investigated the morphometric relationships between the uncinate process, vertebral artery and adjacent nerve roots. Results The height of the uncinate process was 5.6-7.5 mm and the width was 5.8-8.0 mm. The angle between the posterior tip of the uncinate process and vertebral artery was 32.2-42.4°. The distance from the upper tip of the uncinate process to the vertebral body immediately above was 2.1-3.3 mm, and this distance was narrowest at the fifth cervical vertebrae. The distance from the posterior tip of the uncinate process to the nerve root was 1.3-2.0 mm. The distance from the uncinate process to the vertebral artery was measured at three different points of the uncinate process : upper-posterior tip, lateral wall and the most antero-medial point of the uncinate process, and the distances were 3.6-6.1 mm, 1.7-2.8 mm, and 4.2-5.7 mm, respectively. The distance from the uncinate process tip to the vertebral artery and the angle between the uncinate process tip and vertebral artery were significantly different between the right and left side. Conclusion These data provide guidelines for anterior cervical surgery, and will aid in reducing neurovascular injury during anterior cervical surgery, especially in anterior microforaminotomy.
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Affiliation(s)
- Sung-Ho Kim
- Department of Neurosurgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
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Kim JH, Lee CW, Chun KS, Shin WH, Bae HG, Chang JC. Morphometric Relationship between the Cervicothoracic Cord Segments and Vertebral Bodies. J Korean Neurosurg Soc 2012; 52:384-90. [PMID: 23133729 PMCID: PMC3488649 DOI: 10.3340/jkns.2012.52.4.384] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/30/2012] [Accepted: 10/04/2012] [Indexed: 11/27/2022] Open
Abstract
Objective The objective of this study was to investigate the morphologic characteristics between the vertebral body and the regions of the cervical and thoracic spinal cords where each rootlets branch out. Methods Sixteen adult cadavers (12 males and 4 females) with a mean age of 57.9 (range of 33 to 70 years old) were used in this study. The anatomical relationship between the exit points of the nerve roots from the posterior root entry zone at each spinal cord segment and their corresponding relevant vertebral bodies were also analyzed. Results Vertical span of the posterior root entry zone between the upper and lower rootlet originating from each spinal segment ranged from 10-12 mm. The lengths of the rootlets from their point of origin at the spinal cord to their entrance into the intervertebral foramen were 5.9 mm at the third cervical nerve root and increased to 14.5 mm at the eighth cervical nerve root. At the lower segments of the nerve roots (T3 to T12), the posterior root entry zone of the relevant nerve roots had a corresponding anatomical relationship with the vertebral body that is two segments above. The posterior root entry zones of the sixth (94%) and seventh (81%) cervical nerve roots were located at a vertebral body a segment above from relevant
segment. Conclusion Through these investigations, a more accurate diagnosis, the establishment of a better therapeutic plan, and a decrease in surgical complications can be expected when pathologic lesions occur in the spinal cord or vertebral body.
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Affiliation(s)
- Ji Hoon Kim
- Department of Neurosurgery, Soonchunhyang University Hospital, Seoul, Korea
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Jeswani S, Drazin D, Shirzadi A, Fan X, Johnson JP. Endometriosis in the Lumbar Plexus Mimicking a Nerve Sheath Tumor. World J Oncol 2011; 2:314-318. [PMID: 29147269 PMCID: PMC5649718 DOI: 10.4021/wjon413w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2011] [Indexed: 11/03/2022] Open
Abstract
Endometriosis consists of ectopic endometrial tissue outside of the uterine cavity. It is typically benign. It may cause neurological symptoms if involving the central or peripheral nervous system. We present in this report a 46-year-old Caucasian female with progressively worsening lumbar pain with radiation to her left anterior thigh. MR imaging showed an enhancing mass in the L4 neural foramen, intrepreted as a nerve sheath tumor. At operation the nerve showed extrinsic and intrinsic abnormality, proven to be endometriosis. Postoperatively, the patient reported relief from her radiculopathy. We review the previous cases, discuss the pathogenesis and additional characteristics that highlight intraspinal endometriosis, although rare, should be considered as a potential cause of neurologic symptoms in women. Surgical resection is recommended in cases having severe or worsening neurologic symptoms or signs of cauda equina syndrome. Adjunctive treatment may be used in cases of residual or recurrent lesions.
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Affiliation(s)
- Sunil Jeswani
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles,CA USA
| | - Doniel Drazin
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles,CA USA
| | - Ali Shirzadi
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles,CA USA
| | - Xuemo Fan
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA USA
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