Diagnostic spinal anaesthesia in chronic spinal cord injury pain.
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In a double blind study, 21 patients with chronic spinal cord injury (SCI) pain underwent placement of a lumbar subarachnoid catheter and injection of placebo and lidocaine. The effects on pain intensity, distribution, altered sensations and sensory level of anaesthesia were monitored. Four patients responded briefly to placebo, while 13 demonstrated a mean reduction of pain intensity of 37.8 +/- 37% for a mean duration of 123.1 +/- 95.3 minutes in response to lidocaine. The pain response to subarachnoid lidocaine differed significantly (p less than 0.01) from placebo. Spinal anaesthesia was also associated with changes in pain distribution and altered sensation. A spinal anaesthetic-induced sensory level could not be achieved cephalad to the sensory level of neurological injury in 5 patients who presented with spinal canal obstruction. This study has demonstrated that response to diagnostic spinal anaesthesia in chronic SCI pain is complex, requiring individual interpretation in each patient and consideration of the following factors; symptomatology, etiology, pain perception, spinal canal anatomy, CSF chemistry and local anaesthetic pharmacology. (+info)
Spinal subarachnoid hematoma resulting from lumbar myelography.
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We describe a rare complication of myelography. A subarachnoid filling defect was apparent on the postmyelographic CT but not on conventional myelography. MR imaging performed later showed a spinal subarachnoid hematoma (SSAH), extending from L3 to L5. Lumbar puncture may rarely be a cause for SSAH and is more common in patients with coagulopathy. Significant back pain, paresis, radiculopathy, and even altered consciousness or meningeal signs may herald an SSAH. (+info)
Electro-acupuncture and Chinese herbs for treatment of cervical intervertebral disk disease in a dog.
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A non-ambulatory dog with tetraparesis following a pain episode that had evolved over 2 months was submitted for medical treatment and diagnosed with intervertebral disk disease at C3-C4 and dorsal extradural compression at C1-C2 and C3-C4 using myelography and computed tomography. The dog experienced ambulation recovery after 15 days of treatment with only electroacupuncture and Chinese herbal medicine, with marked improvement occurring after only 10 treatments. Six months of followup demonstrated that the dog was stable and had no recurrence of symptoms. Therefore, it was concluded that the combination of electroacupuncture and Chinese herbal medicine was responsible for motor rehabilitation. (+info)
Pseudopseudohypoparathyroidism and spinal cord compression.
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A 42 year old Greek male with pseudo-pseudohypoparathyroidism presented with difficulty in walking and with lower limb weakness. His physical signs included short stature, thick neck, short fourth metacarpals and metatarsals, and a spastic paraparesis. Serum calcium and phosphate and parathyroid concentrations were normal. Myelography demonstrated compression of the cervical and lumbar cord in association with local bony abnormalities. (+info)
Cisternography and ventriculography gadopentate dimeglumine-enhanced MR imaging in pediatric patients: preliminary report.
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BACKGROUND AND PURPOSE: Complex CSF diseases may be underdiagnosed or poorly understood on conventional CT or MR imaging. Although intrathecal CT cisternography with water-soluble iodinated contrast medium has been used, very few studies have dealt with the intrathecal use of gadopentate dimeglumine (Gd-DTPA), though it appears superior to CT. We report our experience with the intrathecal use of Gd-DTPA for MR cisternography and ventriculography in pediatric patients referred for study and treatment of complex CSF-related diseases. MATERIALS AND METHODS: Ten patients (range, 1 month-16 years of age) were selected after we obtained specific informed consent. Intrathecal gadolinium injection was performed via transfontanelle ventriculostomy, ventriculoperitoneal shunt reservoir, or lumbar puncture. Cases included spontaneous CSF leaks (n=1), complex traumatic frontoethmoidal fractures with suspected CSF leak (n=2), multiloculated congenital or acquired hydrocephalus (n=3), intraventricular tumor (n=1), suspected postoperative arachnoiditis (n=1), complex midline defect (n=1), and acquired orbital meningoencephalocele (n=1). RESULTS: No patient showed biologic, behavioral, or neurologic alterations. In complex hydrocephalus or intraventricular cysts, ventriculography Gd-DTPA MR imaging helped to differentiate isolation of a ventricle or noncommunicating cyst in all 4 patients. In suspected posttraumatic CSF leaks, the procedure established with precision the place of the leak in 1 patient and excluded it in the other. In 1 patient who underwent surgery for spinal cord neoplasm, the procedure excluded arachnoiditis. In the other 3 patients with complex CSF-related diseases, the procedure showed distinctive radiologic findings for the understanding and treatment of the disease. Altogether, in 8 patients, imaging findings influenced or changed clinical decisions and surgical planning. CONCLUSIONS: Our preliminary results showed no side effects and potential useful clinical applications in the evaluation of CNS diseases involving the ventricular system or the subarachnoid space in selected pediatric patients. (+info)
Transoral decompression and posterior stabilisation in Morquio's disease.
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A 3.5 year old boy with Morquio's disease was referred with a persisting left hemiparesis four months after a fall and was found to have craniocervical junction compression due to atlantoaxial subluxation and significant anterior soft tissue compression. Transient unconsciousness at the time of the fall was probably due to medullary concussion as a result of hyperextension, not a head injury. Spinal cord compression due to atlantoaxial subluxation at the craniovertebral junction is a major cause of disability and death in these patients. Once cervical myelopathy appears, early posterior occipitocervical fusion has been advocated in order to arrest the progression of neurological disability and this is successful in most cases. This conventional approach was considered unsafe because of the significant anterior compression. A combined anterior transoral decompression with posterior fusion to deal with this particularly difficult problem is described. (+info)
Pigmented villonodular synovitis originating from the lumbar facet joint: a case report.
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The authors successfully treated a rare case of pigmented villonodular synovitis (PVNS) that originated from the lumbar facet joint (L4-5). A 43-year-old man presented with a complaint of left severe sciatica causing difficulty in walking. Magnetic resonance imaging (MRI) demonstrated an extradural mass on the left side at L4 and the mass compressed the dural tube and was continuous with the left L4-5 facet joint. A computed tomography myelogram revealed an extradural defect of contrast medium at the L4 level and an erosion of the L4 lamina. A total synovectomy with unilateral osteoplastic laminectomy was performed. The histological findings were a diagnosis of PVNS. The patient's symptoms resolved completely and the MRI at postoperative 3 years demonstrated no recurrence of PVNS. It is important to totally remove the synovium, which is the origin of PVNS in order to prevent the recurrence. We think that our procedure is reasonable and adequate for lumbar PVNS. (+info)
Tri-level surgical treatment of cervical spinal cord compression in a Thoroughbred yearling.
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A Thoroughbred yearling was presented with neurological, radiographic, and myelographic abnormalities consistent with cervical vertebral stenotic myelopathy. Surgical correction was performed by using ventral cervical interbody fusion at 3 intervertebral spaces. The patient recovered uneventfully from surgery. The neurological status remained unchanged initially; however, significant improvement was noted 37 weeks postoperatively. (+info)