Clinical Outcomes of Spinal Epidural Abscess

OBJECTIVE: The aim of this study is to elucidate the clinical characteristics of patients with spinal epidural abscess (SEA) and demonstrate the risk factors, treatments and neurologic outcomes. METHODS: We retrospectively reviewed the medical records and radiologic images of 35 patients admitted to our department with SEA between March 1987 and April 2011. While we performed decompressive laminectomy and abscess drainage on 19 patients (54.3%), and 16 patients (45.7%) initially received conservative therapy with antibiotics alone. Medical Research Council (MRC) scale was applied to estimate results objectively. RESULTS: The neurological outcome data showed improved MRC scale from 14 (40%) patients. 13 (37.1%) patients showed unchanged MRC scale and 8 (22.9%) patients revealed worsened MRC scale at the time of discharge. The patients with surgical treatment showed more improved MRC scale than the patients with conservative treatment and this was statistically significant (p=0.001) on univariate analysis. Initially, patients with decreased MRC scale and rapidly progressing neurological deficit underwent emergency surgery within 24 hours. Patients with intact MRC scale and minor neurological deficit received delayed surgery or conservative management with antibiotics. Among 19 patients those who experienced emergent operations within 24 hours showed better prognosis than those who underwent delayed operations after 24 hours. CONCLUSION: Surgical treatment is the modality of choice in patients with SEA and urgent surgery especially is indicated in patients with neurological deficits. And early surgery is more effective in neurological improvements than delayed surgery and conservative management.

The Diagnostic Assessment of Hand Elevation Test in Carpal Tunnel Syndrome

OBJECTIVE: The aim of this study is to establish the value of hand elevation test as a reproducible provocative test for the diagnosis of carpal tunnel syndrome (CTS). METHODS: We had a prospective study of 45 hands of 38 patients diagnosed with CTS between April 2005 and February 2009. The diagnosis of CTS was based on the American Academy of Neurology clinical diagnostic criteria. Experimental and control group patients underwent Tinel's test, Phalen's test, carpal compression test and hand elevation test as provocative tests for CTS. RESULTS: We used chi-square analysis to compare Tinel's test and Phalen's test, carpal compression test with hand elevation test. The sensitivity and specificity of the hand elevation test is 86.7% and 88.9% each. Tinel's test had 82.2% sensitivity and 88.9% specificity. Phalen's test had 84.4% sensitivity and 86.7% specificity. Carpal compression test had 84.4% sensitivity 82.2% specificity. Comparisons of sensitivity and specificity between hand elevation test and Tinel's test, Phalen's test, and carpal compression test had no statistically significant differences. To compare the diagnostic accuracies of four tests, the area under the non-parametric receiver operating character curve was applied. CONCLUSION: The hand elevation test has higher sensitivity and specificity than Tinel's test, Phalen's test, and carpal compression test. Chi-square statistical analysis confirms the hand elevation test is not ineffective campared with Tinel's test, Phalen's test, and carpal compression test.

Horner Syndrome associated with a Herniated Cervical Disc: A Case Report

Horner syndrome (HS) occurs when there is interruption of the oculosympathetic pathway. The causes of HS are various, but HS originated from herniated cervical disc is very few. HS attributable to the lesion of the first-order neuron of cervical spinal cord is extremely rare. A 41-year old male was admitted for sudden onset of left ptosis and right side numbness. Neurological examination revealed ptosis, miosis and facial anhidrosis on the left side. MRI and CT scans demonstrated large left paramedian disc herniation with cord compression at the C4-5 level. The herniated disc was removed through anterior approach and his symptoms were improved after the operation.

Horner Syndrome associated with a Herniated Cervical Disc: A Case Report

Horner syndrome (HS) occurs when there is interruption of the oculosympathetic pathway. The causes of HS are various, but HS originated from herniated cervical disc is very few. HS attributable to the lesion of the first-order neuron of cervical spinal cord is extremely rare. A 41-year old male was admitted for sudden onset of left ptosis and right side numbness. Neurological examination revealed ptosis, miosis and facial anhidrosis on the left side. MRI and CT scans demonstrated large left paramedian disc herniation with cord compression at the C4-5 level. The herniated disc was removed through anterior approach and his symptoms were improved after the operation.

Idiopathic Lumbosacral Spinal Chronic Subdural Hematoma

Reports of spontaneous spinal chronic subdural hematoma (SDH) are extremely rare. In the limited cases reported, the origin, symptoms and treatments are diversely revealed. Therefore accurate diagnoses and proper treatments are difficult to determine. We report a 74-year-old male presented with severe low back pain and both buttocks pain. Magnetic resonance imaging showed a diffuse subdural infiltrating mass compress nerve roots at the level of L2-S2. Emergency operation for decompression and excision of mass revealed spinal chronic SDH. His pain was subsided after the operation. We report a rare case of idiopathic lumbosacral spinal chronic SDH and discuss various causes and treatments.

Idiopathic Lumbosacral Spinal Chronic Subdural Hematoma

Reports of spontaneous spinal chronic subdural hematoma (SDH) are extremely rare. In the limited cases reported, the origin, symptoms and treatments are diversely revealed. Therefore accurate diagnoses and proper treatments are difficult to determine. We report a 74-year-old male presented with severe low back pain and both buttocks pain. Magnetic resonance imaging showed a diffuse subdural infiltrating mass compress nerve roots at the level of L2-S2. Emergency operation for decompression and excision of mass revealed spinal chronic SDH. His pain was subsided after the operation. We report a rare case of idiopathic lumbosacral spinal chronic SDH and discuss various causes and treatments.