Transient paralysis by loculation of the injectant associated with epidural injection

@#Transient paralysis occasionally occurs after an epidural injection, but the reasons for this are still unknown. We present here a patient with transient paralysis following loculation of the injectant associated with the procedure. A 50-year-old woman with a history of two previous spinal operations complained of a burning sensation and radiating pain. A caudal block and right S1 transforaminal epidural block were performed. Loculation of the block injectant into the right L5 and S1 epidural space was confirmed through computed topographic imaging. She showed transient weakness of the right lower limb, which completely recovered after 1 day. This case shows that extra care should be taken when performing an epidural injection in a patient with adhesions around the injection site and appropriate adjustments should be made to the volume of the injectant.

Pusher syndrome improved by secondary newly developed stroke

@#Pusher syndrome is a neurological disorder where the patient actively pushes away from the non-hemiparetic side following brain damage. We experienced a case in whom intractable pusher syndrome associated with thalamic hemorrhage improved following a newly developed pontine infarction. A 63-year-old man showed severe pusher syndrome after an initial thalamic hemorrhage. After approximately 2 years, a pontine infarction developed and improved the persistent pusher syndrome. We postulate that it resulted from involvement of the medial lemniscus with interruption of the distorted upward proprioceptive signal of body orientation.

The Clinical Characteristics of Lower Lumbar Osteoporotic Compression Fractures Treated by Percutaneous Vertebroplasty : A Comparative Analysis of 120 Cases

OBJECTIVE: The purpose of this study is to provide accurate understanding of clinical presentations and surgical outcomes as well as to identify the unique characteristics of lower lumbar osteoporotic compression fracture (OCF). METHODS: Clinical data were collected from 120 patients who had L3, L4 or L5 percutaneous vertebroplasty (PVP) performed from 2008 to 2012 at the single institute. L4 or L5 PVP patients were classified into group 1 and group 2 was for L3 PVP patients. Medical records were retrospectively investigated at 1 month after PVP. Long term follow-up results were obtained at a median value of 22 months after PVP. RESULTS: 75% of the patients in group 1 were not associated with traumatic events, 71% presenting with leg radiating symptoms and 46% requiring an additional decompressive surgery, more often than those in group 2. These differences are statistically significant (p<0.05). The short term medical record review demonstrated that only 73% of patients in group 1 were ameliorated with regard to back motion pain, whereas those in group 2 reported 87.7% rates of amelioration in identical category (p<0.05). The long term follow up confirmed a significantly worse outcome in group 1, with only 55.7% of patients reporting amelioration in their pain or functional status, but 71.7% rate of amelioration in group 2. CONCLUSION: The OCFs at the L4 or L5 level have different clinical characteristics from those at upper levels of the lumbar spine.

Clinical and Radiological Findings of Nerve Root Herniation after Discectomy of Lumbar Disc Herniation

The authors report 2 cases of nerve root herniation after discectomy of a large lumbar disc herniation caused by an unrecognized dural tear. Patients complained of the abrupt onset of radiating pain after lumbar discectomy. Magnetic resonance imaging showed cerebrospinal fluid signal in the disc space and nerve root displacement into the disc space. Symptoms improved after the herniated nerve root was repositioned. Clinical symptoms and suggestive radiologic image findings are important for early diagnosis and treatment.