Intraoperative immediate strength recovery following lacertus fibrosus release in patients with proximal median nerve compression at the elbow.

PURPOSE: In the literature, we find that patients with lacertus syndrome (LS), proximal median nerve compression at the elbow, present subjective improvement of thumb, and index flexion strength after lacertus fibrosus (LF) release. The aim of this study is to objectively evaluate the immediate change in intraoperative flexion strength after LF release. METHOD: We retrospectively reviewed prospectively collected data of a cohort of 24 patients with a double crush syndrome of the median nerve with no response to conservative treatment. All patients had surgery with LF and carpal tunnel release (CTR) under wide-awake local anaesthesia and no tourniquet (WALANT) and were evaluated intraoperatively with a dynamometer immediately before and after LF release. Flexor digitorum profundus of the second finger (FDP2) and Flexor pollicis longus (FPL) were tested in peak strength to failure. The primary outcome was the percentage of change in strength before and after the release in both assessed muscles. CTR was done after evaluating the change in flexor strength. RESULTS: A percentage of 79.2 women with an average age of 43.3 years. The average strength of FDP2 before LF release was 15.5 pounds (lbs.) (7.0 kg) (SD, 7.2 lbs (3.3 kg)) and 27.1 lbs. (12.2 kg) (SD, 7.1 lbs. (3.2 kg)) after LF release, which corresponds to a 96% (SD, 70%) change in strength (p=0.000). For FPL, the average pre-release strength was 17.7 lbs. (8.0kg) (SD, 4.8 lbs. (2.2 kg)) and 27.4 lbs. (12.4 kg) (SD, 5.2 lbs. (2.4 kg)) post-release, this corresponded to a 65% (SD, 38%) change in strength (p=0.000). CONCLUSIONS: Peak strength to failure in FDP2 and FPL has an immediate significant recovery after LF surgical release in patients with Lacertus syndrome. LEVEL OF EVIDENCE: IV, retrospective study.

Unusual association of congenital kyphosis and conus lipoma presenting as a double spinal cord tether.

The case of a four-year-old child is described who presented to our institution with cervicothoracic deformity and a two-year history of progressive paraparesis. His past medical history was significant for meningocele which was closed at age two months. Imaging studies revealed severe congenital kyphosis with a hypoplastic T3 vertebra, as well as a tethered filum terminale with a conus lipoma. The spinal cord was found to be severely compressed at the apex of the kyphotic deformity. Discussion is focused on the diagnosis of tethered cord syndrome, and treatment options. In particular, this case required careful thought on the order of events, which followed initial tethered cord release and removal of the conus lipoma, and subsequent kyphectomy and fusion of the upper thoracic spine. A favorable clinical outcome was obtained with complete reversal of the paraparesis.

Rol de la cirugía en el plasmocitoma vertebral: reporte de 3 casos / Surgical treatment of solitary plasmocitoma of the spine: report of 3 cases

La sobrevida global de los pacientes a los cuales se les diagnóstica un Plasmocitoma solitario (PS) óseo es de 75 por ciento a 5 años. Se trata de una lesión osteolítica que puede comprometer la estabilidad espinal. La radioterapia es un método efectivo para el control local de la enfermedad. Sin embargo, no es efectiva en devolver la estabilidad estructural inmediata, por lo que el riesgo de fractura y colapso vertebral progresivo persiste. Por esto, consideramos necesario evaluar en cada caso parámetros que permitan establecer la probabilidad de colapso vertebral patológico relacionado el grado de destrucción vertebral al momento del diagnóstico. Utilizamos los análisis predictivos de Taneichi y Kaneda, así como los de Heller y Boden, para intentar predecir en qué caso el colapso vertebral puede ser progresivo. Se analizan 3 casos, y se plantean soluciones quirúrgica combinadas con radioterapia