Intradural extramedullary metastasis: a review of literature and case report.

Introduction: Intradural extramedullary (IDEM) metastatic disease is infrequently encountered by spine surgeons and consequently poorly understood. Discovery often corresponds with the onset of neurologic symptoms and no consensus exists regarding the importance of complete resection or anticipated postoperative outcome. We aim to elucidate treatment methodologies that exist in the literature. Case presentation: We present a unique case of a 57-year-old male with a known history of esophageal adenocarcinoma, including brain and visceral metastases, who presented with cauda equina syndrome. An IDEM metastatic esophageal adenocarcinoma lesion was identified on advanced imaging and biopsy. This was treated operatively without return of neurologic function. Discussion: We reviewed and summarized the existing literature. Trends are highlighted to further guide surgeons treating this unusual metastatic phenomenon. Conclusion: Intradural metastasis is a harbinger of advanced disease with a poor prognosis regardless of the etiology of the primary lesion. There are a number of proposed mechanisms for metastatic spread with little available literature for surgeon guidance. Most authors are advocates of a palliative, decompressive approach.

Intraoperative Use of External Fixator Attachments for Reduction of Lower Extremity Fractures and Dislocations.

The mainstay of complex open lower extremity fractures and dislocations is the temporizing external fixator. We propose the use of external fixator attachments that allow for the reduction of fractures and dislocations intraoperatively. By using external fixator carbon fiber rods, the surgeon is able to create a capital "T" (sweet T) shaped attachment and connect this to a Schanz pin. Simultaneously, the external fixator carbon fiber rods can be configured into the shape of a capital Greek letter pi (Cherry II) and applied to an external fixator pin. When both of these configurations are used, multi-directional forces can be applied across the fracture fragments with the added benefit of using extrinsic hand muscle power for force generation and manipulation of fracture fragments to facilitate reduction.