ABSTRACT
INTRODUCTION: Accounting for an estimated 1.10-1.76% of all lumbar herniations, lumbar intradural disc herniation (IDH) occurs primarily in males during the fourth to fifth decades of life. While not validated, congenital lumbar spinal stenosis (CLSS) is implicated as one precipitating factor for IDH. CASE REPORT: We report 28-year-old Hispanic female with CLSS, severe obesity, and degenerative disk disease, with a history of minimally invasive surgical (MIS) decompression for a large paracentral L4-5 disc herniation at 25. After three years, the patient developed sudden burning dysesthesias in the L4-5 dermatomes bilaterally and temporary leg weakness. Lumbar magnetic resonance imaging exhibited severe L4-5 spinal stenosis, and the patient underwent repeat MIS decompression, which again provided her with adequate symptom resolution. However, 20 days postoperatively she developed cauda equina syndrome with anal dysfunction, and bilateral leg and foot weakness. Upon open surgical exploration we discovered a tense L4-5 dural protrusion. After a dorsal durotomy, a large IDH with a ventral dural tear was identified. Subsequent to adequate debulking of the IDH, the ventral tear was repaired, and an expansile duraplasty was performed. Overall, the patient's bladder and bowel function, pain, hypoesthesia, and motor strength all improved. Two weeks after surgery she presented with a lumbar pseudomeningocele that was managed conservatively. CONCLUSION: This report not only highlights an atypical presentation of IDH and is the first case of CLSS linked with IDH, lending support to the hypothesis that CLSS can lead to IDH, but also provides a comprehensive review of IDHs.
Subject(s)
Cauda Equina Syndrome , Intervertebral Disc Displacement , Intervertebral Disc , Spinal Stenosis , Adult , Cauda Equina Syndrome/surgery , Female , Humans , Intervertebral Disc Displacement/complications , Intervertebral Disc Displacement/diagnosis , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Male , Spinal Stenosis/diagnosis , Spinal Stenosis/etiology , Spinal Stenosis/surgeryABSTRACT
BACKGROUND: Urinary tract infections (UTIs) account for about 35% of all nosocomial infections and 75% are associated with the use of urethral catheters. AIM: The goal of this study was to evaluate preoperative factors associated with the risk of UTI and to estimate the impact of UTIs on patient outcome and resource utilization. METHODS: Adult meningioma patients treated with craniotomy in US hospitals between 2002 and 2007 were queried from the Nationwide Inpatient Sample (NIS) database. Univariate and multivariate analyses that correct for sample survey design data were used to study the association of perioperative UTIs and outcomes. FINDINGS: In all, 46,344 patients were included. Women comprised the majority (70.0%), had lower mortality (1.2% vs 2.0%), shorter in-hospital stay (6.7 vs 7.5 days), lower hospital charges (US$76,682 vs 87,220) and higher UTI rates (6.3% vs 3.9%) than men. In multivariate analysis, female gender (odds ratio: 2.2; P < 0.0001), older age (1.4; P < 0.001), emergency room admissions (1.8; P < 0.0001), total length of stay (1.08; P < 0.0001), comorbidity score (1.04; P = 0.0147), postoperative fluid abnormalities (1.96; P < 0.0001) and pulmonary complications (1.3; P < 0.0011) were associated with UTI. UTI was associated with an additional 2.3 days of hospital stay and an incremental US$18,920 in hospital charges. CONCLUSIONS: Perioperative UTIs are associated with specific comorbidities and postoperative complications. They significantly increase in-hospital length of stay and costs. Our data emphasize the need to support national efforts that are underway to reduce hospital-acquired UTIs within the neurosurgical population.
