Comparison of lumbar segmental stabilization and general exercises on clinical and radiologic criteria in grade-I spondylolisthesis patients: A double-blind randomized controlled trial.

OBJECTIVES: The effects of different physiotherapy protocols on patients suffering from grade-I spondylolisthesis have been thus far examined in a limited number of clinical trials. Therefore, the main purpose of this study was to compare the effects of lumbar segmental stabilization and general exercises on clinical and radiologic criteria in grade-I spondylolisthesis patients. METHODS: This study was a double-blind randomized controlled trial (RCT) with a test-retest design and parallel groups. A total of 26 patients with grade-I spondylolisthesis were thus randomly assigned to experimental group (13 patients, lumbar segmental stabilization exercises) and control group (13 patients, general exercises). Subsequently, pain, functional disability, kinesiophobia, translational motion, angular motion and slip percentage of the vertebra were investigated. RESULTS: Of the 120 people recruited in this study, only 26 patients were eligible. According to pre/post-intervention comparison, a statistically significant decrease was observed in the experimental group in terms of pain (p = 0.000), functional disability (p = 0.004), kinesiophobia (p = 0.002), translational motion (p = 0.043) and angular motion (p = 0.011), but not for slip percentage (p = 0.122). Considering the control group, a statistically significant decline was reported for pain (p = 0.043) and functional disability (p = 0.002). However, no significant differences were found for other variables in the control group. With regard to inter-group comparison, there was no statistically significant difference between the two groups regarding the given variables except for kinesiophobia (p = 0.040). CONCLUSION: Both lumbar segmental stabilization and general exercises led to reduction in pain and functional disability of patients with grade-I spondylolisthesis. Therefore, lumbar segmental stabilization exercises seemed to be better than general ones with reference to improving kinesiophobia and intervertebral movements.

Spinal Textiloma After Diskectomy: A Case Report and Review of the Literature.

BACKGROUND: Spinal masses can be diagnosed by clinical and radiographic examinations. Infrequently, pseudotumors may be due to retained masses after surgical interventions. In fact, these spinal or paraspinal expansions are caused by iatrogenic foreign bodies. Pseudotumors are mentioned as textilomas. CASE DESCRIPTION: We present a case of a patient with a history of lumbar diskectomy in the L2-L3 segments performed in 2017. A 53-year-old woman was admitted with the complaint of persistent mechanical lower back and leg pain for 2 months. CONCLUSIONS: There are no specific clinical and paraclinical manifestations for retained surgical foreign bodies. The number of cases of textilomas associated with spinal surgery are few in comparison with abdominal or thoracic interventions. It is better to integrate textiloma in the differential diagnosis of soft-tissue masses in the paraspinal region with surgical history. Although the definitive treatment of textilomas is surgical elimination of the foreign body, exact evaluation of surgical site before its closure is essential to prevent these cases.

The cystic dilation of ventriculus terminalis with neurological symptoms: Three case reports and a literature review.

CONTEXT: The ventriculus terminalis (VT) is a very small ependymal-lined residual lumen in the conus medullaris. It is normally present in all subjects during fetal development. VT in adults appears as an unusual pathology with an uncertain pathogenesis. FINDINGS: In this paper, we described three case reports of symptomatic fifth ventricle cystic dilations. All of them were female and their mean age was 59 years. We treated them surgically and all three patients were improved based on clinical and imaging assessments. CONCLUSION: Our cases suggested that surgical decompression was a safe and effective treatment in symptomatic patients and the neurosurgeons should be aware of such rare situations. A complete list of differential diagnosis about other cystic dilations of the conus medullaris should be emphasized to select the correct clinical approach.

Cervical osteochondroma with neurological symptoms: literature review and a case report.

INTRODUCTION: Osteochondromas are common benign tumors of bone and spinal involvement is uncommon. Solitary spinal osteochondromas may produce a wide variety of symptoms depending on their location and relationship to adjacent neural structures. CASE PRESENTATION: Herein, we present a case of solitary osteochondroma arising from the posterior arch of C1, causing left-sided ascending numbness and paresthesia and difficulty walking. The lesion was totally resected through a posterior approach. Histopathological examination confirmed the diagnosis of benign osteochondroma. DISCUSSION: Spinal cord compression is uncommon in spinal osteochondromas because in most cases the tumor grows out of the spinal column. To prevent neurological compromise, complete surgical removal is mandatory when an intraspinal osteochondroma with cord compression is diagnosed, which also helps to prevent recurrence. Our literature review of similar cases indicates that despite the old belief that C2 is the most commonly involved vertebra for osteochondromas, C1 is actually the most commonly involved vertebra in the cervical region.

Mapping the Internal Anatomy of the Lateral Brainstem: Anatomical Study with Application to Far Lateral Approaches to Intrinsic Brainstem Tumors.

INTRODUCTION: Intramedullary brainstem tumors present a special challenge to the neurosurgeon. Unfortunately, there is no ideal part of the brainstem to incise for approaches to such pathology. Therefore, the present study was performed to identify what incisions on the lateral brainstem would result in the least amount of damage to eloquent tracts and nuclei. Case illustrations are also discussed. MATERIALS AND METHODS: Eight human brainstems were evaluated. Based on dissections and the use of standard atlases of brainstem anatomy, the most important deeper brainstem structures were mapped to the surface of the lateral brainstem. RESULTS: With these data, we defined superior acute and inferior obtuse corridors for surgical entrance into the lateral brainstem that would minimize injury to deeper tracts and nuclei, the damage to which would result in significant morbidity. CONCLUSIONS: To our knowledge, a superficial map of the lateral brainstem for identifying deeper lying and clinically significant nuclei and tracts has not previously been available. Such data might decrease patient morbidity following biopsy or tumor removal or aspiration of brainstem hemorrhage. Additionally, this information can be coupled with the previous literature on approaches into the fourth ventricular floor for more complex, multidimensional lesions.

Vaginal Extrusion of a Ventriculoperitoneal Shunt: A Case Report and Review of Literature.

BACKGROUND: Ventriculoperitoneal shunting is the most common treatment for hydrocephalus (excessive cerebrospinal fluid accumulation in the brain), but has the potential for serious complications such as shunt migration. Potential migration sites include the lateral ventricle mediastinum, gastrointestinal tract, abdominal wall, bladder, vagina, and scrotum. CASE: Here, we present a rare case of vaginal extrusion of a ventriculoperitoneal shunt. SUMMARY AND CONCLUSION: Neurosurgeons and gynecologists should be aware of the potential occurrence of this rare complication.

Effect of progesterone administration on prognosis of patients with diffuse axonal injury due to severe head trauma.

OBJECTIVE: Severe traumatic brain injury (TBI) has a major role in mortality rate among the other types of trauma. The aim of this clinical study was to assess the effect of progesterone on the improvement of neurologic outcome in patients with acute severe TBI. METHODS: A total of 76 patients who had arrived within 8h of injury with a Glasgow Coma Score≤8 were enrolled in the study. In a randomized style 38 received progesterone (1mg/kg per 12h for 5 days) and 38 did not. RESULTS: There was a better recovery rate and GOS score for the patients who were given progesterone than for those in the control group in a 3-months follow-up period (50% vs. 21%); subgroup analysis showed a significant difference in the percentage of favorable outcome between the two groups with GCS of 5-8 (p=0.03). CONCLUSION: The use of progesterone may significantly improve neurologic outcome of patients suffering severe TBI up to 3 months after injury, especially those with 5≤GCS≤8, providing a potential benefit to the treatment of acute severe TBI patients. Considering this drug had no significant side effects, so progesterone could be used in patients with severe TBI as a neuro-protective drug.

Intradural extramedullary primary hydatid cyst of the spine: a case report and review of literature.

Primary intradural extramedullary hydatid cyst is a rare form of parasitic infection, causing focal neurological signs, commonly observed in sheep-raising areas of the world. We report a rare case of intradural, extramedullary spinal cyst, which we had misdiagnosis in the first surgery, because of rarity of the case. A 55-year-old man presented to our hospital in August 2008. He was admitted to our clinic because of lumbar pain of increasing severity and progressive difficulty with walking and stiffness of both lower limbs, which had lasted for 1 month. On the basis of imaging results, arachnoid cyst of the lumbar spine was diagnosed. Due to rapid progression of the patient's symptoms toward spastic paraplegia, he underwent an emergency surgical decompression procedure. The patient underwent exploratory surgery using a posterior approach. A L1-L2 laminectomy was performed. After opening the dura, an intradural extramedullary cystic mass was determined. The surgical specimen measured 6 × 2 cm and was described as a whitish, pearl-like, semitranslucent, cystic material, which was thought to be parasitic. Surgery has to be followed by albendazole therapy.

Basioccipital bone osteochondroma growing into the foramen magnum.

BACKGROUND: Osteochondroma is a common bone tumor and rarely affects the central nervous system. Although intraspinal osteochondromas are known to cause neurological deficits, intracranial osteochondromas with neurological compromise are very rare. CASE DESCRIPTION: The authors report an exceptional case of a quadriparetic 73-year-old patient with a basioccipital bone osteochondroma growing into the foramen magnum. The embryology, differential diagnoses, and optimal management strategies are discussed. CONCLUSION: Although extremely rare, osteochondromas should be included in the differential diagnoses of tumors within the foramen magnum. For the tumors originating from the basioccipital bone, a simple medial suboccipital approach might suffice, while for ventral tumors, a far lateral transcondylar approach is necessary to avoid any neurovascular complications. Despite potentially catastrophic presenting symptoms, these tumors are pathologically benign and complete excision often results in long-term cure. To the best of our knowledge, this is the first report of an osteochondroma arising from the basiocciput.

Postoperative computed tomography assessment of pedicle screw placement accuracy.

AIM: Pedicle screw instrumentation is widely used in the lumbar spine as a means of stabilization to enhance arthrodesis and has gained acceptance in the thoracic spine in recent years. The purposes of this study were to determine the incidence of screw misplacement, complications, the accuracy and usefulness of CT scan in evaluation of pedicle screw placement. MATERIAL AND METHODS: Postoperative CT was performed in all 53 cases to evaluate implant position within first month after surgery. The CT scans were obtained with 2-mm axial slices of the instrumented levels. These images were then inspected for evidence of pedicle violation. RESULTS: In assessing 247 pedicle screws inserted in 53 patients, lateral screw misplacement was observed in 59 screws (67.82%) and medial pedicle wall violation in 28 screws (32.18%). Of the 87 misplaced screws, 41 cases were classified as minor (cortical perforation ≤ 2 mm), 41 cases as moderate (2.1-4 mm), and 5 cases as severe penetration ( > 4 mm).Nerve root injury with radicular pain and neurological deficits was observed in 8 patients with malpositioned screws (15.09% of all patients). CONCLUSION: Pedicle screw placement is a technically demanding procedure with a high complication rate. Fortunately, most complications are not severe.

Late-onset post-diskectomy tuberculosis at the same operated lumbar level: case report and review of literature.

Late post-diskectomy tuberculous spondylodiskitis at the operated level is an extremely rare phenomenon. We describe a unique case of a same level tuberculous spondylodiskitis with pus drainage from the operative scar 8 years after simple L4/L5 diskectomy and review the relevant literature. The therapeutic management and possible pathogenic mechanisms are discussed as well.

Neurological manifestations, imaging characteristics, and surgical outcome of intraspinal osteochondroma.

OBJECT: Spinal osteochondromas (OCs) are rare and can originate as solitary lesions or in the context of hereditary multiple exostoses. Concurrent spinal cord compression is a very rare entity. The purpose of this study was to evaluate the authors' 10-year experience with the imaging characteristics and surgical outcome in patients with symptomatic spinal OC. METHODS: Between 1997 and 2007, 8 consecutive cases of symptomatic intraspinal OC with documented spinal cord compression were treated surgically. These patients were analyzed with regard to presentation, imaging, and outcome. The relevant English literature was reviewed using MEDLINE and Google search engines. RESULTS: Three patients had cervical, 2 had thoracic, and 3 had lumbar lesions. Classic MR imaging characteristics were rarely found. Multiple hereditary exostoses were equally responsible for cervical, thoracic, and lumbar lesions (33%). The origin of the lesion was from the pedicle (25%), lamina (25%), vertebral body (25%), and superior or inferior facets (25%). A posterior approach to the spine was used in 6 patients, and a combined anterior and posterior approach with fusion was performed for 2 thoracic lesions. Surgical outcome was satisfactory in 75% of patients. The prognosis was poor in the patients with thoracic lesions. CONCLUSIONS: In the authors' experience, early detection and surgical removal in cases of symptomatic spinal OC is a key element for the best outcome. Posterior approaches are generally sufficient. The chronicity of symptoms may limit functional recovery postoperatively, especially with cervical and thoracic lesions.

Interaoperative use of epidural methylprednisolone or bupivacaine for postsurgical lumbar discectomy pain relief: a randomized, placebo-controlled trial.

BACKGROUND: Many patients with lumbar disc surgery experience postoperative back and radicular pain, delaying hospital discharge and resumption of normal activity. Some surgeons have used intraoperative epidural corticosteroids and local anesthetics to decrease pain following surgery for a herniated lumbar disc. Controversies still exist regarding the benefits of these drugs. The present study was meant to compare the effects of the intraoperative administration of epidural methylprednisolone and bupivacaine with that of normal saline (placebo) in lumbar disc surgery for postoperative pain control. PATIENTS AND METHODS: One hundred fifty patients with single level herniated nucleus pulposus (L4-L5 or L5-S1), which was refractory to 6 weeks of conservative management, were divided randomly in three groups. A standard hemipartial lamimectomy and discectomy was performed on all patients. At the end of the surgery, before the closure of fascia, 40 mg methylprednisolone with 3 mL normal saline for group 1, 2 mL bupivacaine 5% with 2 mL normal saline for group 2 and 4 mL normal saline for group 3 were instilled onto the epidural and exposed nerve root. Postoperative back and radicular pain intensity was assessed by a visual analogue scale (VAS) before and at 24, 48, 72, and 96 hours after surgery. RESULTS: There was no significant difference in back and radicular pain intensity between the three groups. CONCLUSION: Intraoperative administration of epidural methylprednisolone or bupivacaine does not relieve postoperative back and radicular pain.