Extradural giant multiloculated arachnoid cyst causing spinal cord compression in a child

BACKGROUND: Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. Enlargement may cause progressive signs and symptoms caused by spinal cord compression. They are associated with trauma, surgery, arachnoiditis, and neural tube defects. Most nontraumatic spinal extradural arachnoid cysts are thought to be congenital. DESIGN: Case report and literature review. FINDINGS: A 9-year-old boy with mild paraparesis was found to have an extradural multiloculated arachnoid cyst with fibrous septa at T4-L3 levels and anterior compression and displacement of the spinal cord. CONCLUSIONS: Definitive treatment of arachnoid cyst entails radical cyst removal and dura cleft repair. Formation of a postoperative cerebrospinal fluid fistula may require external lumbar drainage.     

Spinal Hydatid Cyst Mimicking Arachnoid Cyst on Magnetic Resonance Imaging

Abstract

Background: Primary spinal hydatid cysts are uncommon and account for 1% of all cases of hydatid disease. Echinococcus granulosus is most often responsible for the cyst hydatid. Intradural, extramedullary involvement is rare. When the cysts do not demonstrate typical magnetic resonance imaging findings, the differential diagnosis is more complex.

Method: Case report.

Findings: An isolated primary hydatid cyst of the spine in a 35-year-old man that appeared to be an arachnoid cyst on preoperative radiographic examination.

Conclusion: Hydatid cysts that lack the typical radiographic appearance may be mistaken for arachnoid cysts. Misdiagnosis has serious implications for surgical intervention and long-term care.     

高位颈髓压迫症的治疗策略

目的：探讨高位颈髓压迫症的外科治疗。方法：商位颈髓压迫症228例,其中齿突骨折58例（新鲜骨折38例,陈旧性骨折20例）,Hangman骨折45例（其中新鲜骨折28例,陈旧性骨折17例）,寰椎横韧带断裂24例,寰椎单侧后弓骨折19例,类风湿性天节炎17例,一侧关节突骨折9例,Jefferson骨折并慢性不稳3例,先天畸形48例,肿瘤4例。根据复位情况及脊髓受乐部何选择不同的术式,重建其稳定性。结果：平均随访4年11个月。JOA评分术前平均7．5分,随访时评分14．9分,改善率79．9％。结论：充分减压是最大限度恢复神经功能的有效方法,稳定性的重建非常必要。     

Spinal extradural arachnoid cyst

Summary Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. They usually present with progressive signs and symptoms caused by spinal cord compression if they enlarge. A comprehensive review about spinal extradural arachnoid cyst is made including the author’s own case of a 59-year-old woman with a 6-month history of progressive back pain radiating to both legs. Key points concerning the possible pathogenesis including symptomatology, diagnosis, and the implications for treatment are highlighted. Surgical treatment is curative and this rare clinical entity should be considered in the differential diagnosis of spinal extradural lesions.     

Spontaneous Disappearance of Temporo-Frontal Arachnoid Cyst in a Child

Summary  We report a child with a large temporo-frontal arachnoid cyst which resolved spontaneously. There was no history of a head injury. The patient was a boy aged 1.6 years. Though a large head was pointed out (+2SD), no therapeutic intervention was made because the relationship of the head circumference and the cyst was not established. No change in cyst size was visualized on the follow-up CTs at the age of 2.5 years and 6 years. At the age of 7 years, the arachnoid cyst had completely disappeared on CT. In order not to overlook a minute change in cyst size, the volumetry of the cyst and the intracranial cavity was performed, using the Photoshop, Macintosh. Both the cyst volume and the volume ratio of the cyst to the intracranial cavity slightly decreased and then increased. It is speculated that the cyst spontaneously ruptured by factors such as extreme breath holding and crying on the presence of the higher intracystic tension which might become a factor to accelerate spontaneous rupture of the cyst. Since a number of paediatric cases of symptomatic arachnoid cysts in need of surgical intervention has been larger than that of adult cases, we can speculate that a large arachnoid cyst might spontaneously resolve more frequently than we had expected. This case demonstrates that the surgical treatment of asymptomatic arachnoid cyst in the middle cranial fossa is not necessarily indicated in children.     

Vision Loss After Spinal Fusion for Scoliosis in a Child With Spinal Cord Injury

Background:

Vision loss after spinal surgery is a rare and devastating complication. Risk factors include patient age, operative time, estimated blood loss, and intraoperative fluid management. Children with spinal cord injury often develop scoliosis that requires surgical correction.

Study Design:

Case report.

Methods:

Clinical and radiographic review was conducted of a 15-year-old boy who developed severe scoliosis after sustaining a C5 level injury at age 4 years from a motor vehicle crash.

Findings:

The patient underwent a posterior spinal fusion from T2 to the pelvis, and good correction of the spinal deformity was attained. During the 8-hour procedure, blood loss was 4,000 mL (approximately 1.2 blood volumes) and 17,000 mL of fluids were administered. On postoperative day 5, it was determined that the patient had complete visual loss. Neuro-ophthalmology consultation confirmed the diagnosis of posterior ischemic optic neuropathy.

Conclusions:

A significant number of children with spinal cord injury develop scoliosis requiring surgical correction. These procedures are often lengthy, with the potential for extensive blood loss and fluid shifts, factors that may increase the likelihood of postoperative vision loss. Patients should be counseled about this complication, and the surgical and anesthesiology teams should take all measures to minimize its occurrence.     

Vision Loss After Spinal Fusion for Scoliosis in a Child With Spinal Cord Injury

Abstract

Background: Vision loss after spinal surgery is a rare and devastating complication. Risk factors include patient age, operative time, estimated blood loss, and intraoperative fluid management. Children with spinal cord injury often develop scoliosis that requires surgical correction.

Study Design: Case report.

Methods: Clinical and radiographic review was conducted of a 15-year-old boy who developed severe scoliosis after sustaining a C5 level injury at age 4 years from a motor vehicle crash.

Findings: The patient underwent a posterior spinal fusion from T2 to the pelvis, and good correction of the spinal deformity was attained. During the 8-hour procedure, blood loss was 4,000 mL (approximately 1.2 blood volumes) and 17,000 mL of fluids were administered. On postoperative day 5, it was determined that the patient had complete visual loss. Neuro-ophthalmology consultation confirmed the diagnosis of posterior ischemic optic neuropathy.

Conclusions: A significant number of children with spinal cord injury develop scoliosis requiring surgical correction. These procedures are often lengthy, with the potential for extensive blood loss and fluid shifts, factors that may increase the likelihood of postoperative vision loss. Patients should be counseled about this complication, and the surgical and anesthesiology teams should take all measures to minimize its occurrence.     

Bone Cement and Pedicle Screw for the Treatment of Spinal Tumors with Spinal Cord Compression and Posterior Wall Defects

ObjectiveTo compare the safety and efficacy of posterior internal fixation with open vertebroplasty (VP) and posterior internal fixation with open kyphoplasty (KP) in the treatment of metastatic epidural spinal cord compression (MESCC) with posterior wall destruction.MethodsThis retrospective study, conducted between January 2016 and May 2019, equally divided 60 patients with MESCC and posterior wall destruction into two groups based on the surgical method: open vertebroplasty with pedicle screw fixation (VP group) and open kyphoplasty with pedicle screw fixation (KP group). Visual analogue scale (VAS), SF‐36 scores, middle vertebral height (MVH), and posterior vertebral height (PVH) were evaluated for the two groups preoperatively, postoperatively, and 1 year after surgery. Spinal Instability Neoplastic Score, Frankel grades and complications were recorded and evaluated.ResultsFive patients were excluded from the analysis, and our study cohort consisted of 55 adult patients who met the inclusion criteria. The VAS and SF‐36 scores of these two groups of patients significantly improved, when compared with those before the surgery (P < 0.05). There were significant differences in total cost (8835 ± 1468 vs 9540 ± 053 USD) and cement volume (4.51 ± 0.96 ml vs 6.35 ± 1.09 ml) between two groups (P < 0.05). The MVH and PVH of these two groups of patients significantly improved, when compared with those before the surgery (P < 0.05). The MVH was significantly larger in the KP group than in the VP group postoperatively (20.15 ± 4.86 vs 17.70 ± 3.78, P < 0.05) and at the final follow‐up (20.42 ± 5.59 vs 17.28 ± 3.23, P < 0.05). However, the PVH of the two groups did not significantly differ at the two postoperative follow‐ups (P > 0.05). No significant differences were found in surgery time, time from surgery to discharge, blood loss and complications between both groups postoperatively (P > 0.05).ConclusionIn the short term, both approaches are effective and safe in patients with MESCC and posterior wall destruction. The posterior internal fixation with open VP may be a good choice of surgical method in patients with MESCC and posterior wall defects.     

Thoracic Endoscopic‐Assisted Mini‐Open Surgery for Thoracic and Thoracolumbar Spinal Cord Compression

Intervertebral disc herniation is a common cause of spinal cord compression, especially for the thoracic and thoracolumbar spinal cord, which has limited buffer space in the spinal canal. Spinal cord compression usually causes decreased sensation and paralysis of limbs below the level of compression, urinary and fecal incontinence, and/or urinary retention, which brings great suffering to the patients and usually requires surgical intervention. Thoracotomy or abdominothoracic surgery is usually performed for the thoracolumbar cord compression caused by hard intervertebral disc herniation. However, there is high risk of trauma and complications with this surgery. To reduce the surgical trauma and obtain good visibility, we designed athoracic endoscopic‐assisted mini‐open surgery for thoracic and thoracolumbar disc herniation, and performed this procedure on 10 patients who suffered from hard thoracic or thoracolumbar spinal cord compression. During the procedure, the thoracic endoscopy provided clear vision of the surgical field with a good light source. The compression could be fully exposed and completely removed, and no nerve root injury or spinal cord damage occurred. All patients achieved obvious recovery of neurological function after this procedure. This technique possesses the merits of minimal trauma, increased safety, and good clinical results. The aim of this study is to introduce this thoracic endoscopic‐assisted mini‐open surgery technique, and we believe that this technique will be a good choice for the thoracic and thoracolumbar cord compression caused by hard intervertebral disc herniation.     

Metastatic Synovial Sarcoma With Cervical Spinal Cord Compression Treated With Posterior Ventral Resection: Case Report

Abstract

Context: Synovial sarcomas, which represent 5% to 10% of all adult soft-tissue sarcomas, usually metastasize to the lungs. Metastasis to the spine is rare. Spinal cord compression due to spinal metastasis occurs in approximately 3% of patients with extraspinal soft-tissue sarcomas.

Method: Case report.

Findings: A 26-year-old woman presented with neck pain, arm weakness, and a history of metastatic synovial sarcoma originating at the right knee. Computed tomography revealed destruction of the odontoid and C2 body. Magnetic resonance imaging revealed tumor in the posterior elements of C2 and in the ventral epidural space from C2-C5. She was treated with C2-C3 laminectomy, posterior C2 corpectomy with occipital-C7 fixation, and fusion. Postoperatively, her neck pain resolved and left upper extremity strength returned to normal.

Conclusion and Clinical Relevance: Metastatic spinal cord compression from synovial sarcoma is rare. Surgical resection can lead to neurologic improvement.     

脊髓撞击并压迫性损伤减压价值的实验研究

目的　观察脊髓损伤后椎管狭窄程度、减压时间与脊髓神经功能恢复之间的关系。方法　选择新西兰兔 76只 ,分 4组。A组 (对照组 ) 8只 ,L1 椎体前路 ,前后方向钻孔开窗 ;B组 (撞击组 ) 8只 ,经椎体骨窗处 ,72 0gcm力脊髓撞击损伤 ;C组、D组于撞击致伤后 ,从骨窗处置入小螺钉分别造成 <30 %和 >5 0 %的椎管狭窄 ,并根据术后 1 2h ,3、 7、 2 8、 4 2d去除小螺钉 (减压 )的时间不同各分为 5个小组。通过病理 ,SEP检测及免疫学观察 (斜板试验及BBB评分 ) ,观察神经功能恢复的差异性。结果　B组、C组及D组中d8组术后 4 2d与A组相比 ,斜板试验及BBB评分P >0 0 5无统计学意义 ,实验兔运动功能均能恢复。结论　上述实验条件下 ,椎管狭窄程度 <30 % ,进行或不进行椎管减压 ,脊髓神经功能均可在 4 2d内恢复 ;椎管狭窄 >5 0 % ,1 2h内减压 ,神经功能基本恢复 ,3d后减压神经功能大部分丧失     

Effectiveness of an Upper Extremity Exercise Device Integrated With Computer Gaming for Aerobic Training in Adolescents With Spinal Cord Dysfunction

Abstract

Background/Objective: To determine whether a new upper extremity exercise device integrated with a video game (GameCycle) requires sufficient metabolic demand and effort to induce an aerobic training effect and to explore the feasibility of using this system as an exercise modality in an exercise intervention.

Design: Pre-post intervention.

Setting: University-based research facility.

Subject Population: A referred sample of 8 adolescent subjects with spina bifida (4 girls, 15.5 ± 0.6 years; 4 boys, 1 7.5 ± 0.9 years) was recruited to participate in the project. All subjects had some level of mobility impairment that did not allow them to participate in mainstream sports available to their nondisabled peers. Five subjects used a wheelchair full time, one used a wheelchair occasionally, but walked with forearm crutches, and 2 were fully ambulatory, but had impaired gait.

Main Outcome Measures: Peak oxygen uptake, maximum work output, aerobic endurance, peak heart rate, rating of perceived exertion, and user satisfaction.

Results: Six of the 8 subjects were able to reach a Vo2 of at least 50% of their Vo2 reserve while using the GameCycle. Seven of the 8 subjects reached a heart rate of at least 50% of their heart rate reserve. One subject did not reach either 50% of Vo2 reserve or 50% of heart rate reserve. Seven of the 8 subjects increased their maximum work capability after training with the GameCycle at least 3 times per week for 16 weeks.

Conclusions: The data suggest that the GameCycle seems to be adequate as an exercise device to improve oxygen uptake and maximum work capability in adolescents with lower extremity disability caused by spinal cord dysfunction. The subjects in this study reported that the video game component was enjoyable and provided a motivation to exercise.     

Giant Chylolymphatic Cyst of the Jejunal Mesentry in a Child: Report of a Case

A giant chylolymphatic cyst from the jejunal mesentery in a 4-year-old boy is herein described. The child presented with an acute intestinal obstruction and the etiology of the obstruction was only discovered at surgery, even though preoperative abdominal sonography had hinted at the presence of a mesenteric lesion. An excision of the cyst, along with part of the involved bowel, was performed and was curative. The literature regarding the origin, presentation, complications, and particularly, the diagnosis of this rare lesion is also reviewed. Received: November 5, 2001 / Accepted: July 2, 2002 Reprint requests to: S.K. Ratan, E-13/13, Khirki Extension, Malviya Nagar, New Delhi, PIN 110017, India     

Evaluation of the Effects of Compression Stockings Using Venous Plethysmography in Persons With Spinal Cord Injury

Abstract

Background/Objective: To examine the effect of graduated compression stockings (GCS) on the properties of the venous vascular system, as characterized by venous capacitance (VC) and venous outflow (VO), in the lower extremities of individuals with spinal cord injury (SCI), according to injury level.

Methods: Nine male subjects with SCI (5 with low paraplegia [LP], 4 with high paraplegia [HP]) performed 2 plethysmography tests: with and without graduated compression knee-length stockings (pressure of 21 mm/Hg). The VC, VO, and cardiovascular parameters (heart rate and blood pressure) were evaluated with and without GCS.

Results: The VC and VO were lower in patients with HP than in those with LP. For all subjects, VC was significantly lower (-14%) with GCS than without (1.77 ± 1.18 vs 1.53 ± 1.09 vol%, P < 0.01). On the contrary, VO did not differ significantly when wearing or not wearing GCS.

Conclusions: This study demonstrated that 21-mm/Hg knee-length GCS are sufficient to prevent venous distension in individuals with SCI, even those with longstanding paraplegia, by significantly decreasing venous capacitance. This intervention may help to prevent deep vein thrombosis.     

Inflammatory Sacroiliitis in a Man With Spinal Cord Injury

Abstract

Background: Inflammatory sacroiliitis associated with spinal cord injury (SCI) as an unusual cause of elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level has not been reported previously to our knowledge.

Objective: To represent a case of SCI associated with bilateral sacroiliitis causing ESR and CRP level elevation.

Methods: Case report of a man with T9 paraplegia.

Findings: ESR and CRP levels were high. Pelvic radiography was nearly normal, except for mildly blurred sacroiliac joints with normal margins. A 3-phase bone scan revealed bilateral sacroiliitis and heterotopic ossification at medial side of the left knee. Past history was significant for a recent urinary tract infection. Indomethacin and etidronate were prescribed. Significant decreases in ESR and CRP level were seen 1 month later.

Conclusions: Sacroiliitis might be an unusual cause of elevated ESR and CRP levels in patients with SCI. Sensory and motor deficits may obscure the typical clinical presentation; therefore, imaging studies are essential for the diagnosis.     

Prevention of Venous Thromboembolism in Patients with Spinal Cord Injury: Effects of Sequential Pneumatic Compression and Heparin

Abstract

Objective: To estimate the incidence of and risk factors for venous thromboembolism in patients with acute traumatic spinal cord injury (SCI) and evaluate the effectiveness of sequential pneumatic compression devices (SCD), gradient elastic stockings (GES), and heparin in preventing thromboembolism. Design: Prentice’s case-cohort design.

Setting: All patients admitted to our hospital between 1976 and 1995 with acute traumatic SCI. Main outcome measures: Demographic characteristics, venous thromboembolism risk factors, methods of surveillance and prophylaxis, and thromboembolic events during the first 6 weeks following injury. Results: Venous thromboembolism occurred in 84 of 428 patients (19.6%). Venous thromboembolism increased from 21% between 1976 and 1979 to 31% between 1980 and 1984, then decreased to 16% between 1985 and 1989 and to 8% between 1990 and 1995. Routine surveillance for venous thromboembolism increased through 1983, and SCD/GES use increased after 1983, with a concurrent decline in incidence of thromboembolism. Multivariate analysis showed that SCD/GES reduced the risk of deep venous thrombosis (DVT) or pulmonary embolism (relative risk, 0.5; 95% CI, 0.28 to 0.90). Multivariate analysis suggested a reduced risk of DVT in patients receiving heparin therapy within the first 14 to 42 days after injury, but estimates of reduced risk were not statistically significant (p = .064 for first 14 days, p = .13 for heparin anytime).

Conclusion: The SCD/GES combination and heparin are each effective in preventing venous thromboembolism in individuals’ acute traumatic SCI. Effectiveness of heparin prophylaxis may be greatest during the first 14 days after injury, whereas benefit from SCD continues to 6 weeks after injury.     

Ileal Perforation in a Patient with High Spinal Cord Injury: Report of a Case

Assessing abdominal complications in patients who have previously suffered high spinal cord injury is very difficult because the resultant loss of sensory, motor, and reflux function of the abdominal wall can mask the typical signs of acute abdomen such as tenderness, muscle rigidity, and peritoneal rebound pain. We recently diagnosed a small intestinal perforation in a 77-year-old man with a C6–7 spinal cord injury sustained 14 years earlier. The patient was correctly diagnosed as having an acute abdominal condition, despite palsy of abdominal wall sensation. An emergency laparotomy was done and a 40-cm length of affected ileum, about 180cm distal to the Treitz ligament, including a 1-cm perforation, was resected, followed by an end-to-end anastomosis. We report this case to raise awareness of the need for appropriate diagnosis and early surgical treatment of abdominal complications in spinal-cord-injured patients.     

Reduction of Spinal Cord Injury with Pentobarbital and Hypothermia in a Rabbit Model

OBJECTIVES: to evaluate the effects of hypothermia and pentobarbital on spinal cord ischaemia induced in a rabbit model. MATERIALS AND METHODS: thirty-two rabbits, allocated into four equal groups, had the infrarenal aorta clamped distal to the left renal artery and above the iliac bifurcation for 40 min. Groups 3 and 4 had infusion of 15 mg/kg of pentobarbital intravenously for 5 min, 15 min before the cross-clamping. Groups 2 and 4 had infusion of 20 ml of Ringer's lactate (LR) solution at 3 degrees C for 3 min during aortic cross clamp into the isolated aortic segment. Group 1 was untreated and served as control. Postoperative functions of spinal cord were assessed. RESULTS: paraplegia occurred in all rabbits in Group 1, in one in each of Groups 2 and 3, whereas no paraplegia was observed in Group 4. In addition 2 and 3 animals of Groups 2 and 3, respectively revealed varying degree of neurological disturbances, whereas all animals of Group 4 had normal function. This difference between Groups 2, 3, and 4 vs Group 1 was significant (p<0.002). So was the difference between Groups 2 and 4 (p=0.03), whereas the difference between Groups 3 and 4 was not significant. CONCLUSIONS: hypothermia and pentobarbital was more effective than hypothermia alone for prevention of spinal cord ischaemia in a rabbit model.