Spinal Subdural Empyema

Neurosurgery ◽  
1978 ◽  
Vol 3 (3) ◽  
pp. 400-403
Author(s):  
Ralph G. Dacey ◽  
Richard H. Winn ◽  
John A. Jane ◽  
Albert B. Butler
Keyword(s):  
Back Pain ◽  
Intracerebral Hemorrhage ◽  
Lumbar Puncture ◽  
Spontaneous Abortion ◽  
Neurological Deficit ◽  
Nerve Root ◽  
Clinical Manifestations ◽  
Subdural Empyema ◽  
Nerve Root Compression

Abstract Spinal subdural empyema (SSE) is a rare variety of intraspinal infection. SSE should be suspected in patients presenting with fever, back pain, and signs of cord or nerve root compression. Two patients with SSE are presented. The first patient complained of fever and back pain. She had no neurological deficit but was found to have SSE. The second patient, who presented with intracerebral hemorrhage in the fifth month of pregnancy and spontaneous abortion, was found to have SSE at lumbar puncture. The clinical manifestations and management are discussed.

scholarly journals Appropriateness of Lumbar Spine Referrals to a Neurosurgical Service

2010 ◽  
Vol 37 (6) ◽  
pp. 843-848 ◽  
Author(s):  
J. Max Findlay ◽  
Nathan Deis
Keyword(s):  
Lumbar Spine ◽  
Neurological Deficit ◽  
Nerve Root ◽  
Leg Pain ◽  
Lumbar Spine Surgery ◽  
Nerve Root Compression ◽  
Clinical Criteria ◽  
University Of Alberta ◽  
Radiological Evidence ◽  
The University

AbstractBackground:Patients with lumbar spine complaints are often referred for surgical assessment. Only those with clinical and radiological evidence of nerve root compression are potential candidates for surgery and appropriate for surgical assessment. This study examines the appropriateness of lumbar spine referrals made to neurosurgeons in Edmonton, Alberta.Methods:Lumbar spine referrals to a group of ten neurosurgeons at the University of Alberta were reviewed over three two month intervals. Clinical criteria for “appropriateness” for surgical assessment were as follows: •“Appropriate” referrals were those that stated leg pain was the chief complaint, or those that described physical exam evidence of neurological deficit, and imaging reports (CT or MRI) were positive for nerve root compression. •“Uncertain” referrals were those that reported both back and leg pain without specifying which was greater, without mention of neurologic deficit, and when at least possible nerve root compression was reported on imaging. •“Inappropriate” referrals contained no mention of leg symptoms or signs of neurological deficit, and/or had no description of nerve root compression on imaging.Results:Of the 303 referrals collected, 80 (26%) were appropriate, 92 (30%) were uncertain and 131 (44%) were inappropriate for surgical assessment.Conclusions:Physicians seeking specialist consultations for patients with lumbar spine complaints need to be better informed of the criteria which indicate an appropriate referral for surgical treatment, namely clinical and radiological evidence of nerve root compression. Avoiding inappropriate referrals could reduce wait-times for both surgical consultation and lumbar spine surgery for those patients requiring it.

Persistent Nerve Root Compression by Buckling of the Longitudinal Ligament after Chemonucleolysis

Neurosurgery ◽  
1987 ◽  
Vol 20 (2) ◽  
pp. 332-334
Author(s):  
Robert M. Beatty
Keyword(s):  
Computed Tomography ◽  
Back Pain ◽  
Nerve Root ◽  
Posterior Longitudinal Ligament ◽  
Nerve Root Compression

Abstract Buckling of the posterior longitudinal ligament with compression against the thecal sac was the cause of persistent positional back pain after chemonucleolysis. Computed tomography in the supine and prone positions was helpful in making the diagnosis, and the cause was confirmed at laminectomy.

scholarly journals Oxygen-Ozone Therapy for Herniated Lumbar Disc in Patients with Subacute Partial Motor Weakness Due to Nerve Root Compression

2014 ◽  
Vol 20 (5) ◽  
pp. 547-554 ◽  
Author(s):  
Massimo Dall'Olio ◽  
Ciro Princiotta ◽  
Luigi Cirillo ◽  
Caterina Budai ◽  
Fabio de Santis ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Low Back ◽  
Nerve Root Compression ◽  
Disc Disease ◽  
Motor Weakness ◽  
Anti Inflammatory

Intradiscal oxygen-ozone (O2-O3) chemonucleolysis is a well-known effective treatment for pain caused by protruding disc disease and nerve root compression due to bulging or herniated disc. The most widely used therapeutic combination is intradiscal injection of an O2-O3 mixture (chemonucleolysis), followed by periradicular injection of O2-O3, steroid and local anaesthetic to enhance the anti-inflammatory and analgesic effect. The treatment is designed to resolve pain and is administered to patients without motor weakness, whereas patients with acute paralysis caused by nerve root compression undergo surgery 24–48h after the onset of neurological deficit. This paper reports on the efficacy of O2-O3 chemonucleolysis associated with anti-inflammatory foraminal injection in 13 patients with low back pain and cruralgia, low back pain and sciatica and subacute partial motor weakness caused by nerve root compression unresponsive to medical treatment. All patients were managed in conjunction with our colleagues in the Neurosurgery Unit of Bellaria Hospital and the IRCCS Institute of Neurological Sciences, Bologna. The outcomes obtained are promising: 100% patients had a resolution of motor weakness, while 84.6% had complete pain relief. Our results demonstrate that O2-O3 therapy can be considered a valid treatment option for this category of patients.

scholarly journals Ligamentum Flavum Hematoma Associated with L5–S1 Pars Interarticularis Defect: A Case Report and Review of the Literature

2020 ◽  
Author(s):  
Kenan Kıbıcı ◽  
Berrin Erok ◽  
Ahmet Çolak
Keyword(s):  
Nerve Root ◽  
Ligamentum Flavum ◽  
Histopathological Examination ◽  
Clinical Manifestations ◽  
Spinal Instability ◽  
Surgical Removal ◽  
Nerve Root Compression ◽  
Left Posterior ◽  
Pars Interarticularis ◽  
Magnetic Resonance Imaging Mri

AbstractLigamentum flavum hematoma (LFH) is an extremely rare compressive epidural lesion of the spine. The clinical manifestations of LFH are similar to that caused by other more common pathologies of nerve root compression like disc herniation. In the diagnosis, magnetic resonance imaging (MRI) is very important but challenging due to the changing intensities of the hematoma in relation to the stages of the aging blood. Herein, we report a case of LFH compressing the spinal canal in a 60-year-old man with pars interarticularis defect. He presented with low back pain radiating to the left leg. The neurological examination was consistent with left S1 nerve root compression. The MRI revealed a left posterior epidural mass compressing the thecal sac and S1 nerve root at the left L5–S1 level near the pars interarticularis defect. After surgical removal of the lesion, histopathological examination confirmed the diagnosis of LFH. Following surgery, he recovered rapidly. LFH due to spinal instability is important in terms of the understanding of the pathophysiological mechanisms related with LFH.

Weight-Bearing MRI of the Lumbosacral Spine: Difference between Supine and Weight Bearing Positions and Additional Value in Patients with Low Back Pain

2020 ◽  
Vol 103 (10) ◽  
pp. 1057-1065
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Supine Position ◽  
Nerve Root ◽  
Weight Bearing ◽  
Lumbosacral Spine ◽  
Low Back ◽  
Nerve Root Compression ◽  
Significant Change ◽  
Additional Value

Objective: To study the difference of magnetic resonance imaging (MRI) parameters of the lumbosacral spine between weight-bearing and supine positions, and evaluate whether there is additional value in patients with low back pain. Materials and Methods: Eight-six patients with low back pain with or without leg pain who underwent MRI of the lumbosacral spine in weight-bearing and supine positions were included in the present retrospective study. The patients’ characteristics and MRI parameters were measured. The data were analyzed to find significant differences between these two positions. Results: MRI parameters which significantly increased in weight-bearing position compared to supine position (p<0.05) included lumbar lordotic angle, lumbosacral angle, presence of spondylolisthesis (at L4/L5 level), and presence of nerve root compression (at L3/L4, L4/L5, and L5/S1 levels). Parameters or findings that significantly decreased were spinal canal diameter (at L2/L3, L4/L5, and L5/S1 levels), and intervertebral disk height (at L2/L3, L4/L5, and L5/S1 levels). Older age group (mean age of 54.3 years versus 45.6 years as younger group) showed a significant change in number of nerve root compression. Forty-three percent of patients with radiating symptom showed a changed number of nerve root compression but this was not statistically significant. Conclusion: Multiple MRI parameters of the lumbosacral spine show significant change in weight-bearing compared to supine position. Increased presence of spondylolisthesis and nerve root compression might be beneficial in patients with radiating symptom unexplained by conventional MR studies in supine position. Older age group showed a significant change in number of nerve root compression. Keywords: Weight-bearing, MRI, Lumbar spine, Back pain

Microdecompression without fusion for radiculopathy associated with lytic spondylolisthesis

1996 ◽  
Vol 85 (4) ◽  
pp. 582-585 ◽  
Author(s):  
Bradley K. Weiner ◽  
John A. McCulloch
Keyword(s):  
Back Pain ◽  
Nerve Root ◽  
Therapeutic Option ◽  
Radicular Pain ◽  
Nerve Root Compression ◽  
Surgical Morbidity ◽  
Content Type ◽  
Transpedicular Instrumentation ◽  
Limited Surgery ◽  
Fine Print

✓ Patients with symptomatic L-5 nerve root compression and associated lytic spondylolisthesis are commonly treated by bilateral wide posterior decompression and concomitant fusion, often accompanied by transpedicular instrumentation. More limited surgery aimed solely at the relief of nerve root compression offers the potential for significant relief of radicular pain while avoiding iatrogenic instability, thereby alleviating the need for arthrodesis with its increased surgical morbidity. Nine patients with unilateral radicular symptoms referable to the L-5 nerve root, minimal back pain, and a lytic pars lesion with mild spondylolisthesis underwent unilateral microdecompression on their symptomatic side without associated fusion. All patients obtained relief of radicular pain at both short- and long-term follow-up examination. One patient demonstrated increased back pain and, accordingly, the procedure is now recommended only for patients with no greater than a 25% spondylolisthesis. Unilateral microdecompression without stabilization is an effective and safe method for relieving radicular pain in patients with a lytic pars defect, a mild spondylolisthesis, and minimal back pain. This therapeutic option should be considered in select cases as an alternative to bilateral wide decompression with fusion and instrumentation.

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