Database : MEDLINE
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[PMID]: 29517672
[Au] Autor:Amano E; Ozaki K; Egawa S; Suzuki M; Hirai T; Ishibashi S; Ohkubo T; Yoshii T; Okawa A; Yokota T
[Ad] Address:Department of Neurology and Neurological Science.
[Ti] Title:Dynamic spinal compression revealed by computed tomography myelography in overshunting-associated myelopathy: A case report.
[So] Source:Medicine (Baltimore);97(10):e0082, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: OSAM is a rare ventriculoperitoneal (VP) shunt complication where cervical spinal cord compression by epidural venous plexus engorgement is caused by cerebrospinal fluid (CSF) overdrainage. Symmetrically indented deformity of the upper cervical spinal cord and surrounding epidural venous engorgement are characteristic radiological findings. Both of them are typically detected on magnetic resonance imaging (MRI) and enhanced computed tomography (CT). PATIENT CONCERNS: The 77-year-old man who underwent the placement of a VP shunt without an antisiphon device to treat post-subarachnoid hemorrhage (SAH) hydrocephalus presented with progressive quadriplegia 10 years postoperatively. DIAGNOSIS: MRI revealed a symmetrically indented spinal cord from the craniocervical junction (CCJ) to the C2 level and enhanced CT showed the epidural venous engorgement, which were characteristic radiological findings of overshunting-associated myelopathy (OSAM). However, MRI atypically failed to detect the engorged epidural vein and showed no compressive lesion around the spinal cord. INTERVENTION: In order to reveal how the cervical spinal cord was deformed and compressed by engorged epidural vein, CT myelography was performed. OUTCOMES: CT myelography proved that the epidural vein dynamically engorged and compressed the cervical spinal cord immediately after rotation and extension of the neck. LESSONS: CT myelography combined with neck rotation and extension revealed the dynamic change of the epidural venous engorgement, and is useful for evaluation and diagnosis of OSAM especially when epidural venous engorgement was not detectable on MRI.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Process
[do] DOI:10.1097/MD.0000000000010082

  2 / 9664 MEDLINE  
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[PMID]: 29390372
[Au] Autor:Notani N; Miyazaki M; Yoshiiwa T; Ishihara T; Kanezaki S; Tsumura H
[Ad] Address:Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
[Ti] Title:Dynamic paraspinal muscle impingement causing acute hemiplegia after C1 posterior arch laminectomy: A case report.
[So] Source:Medicine (Baltimore);96(50):e9264, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Acute neurological deficits following spinal surgery commonly result from epidural hematoma, surgical trauma, vascular compromise, and graft or hardware impingement, with the cause identified by magnetic resonance imaging (MRI). We present a rare case of dynamic paraspinal muscle impingement after C1 posterior arch laminectomy, which was diagnosed by myelography, with no significant findings on MRI. PATIENT CONCERNS: An 81-year-old, severely obese male, was referred to our department for the treatment of vertebral disease of the lumbar spine. The patient presented with bilateral weakness and numbness of the upper extremities and gait disturbances. Based on MRI, a diagnosis of retro-odontoid pseudotumor was made, and C1 posterior arch laminectomy, in combination with C4 partial laminectomy and C5 to C6 laminoplasty, was performed. On postoperative day 3, the patient's neurological status deteriorated, with right upper extremity and right lower extremity weakness increasing with neck extension. Although there was no evidence of epidural hematoma formation on MRI, obstruction of the flow of contrast medium by an external posterior compression in neck extension at the level of C1 was identified by myelography. Revision surgery was performed and local muscle swelling at the surgical site identified with no hematoma formation. Occiput to C3 fixation, with instrumentation, was performed. OUTCOMES: Muscle strength of the right upper extremity and lower extremities recovered postsurgery, and the patient has continued to improve function 3 years after surgery, with no further neurological episodes. LESSONS: Dynamic paraspinal muscle impingement following C1 laminectomy in a muscular man was diagnosed by myelography, with no significant findings on standard MRI. CONCLUSION: The possibility of dynamic paraspinal muscle impingement should be considered in patients developing acute, progressive, neurological deficits after posterior cervical decompression, with myelography being the imaging method of choice for diagnosis.
[Mh] MeSH terms primary: Cervical Vertebrae/surgery
Hemiplegia/etiology
Odontoid Process/surgery
Paraspinal Muscles/surgery
Postoperative Complications/etiology
Spinal Cord Diseases/diagnosis
Spinal Cord Diseases/surgery
[Mh] MeSH terms secundary: Aged, 80 and over
Humans
Laminectomy
Magnetic Resonance Imaging
Male
Myelography
Neurosurgical Procedures
Recovery of Function
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180301
[Lr] Last revision date:180301
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009264

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[PMID]: 29472069
[Au] Autor:Ghali MGZ; Srinivasan VM; Rao VY; Omeis I
[Ad] Address:Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States.
[Ti] Title:Idiopathic thoracic spinal cord herniation.
[So] Source:J Clin Neurosci;, 2018 Feb 19.
[Is] ISSN:1532-2653
[Cp] Country of publication:Scotland
[La] Language:eng
[Ab] Abstract:Idiopathic spinal cord herniation represents an uncommon and unique diagnostic entity, most commonly affecting middle-aged individuals, with a nearly twofold female predilection. It most characteristically affects the mid-thoracic spine, with the herniation occurring ventrally or ventrolaterally. Clinical presentation is typically a slowly-progressive myelopathy, with Brown-Séquard syndrome occurring more frequently than spastic paraparesis. Diagnosis is made by imaging, with high-resolution or phase-contrast MR sequences and/or CT myelography. Treatment should be individualized, with options including conservative management with routine follow-up and surgical intervention. We review the literature on this interesting topic and report on, and present our technique for, operative reduction and repair of idiopathic spinal cord herniation in a 66 year-old woman.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180223
[Lr] Last revision date:180223
[St] Status:Publisher

  4 / 9664 MEDLINE  
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[PMID]: 29463942
[Au] Autor:Umakoshi M; Yasuhara T; Toyoshima A; Sasada S; Kusumegi A; Morimoto J; Kin K; Tomita Y; Date I
[Ad] Address:Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
[Ti] Title:Spinal Extradural Arachnoid Cyst: Significance of Intrathecal Infusion after Fistula Closure.
[So] Source:Acta Med Okayama;72(1):73-76, 2018 Feb.
[Is] ISSN:0386-300X
[Cp] Country of publication:Japan
[La] Language:eng
[Ab] Abstract:The spinal extradural arachnoid cyst is a rare entity. Obtaining the correct diagnosis and detecting the fistula location are critical for providing effective treatment. A 41-year-old man had numbness in the soles of his feet for 2 years with accompanying gait disturbance, and a defecation disorder. Computed tomography myelography performed at another hospital revealed an epidural arachnoid cyst from Th11 to L2. He received a subarachnoid-cyst shunt at the rostral part of the cyst. However, his symptoms worsened and he was admitted to our hospital. Neuroradiological investigations revealed the correct location of the fistula at the level of Th12. We performed partial removal of the cyst wall with fistula closure via right hemilaminectomy of Th11 and 12. The complete closure of the fistula was confirmed by intrathecal infusion of artificial cerebrospinal fluid through the shunt tube. The shunt tube was removed with the sutures. The patient's symptoms improved, although numbness remained in his bilateral heels. There has been no recurrence in 15 months since the surgery. Fistula closure may work as a balanced therapeutic strategy for spinal extradural arachnoid cyst, and intrathecal cerebrospinal fluid infusion is useful for the confirmation of complete fistula closure.
[Pt] Publication type:CASE REPORTS
[Em] Entry month:1802
[Cu] Class update date: 180221
[Lr] Last revision date:180221
[St] Status:In-Process
[do] DOI:10.18926/AMO/55666

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[PMID]: 29315969
[Au] Autor:Liu C; Desai S; Krebs LD; Kirkland SW; Keto-Lambert D; Rowe BH; PRIHS-2 Choosing Wisely Team
[Ad] Address:Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
[Ti] Title:Effectiveness of Interventions to Decrease Image Ordering for Low Back Pain Presentations in the Emergency Department: A Systematic Review.
[So] Source:Acad Emerg Med;, 2018 Jan 08.
[Is] ISSN:1553-2712
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Low back pain (LBP) is an extremely frequent reason for patients to present to an emergency department (ED). Despite evidence against the utility of imaging, simple and advanced imaging (i.e., computed tomography [CT], magnetic resonance imaging) for patients with LBP has become increasingly frequent in the ED. The objective of this review was to identify and examine the effectiveness of interventions aimed at reducing image ordering in the ED for LBP patients. METHODS: A protocol was developed a priori, following the PRISMA guidelines, and registered with PROSPERO. Six bibliographic databases (including MEDLINE, EMBASE, EBM Reviews, SCOPUS, CINAHL, and Dissertation Abstracts) and the gray literature were searched. Comparative studies assessing interventions that targeted image ordering in the ED for adult patients with LBP were eligible for inclusion. Two reviewers independently screened study eligibility and completed data extraction. Study quality was completed independently by two reviewers using the before-after quality assessment checklist, with a third-party mediator resolving any differences. Due to a limited number of studies and significant heterogeneity, only a descriptive analysis was performed. RESULTS: The search yielded 603 unique citations of which a total of five before-after studies were included. Quality assessment identified potential biases relating to comparability between the pre- and postintervention groups, reliable assessment of outcomes, and an overall lack of information on the intervention (i.e., time point, description, intervention data collection). The type of interventions utilized included clinical decision support tools, clinical practice guidelines, a knowledge translation initiative, and multidisciplinary protocols. Overall, four studies reported a decrease in the relative percentage change in imaging in a specific image modality (22.7%-47.4%) following implementation of the interventions; however, one study reported a 35% increase in patient referrals to radiography, while another study reported a subsequent 15.4% increase in referrals to CT and myelography after implementing an intervention which reduced referrals for simple radiography. DISCUSSION: While imaging of LBP has been identified as a key area of imaging overuse (e.g., Choosing Wisely recommendation), evidence on interventions to reduce image ordering for ED patients with LBP is sparse. There is some evidence to suggest that interventions can reduce the use of simple imaging in LBP in the ED; however, a shift in imaging modality has also been demonstrated. Additional studies employing higher-quality methods and measuring intervention fidelity are strongly recommended to further explore the potential of ED-based interventions to reduce image ordering for this patient population.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180219
[Lr] Last revision date:180219
[St] Status:Publisher
[do] DOI:10.1111/acem.13376

  6 / 9664 MEDLINE  
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[PMID]: 29429117
[Au] Autor:Morelli N; Rota E; Immovilli P; Marchesi G; Michieletti E; Guidetti D
[Ad] Address:Neurology Unit, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy. nicola.morelli.md@gmail.com.
[Ti] Title:CT and MR myelography in superficial siderosis.
[So] Source:Neurol Sci;, 2018 Feb 10.
[Is] ISSN:1590-3478
[Cp] Country of publication:Italy
[La] Language:eng
[Pt] Publication type:LETTER
[Em] Entry month:1802
[Cu] Class update date: 180211
[Lr] Last revision date:180211
[St] Status:Publisher
[do] DOI:10.1007/s10072-018-3271-z

  7 / 9664 MEDLINE  
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[PMID]: 29424675
[Au] Autor:Moses ZB; Friedman GN; Penn DL; Solomon IH; Chi JH
[Ad] Address:Departments of 1 Neurosurgery and.
[Ti] Title:Intradural spinal arachnoid cyst resection: implications of duraplasty in a large case series.
[So] Source:J Neurosurg Spine;:1-7, 2018 Feb 09.
[Is] ISSN:1547-5646
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE Optimal diagnosis and management strategies for intradural spinal arachnoid cysts (SACs) are still unresolved given the rare nature of this entity, with few large case series and virtually no statistical analyses of patient characteristics in the literature. Here, the authors studied a large patient cohort with these lesions to determine whether pre- or postoperative attributes could be used to aid in either diagnosis or prognosis. METHODS A chart review was completed at a single institution for the period from 2002 to 2016 to determine the preoperative characteristics and postoperative outcomes of 21 patients with exclusively intradural SACs. Patients were assessed for symptoms such as weakness, pain, sensory changes, bowel and/or bladder dysfunction, and gait changes. Postoperatively, patients were analyzed for symptom improvement, complication occurrence, and duration of follow-up. RESULTS Approximately two-thirds of the patients in this series had developed SACs idiopathically, and the mean duration of symptoms prior to diagnosis was 15 months among all patients. A slight majority (57%) underwent CT myelography in the course of diagnosis, and a quarter of the patients had a syrinx. There was a statistically significant association between location of the SAC and number of presenting signs and symptoms; that is, patients with cysts in the lumbosacral region had more symptoms than those with cysts at the cervical or thoracic levels (p = 0.031). Overall, outcomes were largely positive, with approximately 60%-70% of patients experiencing postoperative improvement in symptoms, with motor weakness showing the highest response rate (71%) and pain symptoms the least likely to subside (50%). In the cohort with preoperative pain, those who had undergone expansile duraplasty were significantly more likely to experience relief of their pain symptoms (p = 0.028), which may have been a result of the superior restoration of cerebrospinal fluid pathways allowing for more adequate reduction in compression. CONCLUSIONS In this large case series on intradural SACs, new light has been shed on aspects of both pre- and postoperative care for patients with these rare lesions. Specifically, the authors revealed that lumbosacral intradural SACs may be associated with a higher disease burden and that patients who undergo expansile duraplasty may have an increased likelihood of experiencing postoperative pain relief.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180209
[Lr] Last revision date:180209
[St] Status:Publisher
[do] DOI:10.3171/2017.8.SPINE17605

  8 / 9664 MEDLINE  
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[PMID]: 29346832
[Au] Autor:Morgalla M; Frantz S; Dezena RA; Pereira CU; Tatagiba M
[Ad] Address:Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Baden-Würtemberg, Germany.
[Ti] Title:Diagnosis of Lumbar Spinal Stenosis with Functional Myelography.
[So] Source:J Neurol Surg A Cent Eur Neurosurg;, 2018 Jan 18.
[Is] ISSN:2193-6323
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:BACKGROUND AND STUDY AIMS: The diagnosis of a lumbar spinal stenosis demands advanced diagnostic radiologic techniques. In recent decades magnetic resonance imaging (MRI) has replaced myelography, now considered an old-fashioned technique. It was our hypothesis that functional myelography still plays an important role in selected cases. We investigated how our surgical strategy was influenced by the results of MRI, functional myelography, and postmyelography computed tomography (CT) in patients with a lumbar spinal stenosis. METHODS: The sagittal diameters of the lumbar spinal canal were measured from L1 to S1 on patients with lumbar spinal stenosis. MRI, functional myelography, and postmyelography CT were compared in each of the patients. Sensitivity and specificity were calculated in each method. We examined how the surgical strategy was influenced by the results of these different methods. RESULTS: Fifty consecutive patients (21 women and 29 men; mean age: 70 years, [range: 49-86 years]) fulfilled the inclusion criteria. Functional myelography revealed a sensitivity of 0.99, a specificity of 0.79, and a positive predictive value of 0.45. The MRI exhibited a sensitivity of 0.93, a specificity of 0.74, and a positive predictive value of 0.39. Postmyelography CT showed a sensitivity of 0.96, a specificity of 0.75, and a positive predictive value of 0.41. A functional myelography revealed more information than the MRI and resulted in a change in the surgical strategy in 11 of 50 patients (22%) in comparison with the sole results of MRI or a postmyelography CT. CONCLUSIONS: In selected cases with multilevel lumbar spinal stenosis, functional myelography revealed the highest precision in reaching a correct diagnosis. It resulted in a change in the surgical approach in every fifth patient in comparison with the MRI and proved most helpful, especially in elderly patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180118
[Lr] Last revision date:180118
[St] Status:Publisher
[do] DOI:10.1055/s-0037-1618563

  9 / 9664 MEDLINE  
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[PMID]: 29217497
[Au] Autor:Clark MS; Diehn FE; Verdoorn JT; Lehman VT; Liebo GB; Morris JM; Thielen KR; Wald JT; Kumar N; Luetmer PH
[Ad] Address:Department of Radiology, Mayo Clinic, Rochester, MN, USA.
[Ti] Title:Prevalence of hyperdense paraspinal vein sign in patients with spontaneous intracranial hypotension without dural CSF leak on standard CT myelography.
[So] Source:Diagn Interv Radiol;24(1):54-59, 2018 Jan-Feb.
[Is] ISSN:1305-3612
[Cp] Country of publication:Turkey
[La] Language:eng
[Ab] Abstract:PURPOSE: A recently identified and treatable cause of spontaneous intracranial hypotension (SIH) is cerebrospinal fluid (CSF)-venous fistula, and a recently described computed tomography myelogram (CTM) finding highly compatible with but not diagnostic of this entity is the hyperdense paraspinal vein sign. We aimed to retrospectively measure the prevalence of the hyperdense paraspinal vein sign on CTMs in SIH patients without dural CSF leak, in comparison with control groups. METHODS: Three CTM groups were identified: 1) SIH study group, which included dural CSF leak-negative standard CTMs performed for SIH, with early and delayed imaging; 2) Early control CTMs, which were performed for indications other than SIH, with imaging shortly after intrathecal contrast administration; 3) Delayed control CTMs, which included delayed imaging. CTMs were retrospectively reviewed for the hyperdense paraspinal vein sign by experienced neuroradiologists, blinded to the group assignment. All CTMs deemed by a single reader to be positive for the hyperdense paraspinal vein sign were independently reviewed by two additional neuroradiologists; findings were considered positive only if consensus was present among all three readers. For positive cases, noncontrast CTs and prior CTMs, if available, were reviewed for the presence of the sign. RESULTS: Seven of 101 (7%) SIH patients had contrast in a spinal/paraspinal vein consistent with the hyperdense paraspinal vein sign; no patient in either control group (total n=54) demonstrated the hyperdense paraspinal vein sign (P = 0.0463). The finding occurred only at thoracic levels. Each patient had a single level of involvement. Six (86%) occurred on the right. Four occurred in female patients (57%). The sign was seen on early images in 3 of 7 cases (43%) and on both early and delayed images in 4 of 7 cases (57%). In 2 of 7 patients (29%), a noncontrast CT covering the relevant location was available and negative for the sign. A prior CTM was available in 2 of 7 patients (29%), and in both cases the hyperdense paraspinal vein sign was also evident. CONCLUSION: The prevalence of the hyperdense paraspinal vein sign in SIH patients with dural CSF leak-negative standard CTM was 7%. As the sign was not seen in control groups, this sign is highly compatible with the presence of CSF-venous fistula. Since the CTMs were not specifically dedicated to identifying hyperdense paraspinal veins (i.e., they were not dynamic and were not preceded by digital subtraction myelography), the true prevalence of the sign may be higher. Radiologists should scrutinize conventional CTMs for this sign, especially in patients in whom a traditional dural CSF leak is not identified.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180119
[Lr] Last revision date:180119
[St] Status:In-Process
[do] DOI:10.5152/dir.2017.17220

  10 / 9664 MEDLINE  
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[PMID]: 29334327
[Au] Autor:Furuhata R; Nishida M; Morishita M; Yanagimoto S; Tezuka M; Okada E
[Ad] Address:a Department of Orthopaedic Surgery , Saiseikai Central Hospital , Tokyo , Japan.
[Ti] Title:Migration of a Kirschner wire into the spinal cord: A case report and literature review.
[So] Source:J Spinal Cord Med;:1-4, 2018 Jan 15.
[Is] ISSN:2045-7723
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:CONTEXT: A Kirschner wire (K-wire) is a stainless steel pin with at least one sharpened tip that is mainly used for the internal fixation of bone fractures. While some cases of K-wire dislocation and migration have been reported as complications after fracture surgery, the intraspinal migration of a K-wire is rare. Herein, we report a case in which a K-wire used for sternal fixation 7 years earlier migrated into the spinal canal. FINDINGS: A 68-year-old male suddenly sustained severe radiating pain and numbness in his left upper extremity, and walked to our hospital. He had mild weakness in the left wrist extensor muscles and the left extensor digitorum. CT-myelography revealed a K-wire penetrating into the spinal cord at C5-6. There was no injury of the trachea, esophagus, or blood vessels. The patient had a history of surgical infection after cardiovascular surgery seven years before, and had undergone surgical debridement and sternum fixation with two K-wires. One K-wire had broken, and part of it migrated upward. Using an anterior approach, we detected the tip of K-wire below the left sternocleidomastoid muscle. We cut the K-wire into 1 to 2-cm pieces and removed it piece by piece. His postoperative course was uneventful and the symptoms improved markedly after the surgery. CONCLUSION: This is the first report of a K-wire that had been used for sternal fixation migrating into the spinal cord. This case illustrates that although rare, it is possible for a K-wire to migrate upward after sternal fixation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180116
[Lr] Last revision date:180116
[St] Status:Publisher
[do] DOI:10.1080/10790268.2017.1419915


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