Myelopathy caused by chronic epidural hematoma associated with l1 osteoporotic vertebral collapse: a case report and review of the literature.
TL;DR: A case of myelopathy caused by chronic epidural hematoma associated with L1 osteoporotic vertebral collapse is reported and the relevant literature is reviewed.
Abstract: Epidural hematoma associated with osteoporotic vertebral collapse has not been reported yet in the literature. We report a case of myelopathy caused by chronic epidural hematoma associated with L1 osteoporotic vertebral collapse and review the relevant literature.
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TL;DR: Although the optimal treatment has not been determined for patients of OVC with DND in this study, the analysis could provide guidance for choosing an appropriate approach and it is believed that individualized surgical approach should be introduced based on the clinical characteristics of each patient.
17 citations
Cites background from "Myelopathy caused by chronic epidur..."
...Previous studies revealed that the following several factors could confer risk to OVC with DND: 1) neural compression secondary to retropulsed bone fragments; 2) progression of kyphosis with vertebral collapse; 3) intravertebral instability at fracture sites; and 4) OVC-triggered foraminal stenosis and nerve injury-caused chronic epidural hematoma [8,17,20]....
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TL;DR: A 79-year-old woman developed neurological deficits 6 weeks after the onset of a thoracic osteoporotic compression fracture and acute decompressive laminectomy and percutaneous vertebroplasty were performed, and follow-up MR imaging showed complete resolution of the hematoma.
Abstract: A 79-year-old woman developed neurological deficits 6 weeks after the onset of a thoracic osteoporotic compression fracture. Magnetic resonance (MR) imaging of the thoracic spine revealed an epidural hematoma at the T10-L2 levels. Acute decompressive laminectomy and percutaneous vertebroplasty were performed. Following the surgery, the patient's neurologic deficits improved and follow-up MR imaging showed complete resolution of the hematoma. Spinal epidural hematomas are rare and associated delayed neurological deficits are extremely rare. Conservative treatment may be effective for epidural hematomas in neurologically intact patients, but epidural hematomas can be a cause of neural compression and symptomatic deterioration resulting in delayed neurological deficits during the follow-up period.
9 citations
TL;DR: An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture, and a percutaneous vertebroplasty was performed, showed a nearly complete resolution of the hematoma.
Abstract: Chronic spinal epidural hematoma related to Kummell's disease is extremely rare. An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture was transferred to our institute. Lumbar spine magnetic resonance images revealed vertebral body collapse with the formation of a cavitary lesion at L1, and a chronic spinal epidural hematoma extending from L1 to L3. Because of intractable back pain, a percutaneous vertebroplasty was performed. The pain improved dramatically and follow-up magnetic resonance imaging obtained three days after the procedure showed a nearly complete resolution of the hematoma. Here, we present the rare case of a chronic spinal epidural hematoma associated with Kummell's disease and discuss the possible mechanism.
5 citations
TL;DR: Although rare, the possibility of refracture of Kummell disease and spinal epidural hematoma should be kept in mind in patients with osteoporotic fractures.
2 citations
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TL;DR: For spinal instability with preserved anterior load sharing, pedicle screw fixation alone is biomechanically adequate, and interbody cages should not be used because they further increase segmental motion at the adjacent segment.
Abstract: STUDY DESIGN Pedicle screw fixation alone for sequential spinal instabilities was biomechanically compared with pedicle screw fixation using interbody cages. OBJECTIVE To evaluate biomechanical effects of interbody cages on construct stiffness, pedicle-screw strain, and the adjacent level in posterior lumbar reconstruction using pedicle screw fixation. SUMMARY OF BACKGROUND DATA It remains undetermined what types of spinal instability require interbody support in posterior lumbar reconstruction. METHODS For this study, 10 calf spines (L3-L6) were used. Sequential destabilization was performed at L4-L5 followed by posterior reconstruction using pedicle screw fixation (PS) and interbody cages as follows: intact + PS (I-PS), medial facetectomy + PS (MF-PS), total facetectomy + PS (TF-PS), partial discectomy + PS (D-PS), and D-PS + interbody cages (PLIF). Biomechanical testing was performed under flexion and extension loading modes. Construct stiffness (L4-L5), rod-screw bending strain, and range of motion (ROM) at the upper adjacent level (L3-L4) were analyzed. RESULTS In terms of construct stiffness (L4-L5), all the reconstructions except D-PS demonstrated higher construct stiffness than the intact spine (P < 0.05). The PLIF showed the highest stiffness among all the reconstructions (P < 0.05). In terms of ROM (L3-L4), all the reconstructions increased the ROM, as compared with the intact state (P < 0.05). Importantly, PLIF showed significantly greater ROM than all the other reconstructions except I-PS (P < 0.05). In terms of rod-screw strain, the D-PS resulted in higher strain than the other groups (P < 0.05). The PLIF presented less strain than the other reconstructions (P < 0.05). CONCLUSIONS For spinal instability with preserved anterior load sharing, pedicle screw fixation alone is biomechanically adequate, and interbody cages should not be used because they further increase segmental motion at the adjacent segment. However, PS alone provides insufficient stability and high implant strain in case of damaged anterior column. In such cases, additional interbody cages significantly increase construct stiffness and decrease hardware strain. However, they increase ROM at the adjacent segment as well.
44 citations
"Myelopathy caused by chronic epidur..." refers background in this paper
...Anterior column reconstruction is necessary for osteoporotic vertebral collapse with damaged anterior column [13] and anterior decompression and reconstruction is reasonable....
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34 citations
TL;DR: Although in the authors' experience a good spontaneous outcome in this subgroup of minimally symptomatic patients harboring moderate-sized SEHs has been achieved, further studies are necessary to understand the real spectrum of nonsurgical treatment of such lesions.
Abstract: Anterior thoracic intradural arachnoid cysts (ATIACs) are a rare cause of spinal cord and nerve root compression, for which different treatment strategies have been proposed. Although ATIAC represents a well-known clinical entity, the choice of surgical method has not been uniform, and no study has been specifically designed to compare the results of the different treatment options adopted. The authors report the case of a 40-year old man with a 1-year history of dorsal pain, weakness in the lower extremities, gait disturbance, and mild sexual and urinary dysfunction. On neurological examination spastic paraparesis, lower-extremity hypertonia, and hypesthesia below T-2 were demonstrated. Magnetic resonance imaging revealed the presence of an ATIAC at the T-2 level. The patient underwent complete microsurgical removal of the cyst. The authors conducted a Medline search of the relevant literature from 1966 to 1998 and also obtained data on other cases in which patients underwent surgical treatment of ATIAC. The literature search yielded five such cases. Treatment strategies were complete excision and fenestration followed by placement of a shunt. In addition, one case was characterized by intraoperative cyst rupture during retraction of the spinal cord. Correct preoperative workup coupled with microneurosurgical technique allow for successful removal of the lesion and excellent outcome. Based on the literature review and the results in our case, the complete excision of ATIAC is associated with an excellent outcome, which is different from results achieved using other surgical strategies.
30 citations
"Myelopathy caused by chronic epidur..." refers background in this paper
...Spinal epidural hematoma may result from coagulopathy, vascular lesions, iatrogenesis, spontaneous occurrence, and fresh spinal injuries [1-8]....
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24 citations
"Myelopathy caused by chronic epidur..." refers background in this paper
...However, MRIs taken more than three weeks after trauma did not indicate epidural hematoma in any patients [12]....
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TL;DR: It is essential to perform acute laminectomy in case of rapidly increasing neurological symptoms and in the case of slowly increasing symptoms operation may provide a good result even if it is performed a week after the onset of symptoms.
10 citations
"Myelopathy caused by chronic epidur..." refers background in this paper
...Spinal epidural hematoma is mostly spontaneous, postsurgical, or post-traumatic including spinal fracture [1-6]....
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...Spinal epidural hematoma may result from coagulopathy, vascular lesions, iatrogenesis, spontaneous occurrence, and fresh spinal injuries [1-8]....
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