scholarly journals Primary lumbar paraganglioma: A single-centre UK experience over 21 years

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv15-iv15
Author(s):  
Francesco Fiorini ◽  
José Pedro Lavrador ◽  
Francesco Vergani ◽  
Ranjeev Bhangoo ◽  
Richard Gullan ◽  
...  
Keyword(s):  
Back Pain ◽  
Adrenal Glands ◽  
Cauda Equina ◽  
Case Series ◽  
Lumbar Region ◽  
Single Centre ◽  
Histological Features ◽  
Surgical Disease ◽  
Lower Back ◽  
Histological Data

Abstract Objectives Paragangliomas are rare neuro-endocrine neoplasms which may occur at multiple anatomical sites, typically the adrenal glands. In the CNS, they can affect the head and neck, and more rarely the lumbar region. Primary lumbar paragangliomas are prominently vascularised lesions which can present variably and pose both diagnostic and surgical challenges. Methods We identified and analysed all cases of lumbar paraganglioma confirmed both surgically and histologically, treated at our regional neurosurgical centre. We collected retrospective clinical, radiological, surgical and histological data. Results We treated 25 patients with confirmed paraganglioma between 1997–2018. This included 19 primary tumours, of which 13 cases of primary lumbar paraganglioma (8 males (61.5%); mean age 51.3 years, range 33.2 – 68.9). Patients presented most frequently with a recent worsening of long-standing lower back pain and sciatica. 7 patients were admitted as emergency cases, including 3 with cauda equina syndrome. The average Ki67 mitotic index was 5.7% (range 1 – 10%). Conclusion We present one of the largest case series of primary lumbar paragangliomas to date to the best of our knowledge. Defining these clinical, radiological, surgical and histological features may be of assistance in recognising and managing this surgical disease.

scholarly journals Clinical heterogeneity of low flow spinal arteriovenous fistulas; a case series

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
D. Krishnan ◽  
S. Viswanathan ◽  
N. Rose ◽  
H. S. N. Benjamin ◽  
A. M. Ong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Immune Therapy ◽  
False Negative ◽  
Spastic Paraparesis ◽  
Cauda Equina ◽  
Case Series ◽  
Low Flow ◽  
Cervical Region ◽  
Lumbar Region ◽  
Post Surgery

Abstract Background Spinal AVF (SAVF), a potentially treatable cause of myelopathy, remains a challenging diagnosis. Its rarity and non-specific imaging findings often result in misdiagnosis despite a high index of clinical suspicion. The classically described high T2 signal in the spinal cord or prominent vascular flow voids in the intradural space were not infrequently missed on initial imaging, only to be picked up at follow-up imaging after progression of symptoms. Additionally, small sized fistulas(< 1 mm) and SAVF involving less frequent locations like the craniocervical junction in a patient presenting with paraplegia further complicates the diagnosis. On rare occasions, acute atypical presentation following a surgery adds to the conundrum. Definite diagnosis with spinal angiography, the gold-standard modality requires the expertise of highly skilled interventionists which may otherwise lead to false negative findings. We describe four SAVF patients with unconventional presentations, highlighting less described clinical findings. Case presentation First was a 50-year-old man presented with spastic paraparesis and was found to have an AVF at the cervical region arising from the vertebral artery. Second, a 45-year-old man with acute paraplegia post-operatively, initially treated for a transverse myelitis before lumbar region AVF was detected. Thirdly, a 27-year-old man presented with subacute lower thoracic myelopathy and deteriorated after corticosteroid treatment. The last patient, who initially appeared to have conus medullaris/cauda equina syndrome had a SAVF at the mid thoracic level. Presentation varied with some exhibiting acute deterioration mimicking other spinal cord pathology such as inflammatory disorders. All patients eventually underwent endovascular treatment with successful embolization of SDAVF. None of them exhibited further neurological deterioration after embolization. Conclusion Successful treatment of SAVF is possible provided the diagnosis is made early, allowing timely intervention. Certain clues may aid the diagnosis. Firstly, arteriovenous fistula can be located distant to the clinical localization of myelopathy resulting in the unexpected longitudinally extensive spinal cord signal change. This clinical-radiological discrepancy can be a useful clue in diagnosing SAVF. Secondly, an acute myelopathic presentation immediately post-surgery may be related to SAVF. Other SAVF feature of note includes progressive myelopathy mimicking immune-mediated myelitis among young adults below 30 years of age refractory to immune therapy.

scholarly journals ¿Existe alguna relación entre la posición del ciclismo y la aparición de dolor lumbar? Una revisión sistematizada (Is there any relation between the position of cycling and the appearance of lower pain? A systematized Review)

Retos ◽  
2021 ◽  
Vol 43 ◽  
pp. 651-659
Author(s):  
Andrés Fuentes ◽  
Luciano Martínez ◽  
Esteban Aedo-Muñoz ◽  
Ciro Brito ◽  
Bianca Miarka ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pelvic Tilt ◽  
Web Of Science ◽  
Lumbar Region ◽  
Low Back ◽  
The Road ◽  
Lower Back ◽  
Maximum Angle ◽  
Lower Pain

Este trabajo analizó la relación entre la posición de flexión mantenida durante la práctica de ciclismo y la posible relación con dolor lumbar. Se llevó a cabo una revisión sistematizada a través del proceso PRISMA® entre 2015-2020, en las bases de datos PubMed, PEDro, Scopus y Web of Science, empleando los términos; “cycling”, “cyclist”, “position”, “positioning”, “overuse injury”, “spinal biomechanic”, “lower back”, “lower back pain”. Se seleccionaron 5 artículos que cumplieron con todos los criterios de inclusión. Los artículos seleccionados mostraron cambios en la inclinación pélvica, ángulos de flexión de tronco en tomadas medias y bajas del manillar de bicicleta de ruta y bicicleta de montaña, variaciones del asiento más arriba o atrás de la posición adecuada según longitud entrepiernas, la posición de rodilla 40º y tronco 35º de manera simultánea cuando el pedal está en 180º, mientras que en posición anatómica se describieron; ángulo máximo de inclinación de pelvis en anteversión, ángulo máximo de inclinación de pelvis en retroversión y ángulo máximo de flexión lumbar se asocian con molestias o dolor lumbar. Sin embargo, es posible establecer que la asociación entre la práctica de ciclismo y el dolor lumbar no ha sido suficientemente estudiada, lo que nos hace inferir que surge la necesidad de actualizar la información con el objetivo de prevenir este tipo de lesiones asociadas a la posición en ciclismo.  Abstract. This article analyzed the relationship between the flexion position maintained during cycling and the possible relationship with low back pain. A systematic review was carried out through the PRISMA process between 2015-2020, in the PubMed, PEDro, Scopus and Web of Science databases, using the terms; "cycling", "cyclist", "position", "positioning", "injury from overuse", "biomechanics of the spine", "lumbar region", "low back pain". Five articles were selected that met all the inclusion criteria. Selected articles showed changes in pelvic tilt, torso flexion angles in medium and low strokes of the handlebars of the road bike and mountain bike, variations of the highest seat or the appropriate backrest according to the groin length, knee position 40 and trunk 35º simultaneously when the pedal is at 180º, while in anatomical position they have been described; The maximum angle of pelvic tilt in anteversion, the maximum angle of pelvic tilt in retroversion and the maximum angle of lumbar flexion are associated with pain or discomfort in the lumbar region. However, it is possible to establish that the association between cycling and low back pain has not been sufficiently studied, which leads us to infer that there is a need to update the information in order to prevent this type of injury associated with the position in cycling.

Long-term core outcomes in cauda equina syndrome

2021 ◽  
Vol 103-B (9) ◽  
pp. 1464-1471
Author(s):  
Thomas Patrick Barker ◽  
Nick Steele ◽  
Girish Swamy ◽  
Andrew Cook ◽  
Am Rai ◽  
...  
Keyword(s):  
Back Pain ◽  
Sexual Dysfunction ◽  
Autonomic Dysfunction ◽  
Core Outcome Set ◽  
Cauda Equina ◽  
Core Outcome ◽  
Lower Back ◽  
Outcome Set

Aims Cauda equina syndrome (CES) can be associated with chronic severe lower back pain and long-term autonomic dysfunction. This study assesses the recently defined core outcome set for CES in a cohort of patients using validated questionnaires. Methods Between January 2005 and December 2019, 82 patients underwent surgical decompression for acute CES secondary to massive lumbar disc prolapse at our hospital. After review of their records, patients were included if they presented with the clinical and radiological features of CES, then classified as CES incomplete (CESI) or with painless urinary retention (CESR) in accordance with guidelines published by the British Association of Spinal Surgeons. Patients provided written consent and completed a series of questionnaires. Results In total, 61 of 82 patients returned a completed survey. Their mean age at presentation was 43 years (20 to 77; SD 12.7), and the mean duration of follow-up 58.2 months (11 to 182; SD 45.3). Autonomic dysfunction was frequent: 33% of patients reported bladder dysfunction, and 10% required a urinary catheter. There was a 38% and 53% incidence of bowel and sexual dysfunction, respectively: 47% of patients reported genital numbness. A total of 67% reported significant back pain: 44% required further investigation and 10% further intervention for the management of lower back pain. Quality of life was lower than expected when corrected for age and sex. Half the patients reported moderate or worse depression, and 40% of patients of working age could no longer work due to problems attributable to CES. Urinary and faecal incontinence, catheter use, sexual dysfunction, and genital numbness were significantly more common in patients with CESR. Conclusion This study reports the long-term outcome of patients with CES and is the first to use validated patient-reported outcome measures to assess the CES Core Outcome Set. Persistent severe back pain and on-going autonomic dysfunction were frequently reported at a mean follow-up of five years. Cite this article: Bone Joint J 2021;103-B(9):1464–1471.

scholarly journals Idiopathic Arachnoiditis of the Cauda Equina: A Case Report from Tanzania

2021 ◽  
pp. 535-540
Author(s):  
Emmanuel V. Assey ◽  
Abid M. Sadiq ◽  
Magreth J. Swai ◽  
Adnan M. Sadiq ◽  
Marieke C.J. Dekker
Keyword(s):  
Magnetic Resonance Imaging ◽  
Back Pain ◽  
Cauda Equina ◽  
Imaging Modalities ◽  
Rare Clinical Entity ◽  
Resonance Imaging ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Lower Back ◽  
Severe Back Pain

Arachnoiditis is a rare clinical entity that usually presents with severe debilitating radiating pain that can pose a challenge in diagnosis especially in areas without appropriate imaging modalities. We present a 26-year-old male with progressive lower back pain with radiation to the lower extremities, aggravated by movement and touch. We diagnosed idiopathic arachnoiditis based on cerebrospinal fluid analysis and magnetic resonance imaging. He was managed with a 5-day course of methylprednisolone and analgesics with a good outcome. Severe back pain without a specific cause in a young patient should be investigated with proper imaging modalities and lumbar puncture if warranted to evaluate the cause.

Surgical correction of lumbar kyphotic deformity: posterior reduction “eggshell” osteotomy

2000 ◽  
Vol 92 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Olumide A. Danisa ◽  
Dennis Turner ◽  
William J. Richardson
Keyword(s):  
Back Pain ◽  
Thoracolumbar Spine ◽  
Cauda Equina ◽  
Surgical Correction ◽  
Kyphotic Deformity ◽  
Lumbar Region ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. Progressive kyphotic deformity of the lumbar or thoracolumbar spine may lead to back pain, cosmetic deformity, and risk of neurological compromise. The authors describe a series of patients in whom they performed a singlestage, posterior reduction (“eggshell”) osteotomy procedure to improve sagittal contour by creating lordosis within a single vertebral body. Methods. From 1995 to 1997 the authors performed 12 osteotomy procedures in 11 patients with thoracolumbar or lumbar kyphosis. Seven patients presented with iatrogenic deformity, three with deformity secondary to traumatic injury, and one patient with ankylosing spondylitis. Their mean age at time of surgery was 46.6 years (range 23–78 years). All patients suffered from back pain and were unable to stand upright, but in only one patient were neurological findings demonstrated. The mean preoperative deformity was −26° (range −90 to 0°). At 6-month follow-up examination the mean sagittal contour measured 17.5° (range −17 to 44°), indicating that the mean surgical correction was 40.1° (range 25 to 58°). All patients reported decreased back pain at follow up, and none required narcotic analgesic medication. Complications included a dense paresis that developed immediately postoperatively in a patient who was found to have residual dural compression, which was corrected by emergency decompressive surgery. One elderly patient suffered a perioperative cerebrovascular accident, and three patients suffered neurapraxia with transient muscle weakness of the quadriceps. There was one case of a dural tear. There were no deaths, and prolonged intensive care stays were not required. Conclusions. Single-level posterior reduction osteotomy provides excellent sagittal correction of kyphotic deformity in the lumbar region, with a risk of cauda equina and root and plexus compromise due to the extensive neural exposure.

Posterior epidural migration of herniated lumbar disc fragment

2011 ◽  
Vol 14 (3) ◽  
pp. 313-317 ◽  
Author(s):  
Ahmet Sengoz ◽  
Kadir Kotil ◽  
Erol Tasdemiroglu
Keyword(s):  
Surgical Treatment ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Case Series ◽  
Rare Condition ◽  
Neurological Deficits ◽  
Lumbar Region ◽  
Duration Of Symptoms ◽  
First Choice

Object Posterior epidural migration of a free disc fragment in the lumbar region is a very rare condition that has only been reported in isolated cases to date. Patients with this condition present with radiculopathy or major neurological deficits. Difficulties in diagnosis and the choice and timing of surgical treatment are important in these cases. In this clinical case series, features of cases with posterior epidural migration of free lumbar disc fragments accompanied by cauda equina syndrome are discussed. Methods Eight cases (0.27%) of posterior epidural migration of disc fragments were detected among 2880 patients surgically treated for lumbar disc herniation between 1995 and 2008. Seven of these patients had cauda equina syndrome. The mean duration of symptoms in the 8 cases was 4.2 days (range 1–10 days). The group included 6 men and 2 women, with a mean age of 48 years (range 34–72 years). The sequestered disc fragments were at the L3–4 level in 6 patients (75%) and the L4–5 level in 2 (25%). Magnetic resonance imaging showed tumor-like ring contrast enhancement around sequestered fragments in 5 patients. The patients' motor, sensory, sexual, and urological functions were evaluated postoperatively, and modified Odom criteria and a visual analog scale were used in the assessment of postoperative outcomes. Results A microsurgical approach was used in all cases. Sequestrectomy with minimal hemilaminotomy and removal of the free segments were performed. The patients were followed up for a mean period of 28.5 months. Three patients (37.5%) had excellent results, 3 (37.5%) had good results, 1 patient (12.5%) had fair results, and only 1 patient had poor results according to the Odom criteria. The main factors affecting the long-term outcomes were the presence of cauda equina syndrome and the time period between onset of symptoms and surgery. Conclusions Patients with posterior migration of a disc fragment present with severe neurological deficits such as cauda equina syndrome. Because the radiological images of disc fragments may mimic those of other more common posterior epidural space–occupying lesions, definite diagnosis of posteriorly located disc fragments is difficult. All of these lesions can be completely removed with hemilaminotomy and sequestrectomy, and early surgical treatment is important as a first choice to prevent severe neurological deficits.

scholarly journals Congenital haemangiomas: a single-centre retrospective review

2020 ◽  
Vol 4 (1) ◽  
pp. e000816
Author(s):  
Victoire Braun ◽  
Sorilla Prey ◽  
Carlotta Gurioli ◽  
Franck Boralevi ◽  
Alain Taieb ◽  
...  
Keyword(s):  
Heart Failure ◽  
Retrospective Review ◽  
Case Series ◽  
University Hospital ◽  
Single Centre ◽  
Tissue Samples ◽  
Clinical Behaviour ◽  
Imaging Results ◽  
Histological Data

ObjectiveCongenital haemangiomas (CHs) are rare, benign vascular tumours that are fully developed at birth. Three subtypes of CHs have been described based on clinical behaviour: rapidly involuting CHs (RICHs), non-involuting CHs (NICHs) and partially involuting CHs (PICHs). We explore in our study clinical, evolutionary and paraclinical characteristics of the three CH subtypes.DesignChildren with CH attending our department of paediatric dermatology at Bordeaux University Hospital over a 13-year period were retrospectively included. Epidemiological, clinical and evolutionary data, photographs and imaging results were reviewed. All available tissue samples were histologically examined.ResultsWe included 57 patients: 22 with RICH, 22 with NICH and 13 with PICH. Males predominated (ratio 1.7); the most common CH location was on the limbs. RICH, NICH and PICH exhibited overlapping characteristics; all were single telangiectatic lesions with pale peripheral halos. At birth, NICHs were flat but RICHs and PICHs bulky. The median age at complete RICH involution was 12 months. One-third of CHs that appeared RICH-like at birth underwent incomplete involution to become PICHs. Heart failure and thrombocytopenia were rare complications. PICHs were frequently ulcerated. Pain was common for NICH and PICH. The imaging and histological data of the three CH subtypes were rather similar.ConclusionsWe describe the characteristics and evolution of the three CH subtypes using a case series. Certain overlapping features were apparent, reinforcing the hypothesis that RICH, NICH and PICH lie on the same pathological spectrum.

scholarly journals Topographic mapping of pain sensitivity of the lower back – a comparison of healthy controls and patients with chronic non-specific low back pain

2019 ◽  
Vol 19 (1) ◽  
pp. 25-37 ◽  
Author(s):  
Søren O’Neill ◽  
Johanne Brinch Larsen ◽  
Casper Nim ◽  
Lars Arendt-Nielsen
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Sensitivity ◽  
Heat Pain ◽  
Lumbar Region ◽  
Low Back ◽  
Pain Thresholds ◽  
Lower Back ◽  
Clinical Source ◽  
Pain Patients

AbstractBackground and aimsThe choice of testing site for quantitative sensory testing (QST) of pain sensitivity is important and previous studies have demonstrated patterns in pain sensitivity within discrete areas in different body regions. Some areas are characterized by a relatively high degree of spatial pain discrimination and recognizable patterns of pain referral, whilst others are not. The lumbar region is likely to have relatively low pain acuity and overlapping of pain referral. The current study was conducted to determine whether patterns of pain sensitivity (detection thresholds) could be identified in the lower back, whether differences in such patterns exist between different groups and whether such patterns could help identify a clinical source of pain and localized increased pain sensitivity.MethodsTwenty-one patients with non-specific chronic low back pain and 21 healthy controls were tested for pressure and heat pain thresholds on 30 pre-defined locations over the mid and lower back. Topographical maps of mean pain thresholds and variability were produced, inspected visually and analyzed statistically. Between group differences in pain threshold were analyzed statistically as an indicator of widespread increased pain sensitivity. Evidence of segmental increased pain sensitivity was examined by group statistical comparison of mid-line lower range.ResultsA clear pattern of higher pain thresholds in the mid-line was evident in both groups and for both pain modalities. No discernible patterns were evident for variability within groups, but marked differences were seen between groups: variability for pressure pain thresholds appeared similar between groups, however for heat pain threshold, variability was uniformly low in the control group and uniformly high in the patient group. A highly significant (p<0.0001) difference in pain thresholds for pressure and heat was found with patients exhibiting lower thresholds than controls. No between group difference was found for mid-line lower range for either modality (p>0.05).ConclusionsThe current study supports previous findings of widespread, increased pain sensitivity in chronic non-specific low-back pain patients. It also indicates that there are discernible and similar topographical patterns of pain sensitivity in the dorsal area in both groups, but that this pattern is related to the lateral position of the test site and not the segmental level. Specific segments with increased pain sensitivity could not be identified in the patient group, which casts doubt on the utility of pressure and heat pain thresholds as indicators of the clinical source of spinal pain – at least in a population of chronic non-specific low-back pain.ImplicationsIn a cohort of chronic non-specific low-back pain patients and with the chosen methodology, topographical QST mapping in the lumbar region does not appear useful for identifying the spinal segment responsible for clinical pain, but it does demonstrate widespread group differences in pain sensitivity.

scholarly journals Ergonomic Factors Associated with Lower Back Pain Amongst Load-Haul-Dump Truck Operators at Freda Rebecca Gold Mine, Bindura, Zimbabwe

2021 ◽  
Vol 3 (1) ◽  
pp. 50-59
Author(s):  
Gugulethu Dube ◽  
◽  
Brian Chanda Chiluba ◽  
Keyword(s):  
Back Pain ◽  
Lower Back Pain ◽  
Best Practice ◽  
Simple Random Sampling ◽  
Whole Body ◽  
Dump Truck ◽  
Gold Mine ◽  
Lumbar Region ◽  
Cross Sectional ◽  
Lower Back

Background:Lower back pain is broadly defined discomfort or pain within the lumbar region of the human spine and it is the leading cause of function limitation, resulting in significant losses in productivity and billions of dollars in medical costs yearly. Its prevalence is estimated to be associated with a lower socioeconomic status and lower education levels. The intention of this study was to analyse the ergonomic factors linked with lower back pain amongst load-haul-dump truck operators at Freda Rebecca Gold Mine. Methods: A descriptive non-interventional cross-sectional study was used with the probit model and the chi-square used as the estimation techniques. The simple random sampling method was adopted in the survey with a total of 140 respondents who are all employees at Freda Rebecca Gold Mine, Zimbabwe. The Statistical Package Stata was used12. Results: The study indicated that 77.8% of the respondents suffered lower back pain at one time or the other. Results showed an association between lower back pain with demographic factors such as experience, gender and age, organisational factors such as type and duration of shift work, biomechanical factors such as lifting and handling protocols, postures, whole body vibrations exposure resulting from work related conditions such as road conditions, equipment conditions and design and other psychosocial factors. Conclusion: Therefore, the study promoted the adoption of a broad approach to reduction and management of LBP, including equipment engineering solutions to manage whole body vibration exposure, operator education, equipment assistive technology, strong equipment maintenance regime.Further interventions include adoption of best practice systems and improved clinical treatment systems

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