Non-Discal Lumbar Radiculopathy: Combined Diagnostic Approach by CT and MR

1997 ◽  
Vol 10 (2) ◽  
pp. 165-173 ◽  
Author(s):  
M. Muto ◽  
G. De Maria ◽  
R. Izzo ◽  
G. Fucci ◽  
I. Aprile
Keyword(s):  
Clinical Evaluation ◽  
Facet Joint ◽  
Lumbar Radiculopathy ◽  
Disc Disease ◽  
Vascular Abnormality ◽  
Degenerative Disk Disease ◽  
Canal Stenosis ◽  
Ct Findings ◽  
Neoplastic Lesions ◽  
Inflammatory Processes

The goal of this paper was to evaluate the different causes of non-discal radiculopathies and to determine the different sensitivity and specificity of CT and MR. We reviewed 450 patients with non-discal radiculopathy; CT was performed in all patients while MR was done only in 95 cases. MR was obtained only in case of polyradiculopathy, or if there was a discrepancy between clinical evaluation and CT findings or when sphincteral symptoms were present. The most frequent cause of non-discal radiculopathy was degenerative disk disease associated with facet joint abnormality and secondary central and lateral spinal canal stenosis. Other causes were neoplastic lesions, traumas, malformations, inflammatory processes and vascular abnormality. CT was more sensitive and specific in degenerative disc disease while MR was better at evaluating other pathology. CT still represents a satisfactory technique in evaluating patients with non-discal radiculopathy; MR must be also performed in case of discrepancy between clinical evaluation and CT findings. Directly MR examination should be reserved for patients presenting sphincteral symptoms.

Posterior Epidural Migration of Sequestrated Lumbar Disc Fragments Into the Bilateral Facet Joints

Neurosurgery ◽  
2011 ◽  
Vol 69 (5) ◽  
pp. E1148-E1151 ◽  
Author(s):  
Tzuu-Yuan Huang ◽  
Kung-Shing Lee ◽  
Tai-Hsin Tsai ◽  
Yu-Feng Su ◽  
Shiuh-Lin Hwang
Keyword(s):  
Differential Diagnosis ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Synovial Cyst ◽  
Leg Pain ◽  
Hybrid Technique ◽  
Facet Joints ◽  
Disc Disease ◽  
First Case ◽  
Rod System

Abstract BACKGROUND AND IMPORTANCE Symptomatic lumbar disc herniation is common. Migration of a free disc fragment is usually found in rostral, caudal, or lateral directions. Posterior epidural migration is very rare. We report the first case with posterior epidural migration and sequestration into bilateral facet joints of a free disc fragment. CLINICAL PRESENTATION A 78-year-old female presented with low back pain and right leg pain. Plain radiographs showed lumbar spondylolisthesis. Magnetic resonance imaging revealed a posterior epidural mass and intrafacet mass, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. The lesion in the left L3-4 facet joint had rim enhancement, whereas the right one was not contrasted after gadolinium injection. Preoperative differential diagnosis included abscess, tumor, hematoma, or synovial cyst. An interbody cage fusion at L3-4 and L4-5 for spondylolisthesis was performed, and a hybrid technique was applied with the Dynesys flexible rod system at L3-S1 for multisegment degenerative disc disease. The lesion proved to be an epidural disc fragment with sequestration into bilateral facet joints. CONCLUSION A free disc fragment should be considered in the differential diagnosis of posterior epidural lesions, and even in the facet joint.

scholarly journals The appropriate hybrid surgical strategy in three-level cervical degenerative disc disease: a finite element analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Y. M. Xie ◽  
Y. C. Zheng ◽  
S. J. Qiu ◽  
K. Q. Gong ◽  
Y. Duan
Keyword(s):  
Stress Distribution ◽  
Facet Joint ◽  
Ultrahigh Molecular Weight Polyethylene ◽  
Fe Model ◽  
Hybrid Surgery ◽  
Disc Disease ◽  
Element Analysis ◽  
Intact Group ◽  
Joint Force ◽  
3D Ct Scan

Abstract Objective The purpose of this FE study was to analyze the biomechanical characteristics of different HS strategies used in the treatment of three-level CDDD (one-level CDA and two-level ACDF). Methods We validated the FE model of an intact cervical spine established by transferring the data, collected by 3D CT scan, to the FE software ABAQUS and comparing these data with the data from published studies. Then, the FE model of hybrid surgery was reconstructed to analyze the range of motion (ROM), facet joint force, and stress distribution on an ultrahigh molecular weight polyethylene (UHMWPE) core. Results The current cervical FE model was able to measure the biomechanical changes in a follow-up hybrid surgery simulation. The total ROM of the cervical HS models was substantially decreased compared with the total ROM of the intact group, and the M2 (C3/4 ACDF, C4/5 CDA, and C5/6 ACDF) model had the closest total ROM to the intact group, but the facet joint force adjacent to the treatment levels showed very little difference among them. The stress distribution showed noticeable similarity: two flanks were observed in the center core, but the inlay of M2 was more vulnerable. Conclusions Through the comparison of ROM, the facet joint force after CDA, and the stress distribution of the prosthesis, we find that M2 model has a better theoretical outcome, especially in preserving the maximum total ROM.

scholarly journals Lumbar stenosis: indications for fusion with and without instrumentation

1997 ◽  
Vol 3 (2) ◽  
pp. E6 ◽  
Author(s):  
Paul W. Detwiler ◽  
Frederick F. Marciano ◽  
Randall W. Porter ◽  
Volker K. H. Sonntag
Keyword(s):  
Facet Joint ◽  
Dynamic Instability ◽  
Lumbar Fusion ◽  
Rapid Development ◽  
Degenerative Spondylolisthesis ◽  
Lumbar Stenosis ◽  
Disc Disease ◽  
Diagnostic Categories ◽  
Number Of Factors ◽  
Failed Back Surgery

Although the efficacy of posterior decompression for symptomatic lumbar stenosis that is recalcitrant to conservative therapy is well proven, uniform agreement on the need for simultaneous arthrodesis is lacking. The variability in the rate of lumbar fusion with and without instrumentation has been attributed to a number of factors: advances in surgical technique; rapid development of instrumentation; radiographic advances in the diagnosis of disease entities of the lumbar spine; evolution in our understanding of bone healing; improved pre- and postoperative care; aggressive rehabilitation; patient compensation; hospital and surgeon reimbursement; better education of residents, fellows, and practicing neurosurgeons; and, most important, the lack of clear indications based on defined diagnostic categories. Based on review of the literature and their experience at the Barrow Neurological Institute, the authors have attempted to define indications for lumbar fusion with or without instrumentation based on defined diagnostic categories. Clear indications for fusion include trauma, tumor, or infection with two- or three-column injury, iatrogenic instability, and isthmic spondylolisthesis. Relative indications for fusion include degenerative spondylolisthesis, radiographically proven dynamic instability with pain or neurological findings, adult scoliosis, and mechanical back pain. Fusion is rarely indicated with discectomy, abnormal radiographs without appropriate findings (such as degenerative disc disease), facet joint syndrome, failed back surgery, or stable spinal stenosis.

Lumbar Spine Capsule Strain After Total Disc Replacement

2010 ◽  
Author(s):  
Tomoyuki Takigawa ◽  
Alejandro A. Espinoza Orías ◽  
Howard S. An ◽  
Peter Simon ◽  
Keizo Sugisaki ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Facet Joint ◽  
Total Disc Replacement ◽  
Clinical Results ◽  
Disc Replacement ◽  
Segmental Motion ◽  
Low Back ◽  
Disc Disease ◽  
Poor Outcomes

Degenerative disc disease is a common cause for low back pain, and sometimes requires surgical treatment. Total disc replacement (TDR) is one such surgical option performed to remove the painful disc and preserve segmental motion. However, TDR clinical results are not always satisfactory. Altered kinematics and residual low back pain have been reported as frequent poor outcomes. The facet joint is a pure articular joint and can be a pain generator. Although the effect of TDR on ROMs (ranges of motion) and facet contact force is relatively well studied, the influence of TDR on facet capsules has not been clarified yet. The purpose of this study was to evaluate the effect of TDR on facet joint capsule strain.

scholarly journals P26 Case of atypical cutaneous Mycobacterium chelonae infection in a patient with SLE after cyclophosphamide therapy

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Sheraz Rasool ◽  
Amr Afifi ◽  
Denise De Lord
Keyword(s):  
Peripheral Neuropathy ◽  
Antimicrobial Agents ◽  
Cord Compression ◽  
Cervical Cord ◽  
Close Monitoring ◽  
Disc Disease ◽  
Mycobacterium Chelonae ◽  
Canal Stenosis ◽  
The Right ◽  
High Index Of Suspicion

Abstract Background Mycobacterium chelonae is a rapidly growing non-tuberculous mycobacteria that can be isolated from water, soils and aerosols. Localised infection has been reported associated with surgical and cosmetic procedures. Disseminated infection is rare and usually occurs in individuals who are immunocompromised. We present a patient with severe SLE on immunosuppressive therapy who developed localised severe cutaneous infection of the foot. Methods A 69-year-old lady with complex SLE - RNP+, Raynaud's, arthritis, stable for several years had deteriorated within the last year with cardiac myositis and, peripheral neuropathy. Three months pulsed intravenous cyclophosphamide (EUROLUPUS regime) was completed in November 2018. Five weeks later she developed severe pain, inability to weight-bear and extensive erythema and swelling of the right ankle and lower leg. An MRI showed extensive skin thickening especially dorsally in the R foot and anteriorly in distal leg. There was also increased signal in the distal achilles tendon. Orthopedic review confirmed no evidence of septic arthritis or osteomyelitis. A skin biopsy was performed, cultures from which grew Mycobacterium chelonae. She was admitted and started on tobramycin, on which she developed long QTc, linezolid which caused thrombocytopenia and clarithromycin. In March 2019 she was re-admitted with confusion, weakness and AKI, secondary to clarithromycin. She was, then switched to clofazimine and low dose clarithromycin, on which she was stabilized. MRI brain scan was normal, lumbar puncture was negative for M chelonae PCR and MRI spine confirmed cervical cord compression and cervical and lumbar canal stenosis due to osteophytes and disc disease. Results The infection improved considerably after 5 months of successful mycobacterial treatment. It was then possible to treat with rituximab for a deteriorating peripheral neuropathy confirmed on EMG and cardiac myositis. Sadly, whilst awaiting rehabilitation, the patient died unexpectedly in April 2019 from an arrhythmia. Conclusion Mycobacterium chelonae is an uncommon cause of soft tissue infection, which is resistant to all anti-tuberculous drugs. It is susceptible to a wider range of antimicrobial agents including tobramycin, imipenem, clarithromycin, linezolid, co-trimoxazole. A high index of suspicion is necessary for diagnosis, particularly in immunocompromised patients. The incidence may be increasing, possibly due to enhanced detection. Infection can mimic MSK presentations including capsulitis, tendonitis and tenosynovitis. Close monitoring is required as anti-microbial therapy complications are common including prolongation of QTc on tobramycin. Vigilance for disseminated multiorgan involvement is essential due to high mortality, particularly with CNS and lung involvement. Atypical infections should always be considered in the immunocompromised, particularly mycobacteria, nocardia & fungi. Disclosures S. Rasool None. A. Afifi None. D. De Lord None.

scholarly journals Spine Degeneration and Inflammation

2021 ◽  
pp. 197-213
Author(s):  
David J. Wilson ◽  
Marcelo de Abreu
Keyword(s):  
Ankylosing Spondylitis ◽  
Facet Joint ◽  
Joint Disease ◽  
Disc Disease ◽  
Inflammatory Disorders ◽  
Degenerative Disorders ◽  
Dynamic Function ◽  
Spine Degeneration ◽  
As Stress ◽  
Effective Diagnosis

AbstractConventional radiographs and CT are primary investigations in spinal trauma. However MRI is the primary technique in the assessment of degenerative and inflammatory disorders. There are occasions when conventional radiographs, CT and bone scintigraphy assist in the diagnosis of degenerative and inflammatory disorders.A detailed understanding of anatomy and spine dynamic function is essential in the interpretation of imaging.Degenerative disorders including disc disease sometimes result in neural compression, facet joint and costovertebral arthropathy which is also potentially associated with spinal stenosis and neural compression. Scheuermann described a disorder with template irregularity that mimics degenerative disorders but is a genetic condition. Pars interarticularis stress fractures were once thought to be congenital in origin but are now regarded as stress injuries occurring in adolescence potentially leading to lifelong spondylolisthesis.Inflammatory joint disease is not just ankylosing spondylitis. There are a range of disorders, and the reporting practitioner must understand and appreciate the symptoms and signs on images. The early diagnosis of inflammatory arthropathy especially ankylosing spondylitis is essential in the effective management of the disease. Imaging is a major component of an accurate and effective diagnosis.

scholarly journals Clinicopathological study of lesions of nasal cavity and paranasal sinuses- A two year study

2021 ◽  
Vol 6 (4) ◽  
pp. 259-266
Author(s):  
Ankita Sunil Chaudhari ◽  
Shivaji Dadarao Birare
Keyword(s):  
Nasal Cavity ◽  
Clinical Evaluation ◽  
Paranasal Sinuses ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Cost Effective ◽  
Descriptive Study ◽  
Care Hospital ◽  
Diagnostic Dilemma ◽  
Neoplastic Lesions

Sinonasal masses are common in the ENT Outpatient Department. The incidence being 1-4% of population. The symptoms and signs frequently overlap, hence, a diagnostic dilemma exists. The aim of this study was to study the occurrence of various lesions, the age, site and sex wise distribution in a tertiary care hospital of Maharashtra over the period of two years. The study aims to examine the occurrence of various lesions in nasal cavity and paranasal sinuses, to determine the age, sex and site wise incidence of different benign and malignant lesions of nasal cavity and paranasal sinuses and to correlate the clinical and histopathological findings. Descriptive Study A descriptive study was carried out in the Department of Pathology at Tertiary Health Care among patients with clinically diagnosed nasal and paranasal sinus lesions attending the OPD of ENT during a period of 2 years. The specimens were grossly examined; fixed and routine microscopic staining was done. Interpretation was done using colour of the nuclei and the specimens were classified as neoplastic and non-neoplastic lesions. The data was statistical analysed. Mean, Median, Mode The most common clinical presentation was nasal obstruction 97 (93.26%), rhinorrhoea 73 (70.19%) and facial pain 24 (23%). 1: Mean age for the lesions to occur was years with the range 21-30 years (20.92%); 2: Non-neoplastic lesions 82 (79.6%) were more common than neoplastic lesions; 3: Simple nasal polyp 74 (90.23%), hemangiomas (50%) and squamous cell carcinoma (50%) were most common. The study concludes that complete clinical, radiological and histopathological correlation helps us to categorize these sino-nasal lesions into various non-neoplastic and neoplastic types. But final histopathological examination provides a confirmatory diagnosis, as a significant number of cases may be missed on clinical evaluation alone.The clinical features of non-neoplastic and neoplastic nasal and paranasal sinuses lesions may be indistinguishable from each other leading to delay in proper diagnosis and treatment. Histopathological examination is a reliable, cost effective diagnostic tool for accurate diagnosis and management of such lesions, as a significant number of cases may be missed on clinical evaluation alone.

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