Computed Tomography of Epidural Fibrosis after Discectomy: A Comparison between Symptomatic and Asymptomatic Patients

Abstract The evaluation of patients with symptoms recurrent after disc surgery is a difficult diagnostic problem. The most common causes are recurrent herniation and postoperative scarring; routine x-ray and myelographic differentiation between herniation and scarring is difficult or impossible. High resolution computed tomography (CT) has shown some results in the evaluation of postoperative patients, but the role of epidural fibrosis in failed back surgery syndrome (FBSS) is not clear. Some knowledge of the “normal” CT physiological healing and scarring after disc surgery is necessary. We scanned 20 asymptomatic operated patients and 20 patients with recurrent sciatic nerve pain after disc surgery who did not have bony stenosis, recurrent disc herniation, or other causes of FBSS. Our observations showed no important differences in the fibrosis demonstrated by CT between symptomatic and asymptomatic patients. The degree and type of fibrosis are not related to recurrent symptoms.

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Eignung der Kapillarmikroskopie zur Diagnostik und Differenzierung einer ILD

Karger Kompass Pneumologie ◽

10.1159/000514899 ◽

2021 ◽

pp. 1-3

Author(s):

Sabine Adler

Keyword(s):

Computed Tomography ◽

Creatine Phosphokinase ◽

Correct Diagnosis ◽

Diagnostic Assessment ◽

Idiopathic Inflammatory Myopathies ◽

Inflammatory Myopathies ◽

Nailfold Videocapillaroscopy ◽

High Resolution Computed Tomography ◽

Diagnostic Role

Nailfold videocapillaroscopy (NVC) is an easy tool used for the assessment of patients with Raynaud’s phenomenon (RP) as possibly associated with systemic sclerosis (SSc). Recent insights have also highlighted its role in the diagnostic assessment of idiopathic inflammatory myopathies (IIMs). The aim of this study is to describe the diagnostic role of NVC in a series of 361 consecutive patients with interstitial lung disease (ILD). All the patients were assessed by clinical pulmonary and rheumatic examinations, blood exams, high-resolution computed tomography and NVC. NVC was considered positive only in the presence of avascular areas or giant capillaries, but also, the presence of bushy capillaries (BCs) was recorded. NVC was positive in 17.7% of ILD patients and in 78.1% of ILD patients associated with a diagnosis of connective tissue disease (CTD). In 25% of SSc-ILD patients, NVC proved necessary for a correct diagnosis. The presence of BCs and/or NVC positivity in ILD patients with normal levels of creatine phosphokinase is associated with amyopathic IIM, regardless the presence of RP. In conclusion, NVC is useful for the diagnostic assessment of incomplete forms of CTD and in amyopathic IIMs. NVC should be considered in the diagnostic assessment of ILD patients regardless of the presence of RP.

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Asymptomatic secondary hyperparathyroidism can mimic sacroiliitis on computed tomography

Scientific Reports ◽

10.1038/s41598-021-83989-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Virginie Kreutzinger ◽

Torsten Diekhoff ◽

Lutz Liefeldt ◽

Denis Poddubnyy ◽

Kay Geert A. Hermann ◽

...

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Secondary Hyperparathyroidism ◽

Demographic Data ◽

Joint Space ◽

Electronic Patient Records ◽

Retrospective Case ◽

High Resolution Computed Tomography ◽

Asymptomatic Patients ◽

Control Study

AbstractSecondary hyperparathyroidism (sHPT) as a result of chronic kidney disease (CKD) is a common health problem and has been reported to manifest at the sacroiliac joints (SIJ). The aim of this investigation was to systematically assess sacroiliac joint changes in asymptomatic sHPT as detected by high-resolution CT. Included in this IRB-approved retrospective case–control study were 56 patients with asymptomatic sHPT as well as 259 matched controls without SIJ disease. Demographic data were retrieved from electronic patient records. High-resolution computed tomography datasets of all patients were subjected to a structured scoring, including erosions, sclerosis, osteophytes, joint space alterations and intraarticular calcifications. Chi2 tests were used to compare frequencies of lesions. Erosions were significantly more prevalent in patients with sHPT, and were found mainly in the ventral (28.6% vs. 13.9%; p = 0.016) and middle (17.9% vs. 7.7%; p = 0.040) iliac portions of the SIJ. Partial ankylosis was rare in both cohorts (3.6% vs. 5.0%; p > 0.999); complete ankylosis was not observed. Neither extent not prevalence of sclerosis or calcifications differed significantly between groups. Joint lesions reminiscent of sacroiliitis can be found in a substantial portion of asymptomatic patients with secondary hyperparathyroidism. Further investigations into the clinical significance of these findings are warranted.

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Mitomycin C in preventing spinal epidural fibrosis in a laminectomy model in rats

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.100.1.0052 ◽

2004 ◽

Vol 100 (1) ◽

pp. 52-55 ◽

Cited By ~ 9

Author(s):

Jin-Yul Lee ◽

Werner Stenzel ◽

Heinrich Ebel ◽

Christoph Wedekind ◽

Ralf-Ingo Ernestus ◽

...

Keyword(s):

Mitomycin C ◽

Spinal Column ◽

Failed Back Surgery Syndrome ◽

Epidural Fibrosis ◽

En Bloc ◽

Content Type ◽

Failed Back Surgery ◽

Back Surgery ◽

Spinal Epidural ◽

Fine Print

Object. Extensive epidural fibrosis after lumbar surgery may be the underlying cause in most cases of failed—back surgery syndrome. Various materials have been used to prevent epidural fibrosis, but only moderate success has been shown. Mitomycin C, an alkylosing antibiotic substance isolated from Streptomyces caespitosus, potentially supresses fibroblast proliferation after surgery. In this study, the authors investigated the effect of mitomycin C by local application on spinal epidural fibrosis in a rat laminectomy model. Methods. Five Wistar rats underwent laminectomy at cervical, thoracic, and lumbar levels. Based on data obtained from ophthalmological studies, mitomycin C was applied to the laminectomy sites in various concentrations (0.01, 0.05, and 0.1 mg/ml). One laminectomy site in each rat was left untreated and thus served as a control. Evoked potentials were measured pre- and postoperatively, and all rats underwent clinical evaluation. Mobility status and evidence of neurological deficit were recorded. Twelve weeks later, the rats were killed, and the spinal column, including surrounding muscle tissue, was removed en bloc, decalcified, and fixed in formaldehyde. Epidural fibrosis was evaluated histologically. In all mitomycin C—treated laminectomy sites, epidural scarring was significantly reduced compared with control sites. Remarkably, dural adhesions were absent in laminectomy defects treated with mitomycin C concentrations of 0.05 and 0.1 mg/ml. Moderate to marked epidural fibrosis with adhesion to the dura mater was noted at sites receiving 0.01 mg/ml of mitomycin C. All control sites showed dense epidural fibrosis with marked dura adherence. Conclusions. In this experimental model, mitomycin C applied locally at a concentration of 0.1 mg/ml effectively reduced epidural fibrosis, completely avoided dural adherence, and induced no side effects.

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