Cysticercose of the central nervous system: II. Spinal cysticercose

The compromising of the spinal canal by cysticercus is considered infrequent, varying from 16 to 20% in relation to the brain involvement. In the spinal canal the cysticercus predominantly places in the subarachnoid space. Clinical signs in spinal cysticercosis can be caused by direct compression of the spinal cord/roots by cisticerci and by local or at distance inflammatory reactions (arachnoiditis). Another mechanism of lesion is degeneration of the spinal cord due to pachymeningitis or circulatory insufficiency. The most frequent clinical features are signs of spinal cord and/or cauda equina compression. The diagnosis of spinal cysticercosis is based on evidence of cerebral cysticercosis and on neuroradiological examinations (myelography and myelo-CT) that show signs of arachnoiditis and images of cysts in the subarachnoid space and sometimes, signs of intramedullary lesions, but the confirmation can only be made through immunological reactions in the CSF or during surgery. The clinical course of 10 patients with diagnosis of spinal cysticercosis observed among 182 patients submitted to surgical treatment due to this diasease are analyzed. The clinical pictures in all cases were signs of spinal cord or roots compression. All but two presented previously signs of brain cysticercosis. Neuroradiological examinations showed signs of arachnoiditis in 4 patients, images of cysts in the subarachnoid space in 5, and signs of arachnoiditis and images of cysts in one. The 6 patients that presented intraspinal cysts were submitted to exeresis of the cysts and 2 patients with total blockage of the spinal canal underwent surgery for diagnosis. The 2 remaining patients with arachnoiditis and blockge of the spinal canal were clinically treated. All of the six patients submitted to cyst exeresis had initial improvement but 4 of them later developed arachnoiditis and recurrence of the clinical signs and only 2 remained well for long-term. The 2 non operated patients had no improvement of their clinical signs. Two patients died later due to complications of cerebral cysticercosis. Based on the experience acquired in the management of these patients we indicate surgical treatment for patients that present free cyst in subarachnoid space. For those who present arachnoiditis, surgery is indicated only when there is doubt in the diagnosis. Intramedullary cysts should also be surgically treated.

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Late-onset recurrence of neurological deficits after surgery for spinal arachnoid diverticula

Veterinary Record ◽

10.1136/vr.104579 ◽

2017 ◽

Vol 182 (13) ◽

pp. 380-380 ◽

Cited By ~ 7

Author(s):

Emili Alcoverro ◽

James Fraser McConnell ◽

Daniel Sanchez-Masian ◽

Luisa De Risio ◽

Steven De Decker ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Medical Treatment ◽

Medical Records ◽

Late Onset ◽

Clinical Signs ◽

Neurological Deficits ◽

Laminectomy Membrane ◽

Spinal Cord Dysfunction ◽

Time To Relapse

Spinal cord dysfunction secondary to spinal arachnoid diverticula (SAD) has been widely reported in the veterinary literature and there is some suggestion that surgical treatment may provide better outcomes than medical treatment. Despite this, previous reports have mentioned cases with recurrence of clinical signs following surgical treatment but the cause for this has not been further investigated. The medical records of seven dogs and one cat which presented for investigation of recurrence of neurological deficits at least six months after surgery for SAD were retrospectively reviewed. Median time to relapse of the neurological deficits was 20.5 months after surgery. On repeated imaging, 3/8 cases showed clear regrowth of diverticulum, 2/8 cases showed dorsal compression at the previous laminectomy site (presumed to be the laminectomy membrane), and 3/8 cases showed herniation of the spinal cord through the laminectomy defect associated with a stellate appearance to the spinal cord with small multiloculated areas of dilation of the subarachnoid space. Repeat surgical intervention was most successful in the cases where SAD recurrence was identified while medical treatment resulted in either subtle improvement or stabilisation on the clinical signs, sometimes followed by slow deterioration.

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Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.1.92 ◽

2007 ◽

Vol 6 (1) ◽

pp. 92-95 ◽

Cited By ~ 23

Author(s):

Peter C. Gerszten ◽

William C. Welch

Keyword(s):

Spinal Cord ◽

Vertebral Body ◽

Spinal Canal ◽

Cauda Equina ◽

Clinical Effectiveness ◽

Balloon Kyphoplasty ◽

Balloon Inflation ◽

Compression Fractures ◽

Percutaneous Balloon ◽

Tumor Debulking

✓Percutaneous balloon kyphoplasty has become a widely adopted treatment option for patients with pain due to pathological compression fractures. One potential risk of the procedure is the displacement of tumor into the spinal canal and resulting spinal cord or cauda equina injury during inflation of the balloon prior to polymethylmethacrylate (PMMA) placement. In addition, the presence of any remaining tumor between the PMMA and the fractured cortical bone can lead to suboptimal improvement in stabilization and subsequent pain relief. The authors describe a technique to remove tumor from within the vertebral body (VB) through a percutaneous working channel prior to kyphoplasty balloon inflation and augmentation. The technique was successfully used in all three patients who had presented with pain, and the pain improved in all three cases. There was no extravasation of PMMA into the spinal canal in any case. A combined VB tumor debulking and kyphoplasty technique offers the ability to improve the placement of PMMA within the diseased vertebral body, potentially leading to increased safety as well as clinical effectiveness for stabilization of these fractures.

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CURRENT STATE OF CT/MRI SPINAL CANAL STENOSIS DIAGNOSIS AT THE LUMBOSACRAL LEVEL (REVIEW)

Modern medical technologies ◽

10.34287/mmt.1(44).2020.14 ◽

2020 ◽

Vol 44 (1) ◽

pp. 88-93

Author(s):

A. S. Sementsov ◽

V. V. Ponomarenko

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Spinal Stenosis ◽

Spinal Canal ◽

Spinal Canal Stenosis ◽

Canal Stenosis ◽

Current State

Abstract Issues of epidemiology, classification and radiological signs of the spinal stenosis in this review are present. Modern European criteria for spinal stenosis and radicular openings can improve the diagnosis of the condition of the spinal cord and roots; clarify the criteria for indications for surgical treatment. Keywords: spinal canal stenosis, СТ/МРI, diagnosis.

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Surgical treatment of irreducible atlanto-axial dislocation with spinal cord compression

Journal of Neurosurgery ◽

10.3171/jns.1973.38.3.0374 ◽

1973 ◽

Vol 38 (3) ◽

pp. 374-378 ◽

Cited By ~ 16

Author(s):

Chikao Nagashima

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Spinal Cord Compression ◽

Spinal Canal ◽

Cord Compression ◽

Foramen Magnum ◽

Posterior Decompression ◽

Content Type ◽

Arthritic Changes ◽

Fine Print

✓ The author reports the successful treatment of a case of irreducile atlantoaxial dislocation due to separation of the dens and secondary arthritic changes causing sagittal narrowing of the atlanto-axial spinal canal to 3 mm. Complete myelography obstruction was present. A one-stage posterior decompression of the foramen magnum and atlas was performed and occipito-cervical fixation accomplished by wire encased in acrylic plastic.

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Neurological disorder in two moose calves ( Alces alces L.) naturally infected with Elaphostrongylus alces

Rangifer ◽

10.7557/2.10.3.887 ◽

1990 ◽

Vol 10 (3) ◽

pp. 399 ◽

Cited By ~ 1

Author(s):

Margareta Steen ◽

Lars Roepstorff

Keyword(s):

Spinal Cord ◽

Neurological Disorder ◽

Alces Alces ◽

Cauda Equina ◽

Clinical Signs ◽

Inflammatory Cells ◽

Nerve Roots ◽

Neurological Signs ◽

Inflammatory Processes ◽

Eggs And Larvae

Two months old moose calves exhibiting neurological signs were videotaped, killed and necropsied. The parasite Elaphostrongylus alces (Steen et al 1989) was found epidurally along the meninges of the spinal cord, and in the muscle faciae of the thoracic and lumbar regions. Progressive inflammatory processes were present in the epineurium, perineurium and endoneurium. Accumulations of inflammatory cells, eosinophils, lymfocytes and macrophages, were found around eggs and larvae and frequently, around regional blood wessels. The neurological disturbances in the moose calves were pronounced, with locomotive abnormalities and ataxia. They showed weakness in the hindquarters, with uncoordinated and swaying movements of the hind legs. In addition, one of the calves was lame on the left forelimb. The muscles of the leg were visibly atrophic. The lesions produced by E. alces at the lumbar nerve roots and in the cauda equina are suggested to be the cause of the clinical signs observed.

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Intervertebral Disc Extrusion between T8 and T9 in a Dachshund

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.83210 ◽

2016 ◽

Vol 44 (1) ◽

pp. 4

Author(s):

Gabriel Antonio Covino Diamante ◽

Paulo Vinicius Tertuliano Marinho ◽

Carolina Camargo Zani ◽

Bruno Cesar Elias ◽

Mônica Vicky Bahr Arias

Keyword(s):

Spinal Cord ◽

Intervertebral Disc ◽

Spinal Canal ◽

Clinical Signs ◽

Type I ◽

Thoracic Region ◽

Intervertebral Disc Disease ◽

Disc Disease ◽

Rib Head ◽

Disc Extrusion

Background: Intervertebral disc extrusion with consequent spinal compression or intervertebral disc disease (IVDD) is one of the most common causes of compressive myelopathy in dogs, and the thoracolumbar spine discs between T12 and L2 are most affected. Extrusions in cranial thoracic region are rare, and there is few cases in literature reporting this situations, this rarity is attributed to the presence of the intercapital ligament connecting the rib heads between T2 and T10, which strengthens this region both mechanically and anatomically. The aim of this article is report the clinical signs, diagnosis and treatment of a case of Type I Hansen IVDD between T8 and T9 in a Dachshund breed dog.Case: An 8-year-old Dachshund male dog was presented for investigation of pelvic limb incoordination and back pain, which started 10 days prior to the consultation. It had a history of a similar condition 3 months earlier that showed improvement after clinical treatment. On neurological examination was identified in both pelvic limbs proprioceptive ataxia, absence of proprioception, increased muscle tone, presence of interdigital reflex and increased patellar reflex. Cutaneous trunci reflex was absent below T11 on the left side, and pain was noted upon palpation of T7 through the T12 vertebrae. A grade II asymmetric thoracolumbar lesion with hyperesthesia was diagnosed. On suspicion of IVDD, cerebrospinal fluid (CSF) collection and CT scan analysis of the thoracolumbar region were performed. CT scan showed the presence of hyperattenuating and mineralized material, 1 cm long, on the floor of the spinal canal, mainly on the left side, occupying 80% of the diameter of the spinal canal between T8 and T9. The patient was then submitted to decompression surgery through hemilaminectomy and showed a good recovery. As the occurrence of disc extrusion in cranial thoracic region of chondrodystrophic breeds is rare, we report the clinical signs, diagnosis and treatment of a case of Type I Hansen intervertebral disc disease (IVDD) between T8 and T9 in a Dachshund breed dog.Discussion: All spinal discs can undergo a process of degeneration causing IVDD, in which the cervical and thoracolumbar regions are the most affected due to reasons not yet fully understood, however spinal cord compression between the T1 and T9 vertebrae is very rare, probably due to the strengthening provided by the intercapital ligament to the posterior annulus fibrosus. Disc extrusion in unusual locations in chondrodystrophic breeds is mainly reported as extrusion between vertebrae T1 and T2, and T9 and T10, with some cases was attributed to an anatomical abnormality of the intercapital ligament. The evaluation of intervertebral discs of the German shepherd breed dogs using MRI showed disc degeneration processes in thoracic vertebras. Disc extrusions often result in more severe clinical signs than protrusions, and occur acutely or subacutely, which was different from the case described here, maybe because the presence of the intercapital ligament permitted gradual extrusion allowing the spinal cord to adapt to the compression. Despite surgical access to this region being described as more complex due to the presence and proximity of the rib head to the vertebral body and the possibility of injuring the intercostal muscles causing pneumothorax, the hemilaminectomy and rib head excision at T9 could be performed without any complications. Thus, although unusual, the cranial thoracic region should not be overlooked as a possible site of occurrence of IVDD, since the diagnosis, treatment and prognosis are similar to those in patients with extrusions in the most common sites.Keywords: intervertebral disc degeneration, dogs, paresis, ataxia.

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Surgical treatment of post-traumatic luxation of rib heads with spinal cord compression in a cat

Acta Veterinaria Scandinavica ◽

10.1186/s13028-021-00619-6 ◽

2021 ◽

Vol 63 (1) ◽

Author(s):

Jacek Cezary Sterna ◽

Laura Rogowska ◽

Beata Degórska ◽

Jacek Sobczyński ◽

Monika Łumińska

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Spinal Canal ◽

Cord Compression ◽

First Case ◽

Computed Tomography Scanning ◽

History Of ◽

Traumatic Origin ◽

Intervertebral Foramina ◽

Rib Head

Abstract Background Luxation of the rib head with intrusion into the intervertebral foramen seems to be rare in cats. Only one report has been published describing a cat with non-ambulatory paraparesis, which was managed conservatively. Here we report a case of rib head luxation that was managed surgically. Case presentation A 4-year-old, female domestic shorthair cat with a two-week history of non-ambulatory paraparesis was presented at our clinic. Based on history and neurological examination, a diagnosis of thoracolumbar spinal cord lesion of traumatic origin was made. Computed tomography scanning revealed mild scoliosis, a luxation of the 3rd and 4th right rib heads and penetration into the spinal canal through intervertbral foramina. Surgical management using right dorsal approach to the spine was performed. The spinal cord was decompressed by cutting and removing of proximal ribs’ fragments by rotation and pulling out from the intervertebral foramina. The cat was ambulatory and paraparetic four weeks after surgery. Two years after surgery the cat regained functional gait, but ataxia remained. Conclusions We report the first case of a surgical treatment of rib head luxation and intrusion into the spinal canal in a cat. The applied procedure resulted in an improvement of neurological signs.

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Postoperative fibrosis after surgical treatment of the porcine spinal cord: a comparison of dural substitutes

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.2.1.0050 ◽

2005 ◽

Vol 2 (1) ◽

pp. 50-54 ◽

Cited By ~ 31

Author(s):

Iftikharul Haq ◽

Yenisel Cruz-Almeida ◽

Edir B. Siqueira ◽

Michael Norenberg ◽

Barth A. Green ◽

...

Keyword(s):

Spinal Cord ◽

Adverse Effects ◽

Subarachnoid Space ◽

Histological Evaluation ◽

Postoperative Adhesion ◽

Pia Mater ◽

Content Type ◽

Inflammatory Reactions ◽

Dural Substitute ◽

Fine Print

Object. Postoperative adhesion- and fibrosis-induced spinal cord tethering is not uncommon and may be associated with delayed clinical sequelae. Multiple dural substitutes have been used in surgery without a full appreciation of the grafts' adverse effects. The authors conducted a comparative animal experimental study to evaluate the degree of chronic inflammatory reactions, adhesions, and fibrosis caused by the use of four dural substitutes—Surgicel, Durasis, DuraGen, and Preclude. Methods. Twenty-six pigs weighing 30 to 40 kg underwent a two-level lumbar laminectomy (a midline durotomy, implantation of a 2-cm dural substitute in the subarachnoid space, and watertight dural closure). After 8 weeks the animals were killed, and two independent neuropathologists blinded to the dural substitute group evaluated several sites along the implants, providing descriptions and quantitative scoring of fibrosis, chronic inflammatory reactions, foreign-body reactions, and spinal cord changes. Kruskal—Wallis one-way analysis of variance for ranks corrected for multiple comparisons was used to examine differences among the materials. Conclusions. The DuraGen dural substitute produced the least amount of inflammation in the subarachnoid space and Preclude generated the most (p < 0.001). Surgicel and DuraGen were completely resorbed on histological sections, but both produced some inflammation, which diminished gradually from the dural implant center. Histological evaluation of the nonresorbed grafts demonstrated that Durasis caused the least degree of inflammatory cell infiltration (p < 0.001). The Preclude dural substitute consistently demonstrated encapsulation and arachnoidal reaction. There was no evidence of implant-related adverse effects on the underlying pia mater and white matter regardless of the substitute type.

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SURGICAL TREATMENT OF CONSTRICTIVE MYELOPATHY IN DOGS

Scientific Notes Kazan Bauman State Academy of Veterinary Medicine ◽

10.31588/2413-4201-1883-246-2-276-282 ◽

2021 ◽

Vol 246 (2) ◽

pp. 276-282

Author(s):

I.R. Yunsi ◽

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Treatment ◽

Clinical Signs ◽

Spinal Column ◽

Neurological Status ◽

Chronic Spinal Cord Injury ◽

Cord Injury ◽

Thoracolumbar Region

Article describes the examination and treatment of dogs with a constrictive myelopathy (CM). CM is a degenerative pathology of the spinal cord associated with instability of the spinal column in the thoracolumbar region due to dysplasia of the caudal articular processes (aplasia or hypoplasia), which leads to microtraumas of the spinal cord and requires surgical treatment. Орerative technique was used to stabilize the spinal column by installing a system of multiaxial screws in the vertebrae with dysplasia of the caudal articular processes for the treatment of CM. Positive dynamics of neurological status was observed in 8 of 13 operated animals, in 3 patients the progression of clinical signs significantly slowed down, the neurological status of two dogs did not change after operation. The described method of stabilization of the spinal column prevents abnormal mobility of the spinal column in the area of dysplasia of the articular processes of the vertebrae. Our observations confirm that one of the causes of pia-arachnoid fibrosis is chronic spinal cord injury due to instability of the spinal column.

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