scholarly journals An extremely rare presentation of AV fistula: Massive destruction of multiple vertebral bodies with paraparesis

2021 ◽  
Vol 12 ◽  
pp. 123
Author(s):  
Kuldeep Bansal ◽  
Kalyan Kumar Varma Kalidindi ◽  
Anuj Gupta ◽  
Venkata Nishant Surapaneni ◽  
Rajesh Kapur ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Spinal Tuberculosis ◽  
Young Male ◽  
Transcatheter Embolization ◽  
Lower Limbs ◽  
Anterior Decompression ◽  
Rare Presentation ◽  
Av Fistula ◽  
Excellent Outcome ◽  
Spinal Epidural

Background: Spinal ventral epidural arteriovenous fistulas (EDAVFs) are rare and underdiagnosed entities and usually present with benign symptoms such as radiculopathy. To the best of our knowledge, EDAVFs presenting with massive vertebral body destruction have not been reported in the literature. Case Description: A young male presented with mid back pain for 1 year and weakness of both lower limbs for 3 months. He was clinicoradiologically diagnosed with spinal tuberculosis and started on antitubercular treatment elsewhere. Radiological investigations suggested destruction and collapse of T12 and L1 vertebrae. Prominent flow voids were seen in T9-L2 epidural space, likely prominent epidural vessels. The primary differential diagnoses were spinal tuberculosis and neoplastic etiologies. T9 to L3 surgical stabilization and anterior decompression by pediculectomy of left T12 and L was done. The surgeon encountered massive bleeding at the time of anterior decompression and a vascular etiology was suspected. Biopsy revealed negative results for infection or malignancy. DSA revealed ventral EDAVFs, and hence, transcatheter embolization was performed. He had excellent outcome on assessment at 21 months postoperative follow-up. Conclusion: Spinal epidural AVFs can rarely present with gross vertebral body destruction and paraparesis. Preoperative radiological assessment with suspicion of spinal epidural AVFs can help to avoid intraoperative difficulties and complications. Timely, management of spinal epidural AVFs can result in excellent outcomes

scholarly journals Large multicystic spinal lesion in a young African migrant: a problem of differential diagnosis

2021 ◽  
Vol 14 (7) ◽  
pp. e242690
Author(s):  
Tamara Ursini ◽  
Paola Rodari ◽  
Geraldo Badona Monteiro ◽  
Valeria Barresi ◽  
Carmelo Cicciò ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cystic Echinococcosis ◽  
Bone Cyst ◽  
Spinal Tuberculosis ◽  
Final Diagnosis ◽  
Lower Limbs ◽  
Migration Flow ◽  
Spinal Lesion ◽  
African Migrant ◽  
Expansive Lesion

We describe a rare case of large, fully cystic spinal schwannoma in a young adult from The Gambia. The initial clinical suspicion was spinal cystic echinococcosis. He came to our attention reporting progressive walking impairment and neurological symptoms in the lower limbs. An expansive lesion extending from L2 to S1 was shown by imaging (ie, CT scan and MRI). Differential diagnoses included aneurysmal bone cyst and spinal tuberculosis and abscess; the initial suggested diagnosis of spinal cystic echinococcosis was discarded based on contrast enhancement results. The final diagnosis of cystic schwannoma was obtained by histopathology of the excised mass. Cystic spinal lesions are rare and their differential diagnosis is challenging. Awareness of autochthonous and tropical infectious diseases is important, especially in countries experiencing consistent migration flow; however, it must be kept in mind that migrants may also present with ‘non-tropical’ pathologies.

scholarly journals Spinal Tuberculosis Presenting as Abdominal Pain: Rare Presentation of a Common Disease

2014 ◽  
Vol 29 (2) ◽  
Author(s):  
Sanjay Meena ◽  
Nilesh Barwar ◽  
Tusshar Gupta ◽  
Buddhadev Chowdhury
Keyword(s):  
Abdominal Pain ◽  
Spinal Tuberculosis ◽  
Common Disease ◽  
Rare Presentation

scholarly journals Functional Outcome Following Synthetic Vertebral Body Implantation in the Management of Spinal Disorders

2020 ◽  
Vol 8 (B) ◽  
pp. 76-80
Author(s):  
Moneer K. Faraj ◽  
Bassam Mahmood Flamerz  Arkawazi ◽  
Hazim Moojid Abbas ◽  
Zaid Al-Attar
Keyword(s):  
Functional Outcome ◽  
Vertebral Body ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Spinal Tuberculosis ◽  
Vertebral Body Replacement ◽  
Spinal Tumors ◽  
Karnofsky Performance Status Scale ◽  
Significant Change

OBJECTIVE: Synthetic vertebral body replacement has been widely used recently to treat different spinal conditions affecting the anterior column. They arrange from trauma, infections, and even tumor conditions. In this study, we assess the functional outcome of this modality in different spinal conditions. PATIENTS AND METHODS: Thirty-six cases operated from October 2010 to December 2017. Twelve patients had spinal type A3 fractures, 11 cases with spinal tuberculosis (TB), and 13 cases with spinal tumors. They were followed clinically for a mean period of 2.4 years. RESULTS: All the cases were approached anteriorly. Seven cases had a post-operative infection. No neurological worsening reported. We had dramatic neurological improvement in all spinal TB cases. Mortality recorded in only 4 cases with metastatic spinal tumor during the mean period of follow-up. Karnofsky performance status scale showed statistically significant change for spinal TB, and tumor cases during the follow-up period, but there was no significant change in cases of spinal type A3 fractures. CONCLUSION: The positive outcome of this surgery makes it recommended for properly selected patients, especially with spinal TB and tumors.

Annular erythema nodosum leprosum reaction in a young male: a rare presentation

2018 ◽  
Vol 57 (4) ◽  
pp. 500-501
Author(s):  
Gnaneshwar R. Angoori ◽  
Farheen S. Syeda ◽  
Amit Kolli ◽  
Aparna Karanam ◽  
Uday R. Deshmukh ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Young Male ◽  
Rare Presentation ◽  
Erythema Nodosum Leprosum ◽  
Annular Erythema

P071 Osteoid osteoma in children: About 15 cases

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
N Khernane ◽  
S Fortas ◽  
M M Makhloufi ◽  
T Boussaha
Keyword(s):  
Femoral Neck ◽  
Ct Scan ◽  
Vertebral Body ◽  
Osteoid Osteoma ◽  
Lower Limbs ◽  
Bone Tumours ◽  
Lumbar Pain ◽  
Surgical Removal ◽  
Posterior Arch ◽  
Impact Compression

Abstract Background Osteoid osteoma (OO)also called osteoblastoma, if the localization is in the spine, is a benign osteoblastic tumor of variable clinical expression, depending on the location of the lesion. It represents 2% to 3% of bone tumours and 15% of benign bone tumours in children. It affects mainly older children and adolescents and most often occurs in the lower limb, especially the femur. The diagnosis is radio-clinical. The aim of this study is to demonstrate the effectiveness of surgical removal of the tumor, the therapeutic difficulty in certain osteoarticular localizations and finally the radio-clinical evolution after surgery. Material & methods We report the radio-clinical outcomes of a series of 15 children (4 girls/11 boys; aged of 03–14 years) with OO operated in our department, over a period of 08 years (2011–2019). Results The OO is located in most of cases of the lower limbs: acetabulum (1 case); femoral neck (3 cases); femoral diaphysis (2 cases); tibial diaphysis (4 cases); distal metaphysis of the tibia (1 case); talus (1 case) and in the spine (3 cases: vertebral body of T3, the posterior arch of T12 and the sacrum S3). Nocturnal pain yielding to aspirin, was the main symptom. It was associated with lameness when walking in patients with location of OO in the lower limbs. Diagnosis was delayed in patients with localization of OO in the spine (after 3 years) and in the talus (after 2 years). Imaging (standard Rx, CT scan and MRI) allowed the diagnosis of OO in all cases (nidus and cocarde image) and assessed the loco-regional impact (compression of the spinal canal in the sacral location; eccentricity of the femoral epiphysis, in the acetabular location, scoliosis in the spinal location). Thirteen children received surgical treatment under fluoroscopic guidance, which consisted of: A surgical abstention was decided in 2 cases: an inaccessible location at the bottom of the acetabulum and the T3 thoracic vertebral body localization in a 6-year-old girl. 12 operated children have good outcomes. However, 03 children experienced post-therapy problems: lumbar pain radiating towards the left thigh in the girl with sacral location (S3) despite the large laminectomy; a relapse 7 months later in the child with the femoral neck localization; A valgus misalignment of the right knee after removal of the OO of the proximal metaphysis of the tibia with a relapse 3 months later. Conclusion OO is a rare, benign tumor. However, certain locations can lead to diagnostic difficulties, loco-regional, organic and functional repercussions and certain constraints on their therapeutic management. Modern imaging helps to improve the care of these patients, both in terms of early diagnosis (scintigraphy, CT scan and MRI) and therapeutic precision (photo-coagulation, radiofrequency ablation).

Anatomy of the Spinal Cord

2021 ◽  
pp. 60-67
Author(s):  
Jennifer A. Tracy
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Spinal Canal ◽  
Conus Medullaris ◽  
Lower Limbs ◽  
Cervical Cord ◽  
Filum Terminale ◽  
Upper Limbs ◽  
Descending Pathways ◽  
Lumbar Vertebral Body

The spinal cord begins as the cervical cord immediately below the medulla and extends through the spinal canal, where it becomes the thoracic, lumbar, sacral, and coccygeal parts of the cord. In most persons, the spinal cord proper ends at the lower portion of the first lumbar vertebral body, where it forms the conus medullaris and, finally, the filum terminale. A cervical enlargement contains the innervation pathways of the upper limbs; a lumbar enlargement contains the pathways of the lower limbs. This chapter reviews ascending and descending pathways in the spinal cord.

scholarly journals Comparison of Extrapleural Anterolateral Decompression and Transthoracic Anterior Decompression for Tuberculosis of The Dorsal Spine

2015 ◽  
Vol 3 (1) ◽  
pp. 46-51
Author(s):  
Navin Kumar Karn ◽  
Ranjeev Jha ◽  
Prakash Sitoula ◽  
Mahipal Singh ◽  
Anil Kumar Jain
Keyword(s):  
Blood Loss ◽  
Complication Rate ◽  
Spinal Tuberculosis ◽  
Surgical Decompression ◽  
Dorsal Spine ◽  
Neurological Recovery ◽  
Anterolateral Approach ◽  
Anterior Decompression ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Spinal tuberculosis (TB) comprises 50% of all skeletal tuberculosis and it affects body of the vertebra in about 98% of the cases, hence surgical decompression when needed should be anterior. There are a number of studies describing transthoracic approach but very few describing extrapleural anterolateral approach and none were comparative trial. Therefore, the present study was conducted to compare extrapleural anterolateral decompression and transthoracic anterior decompression for tuberculosis of dorsal spine. Aims and Objectives: To compare the duration of surgery, amount of blood loss, neurological recovery and complication rate. Design: Prospective Randomised controlled Trial Setting: The study was performed in Department of Orthopedics, NMCH,Biratnagar, Nepal Material and methods: The patients with tuberculosis of dorsal spine those required surgical decompression were randomly allocated into two groups. For the first group we performed extrapleural anterolateral decompression and for the second group we performed transthoracic anterior decompression We excluded patients with ischemic heart disease, end stage renal disease, immunocom promised stage. We did follow up for one year with comparing outcome in terms of duration of surgery, amount of blood loss neurological recovery and complication rate. Results: 60 patients were left after exclusion. We found duration of surgery, amount of blood loss were significantly higher in transthoracic anterior decompression group. There was single case of wound infection (3.3%)in the transthoracic anterior decompression group. 3 cases of transthoracic anterior decompression had to convert into anterolateral decompression because of adhesion of pleura to lung. There was no significant difference in neurological recovery and development of kyphotic deformity. Conclusion: We found anterolateral decompression did better than transthoracic anterior decompression in terms of duration of surgery, amount of blood loss, postoperative morbidity but similar neurological recovery rate.DOI: http://dx.doi.org/10.3126/jonmc.v3i1.12237Journal of Nobel Medical CollegeVol. 3, No.1 Issue 6, 2014, Page: 46-51

scholarly journals Cauda equina syndrome due to Factor Xa inhibitor (Rivaroxaban): Case report and review of literature

2020 ◽  
Vol 7 (1) ◽  
pp. 7
Author(s):  
SR Gowda ◽  
PJ O’Hagan ◽  
JT Griffiths
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Factor Xa ◽  
Epidural Haematoma ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Spontaneous Bleeding ◽  
Gradual Improvement ◽  
Spinal Epidural Haematoma ◽  
Spinal Epidural

Background: Factor Xa inhibitors are widely used by the physicians to reduce the incidence of thrombosis in order to protect the cardiovascular function. Although complications of bleeding and spontaneous gastrointestinal sources have been reported before, there are very sporadic cases of spinal epidural haematoma causing neurological compromise. Case presentation: We report a case of spontaneous spinal epidural haematoma (SSEH) in an 85-year-old female patient treated with Rivaroxaban, a new agent to prevent the incidence of thrombo-embolic events. Anticoagulant therapy is a recognised risk factor in the development of spontaneous bleeding and haematomas. The patient presented to the emergency department with sudden onset of severe back pain in the lumbar spine associated with paraplegia in the lower limbs. Magnetic resonance imaging (MRI) of the spine demonstrated a SSEH from T12 to L5 affecting the cauda equina. Rivaroxaban was discontinued and the patient was monitored as an inpatient. There was gradual improvement in the symptoms of the lower limbs. Conclusion: This rare condition of incomplete cauda equina syndrome due to Rivaroxaban therapy has not been reported previously. Clinicians must have a high index of suspicion in patients on regular anti-coagulation regimen.

scholarly journals MRI Diagnosis of Obesity-Related Spinal Epidural Lipomatosis

2019 ◽  
Vol 47 (1) ◽  
pp. 124-125
Author(s):  
Paolo Spinnato ◽  
Federico Ponti ◽  
Silvia de Pasqua
Keyword(s):  
Body Mass Index ◽  
Antithrombin Iii ◽  
Lower Limbs ◽  
Low Back ◽  
Cervical Pain ◽  
Spinal Epidural Lipomatosis ◽  
Leg Weakness ◽  
Mri Diagnosis ◽  
Antithrombin Iii Deficiency ◽  
Spinal Epidural

A 61-year-old male presented to our hospital complaining of claudication: bilateral leg weakness impeding mobility. Symptoms started after 100 m of walk and recede after several minutes of rest. The patient was obese, with a body mass index (BMI) of 41 kg/m2 and reported a weight gain of about 55 pounds in the last year. Patient’s comorbidities were dyslipidemia, hypertension, and antithrombin III deficiency. The patient also suffered from chronic low-back pain recently worsened and cervical pain. Pulses in the lower limbs were present. Neurological examination was also unremarkable.

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