Conservative treatment of TB Spondylitis in Dorsolumbar and Lumbar spine

Introduction: Tuberculosis (TB) is endemic in South Asia including Nepal. TB spine is the most common musculoskeletal manifestations and can have devastating complications. Early diagnosis by proper history, physical and radiological examination is mandatory. Chemotherapy is effective in most cases while some require surgical treatment. Methods: Forty-four patients with clinico-radiological evidence of TB were treated with four drug regime for 18 months and all patients were followed up till the end of the chemotherapy. Results: All 44 patients (M-28/ F-16) had back pain not responding to analgesics and physiotherapy while few had constitutional symptoms. Localized tenderness and paravertebral muscle spasm was present in 32/44 (72.7%) and the rest had palpable swelling at the dorsolumbar and lumbar regions. According to the classification by Oguz et al. the majority of the patients were in the Type I B. Six patients who did not show any improvement in pain and resolution of swelling were admitted and two more drugs (Steptomycin and Ofloxacin) were added. Conclusions: Conservative treatment of TB spondylitis of the lumbar spine can be treated with chemotherapy and appropriate investigations should be performed in patients with back pain who do not respond to rest, analgesics and physiotherapy. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9526 NOAJ July-December 2013, Vol 3, Issue 2, 33-37

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Pott's Spine with Bilateral Psoas Abscesses

Case Reports in Orthopedics ◽

10.1155/2012/208946 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Sanjeevani Masavkar ◽

Preeti Shanbag ◽

Prithi Inamdar

Keyword(s):

Lumbar Spine ◽

Conservative Treatment ◽

Early Diagnosis ◽

Percutaneous Drainage ◽

Imaging Studies ◽

Antituberculous Treatment ◽

Pott’S Disease ◽

High Degree

A high degree of suspicion and appropriate imaging studies are required for the early diagnosis of Pott’s spine. We describe a 4-year-old boy with Pott’s disease of the lumbar spine with bilateral psoas abscesses. The child responded to conservative treatment with antituberculous treatment and ultrasonographically guided percutaneous drainage of the abscesses.

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Grisel’s Syndrome in Children: Two Case Reports and Systematic Review of the Literature

Case Reports in Pediatrics ◽

10.1155/2020/8819758 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Nicole Pini ◽

Martina Ceccoli ◽

Patrizia Bergonzini ◽

Lorenzo Iughetti

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Conservative Treatment ◽

Early Diagnosis ◽

Head And Neck ◽

Case Reports ◽

Atlantoaxial Joint ◽

Review Of The Literature ◽

Grisel’S Syndrome

Background and Objective. Grisel’s syndrome is a rare syndrome characterized by nontraumatic rotatory subluxation of the atlantoaxial joint. It usually affects children and typically presents with torticollis after ear, nose, and throat (ENT) surgery or head and neck infections. In the pediatric literature, there is only a small amount of available data; moreover, no systematic review has been previously done with focus on the pediatric population. We report our experience of two cases, and we provide a systematic review on Grisel’s syndrome in children in order to offer a deeper insight about its clinical presentation, its current diagnosis, and principles of treatment. Case Reports and Review. We describe two boys of 9 and 8 years old, who developed atlantoaxial subluxation after adenoidectomy. Considering the early diagnosis, a conservative treatment was chosen, with no recurrence and no sequelae at follow-up. We identified 114 case reports, of which 90 describe children, for a total of 171 pediatric patients. Of the 154 cases in which cause was reported, 59.7% presented a head and neck infection and 35.7% had previous head and neck surgery. There is no sex prevalence (49.7% males versus 50.2% females). Mean delay in diagnosis is 33 days. Eight % of the patients had neurological impairment of the 165 cases which mentioned treatment, 96% underwent a conservative treatment, of whom the 8.8% recurred with the need of surgery. As a whole, 12% underwent surgery as a first- or second-line treatment. 3 6% of the patients whose follow-up was reported developed a sequela, minor limitation of neck movement being the most frequent. Conclusion. Grisel’s syndrome should be suspected in children with painful unresponsive torticollis following ENT procedures or head and neck inflammation. CT scan with 3D reconstruction is the gold standard for diagnosis, allowing the identification of the subluxation and the classification according to the Fielding–Hawkins grading system. Surgical treatment is indicated in case of high-grade instability or failure of conservative treatment. Review of the literature shows how early diagnosis based on clinical and radiological evaluation is crucial in order to avoid surgical treatment and neurologic sequelae.

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Posterior osteosynthesis of a spontaneous bilateral pedicle fracture of the lumbar spine

Journal of Neurosurgery Spine ◽

10.3171/2015.7.spine141207 ◽

2016 ◽

Vol 24 (3) ◽

pp. 398-401 ◽

Cited By ~ 3

Author(s):

Sang-Hyun Han ◽

Seung-Jae Hyun ◽

Tae-Ahn Jahng ◽

Ki-Jeong Kim

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Surgical Treatment ◽

Lumbar Spine ◽

Pedicle Screws ◽

Leg Pain ◽

Low Back ◽

Pedicle Fracture ◽

Effective Option ◽

Radiological Studies

Spontaneous bilateral pedicle fractures of the lumbar spine are rare, and an optimal surgical treatment has not been suggested. The authors report the case of a 50-year-old woman who presented with low-back pain and right leg radiating pain of 1 year’s duration. Radiological studies revealed a spontaneous bilateral pedicle fracture of L-5. All efforts at conservative treatment failed, and the patient underwent surgery for osteosynthesis of the fractured pedicle using bilateral pedicle screws connected with a bent rod. Her low-back and right leg pain were relieved postoperatively. A CT scan performed 3 months postoperatively revealed the disappearance of the pedicle fracture gap and presence of newly formed bony trabeculation. In rare cases of spontaneous bilateral pedicle fracture of the lumbar spine, osteosynthesis of the fractured pedicle using bilateral pedicle screws and a bent rod is a motion-preserving technique that may be an effective option when conservative management has failed.

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Management of iatrogenic flat-back syndrome

Neurosurgical FOCUS ◽

10.3171/foc.2003.15.3.8 ◽

2003 ◽

Vol 15 (3) ◽

pp. 1-9 ◽

Cited By ~ 44

Author(s):

Gregory C. Wiggins ◽

Stephen L. Ondra ◽

Christopher I. Shaffrey

Keyword(s):

Back Pain ◽

Surgical Treatment ◽

Lumbar Spine ◽

Surgical Management ◽

Clinical Presentation ◽

Lateral Radiograph ◽

Wedge Osteotomy ◽

Common Cause ◽

Pain Evaluation ◽

Flat Back

Iatrogenic loss of lordosis is now frequently recognized as a complication following placement of thoracolumbar instrumentation, especially with distraction instrumentation. Flat-back syndrome is characterized by forward inclination of the trunk, inability to stand upright, and back pain. Evaluation of the deformity should include a full-length lateral radiograph obtained with the patient's knees and hips fully extended. The most common cause of the deformity includes the use of distraction instrumentation in the lumbar spine and pseudarthrosis. Surgical treatment described in the literature includes opening (Smith-Petersen) osteotomy, polysegmental osteotomy, and closing wedge osteotomy. The authors will review the literature, cause, clinical presentation, prevention, and surgical management of flat-back syndrome.

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Epidural Abscess

10.1093/med/9780199976805.003.0009 ◽

2016 ◽

Author(s):

David Mabey

Keyword(s):

Back Pain ◽

Surgical Treatment ◽

Early Diagnosis ◽

Epidural Abscess ◽

Spinal Epidural Abscess ◽

Surgical Drainage ◽

Stable Patient ◽

Common Presentation ◽

Spinal Epidural

An epidural abscess is a collection of pus that has accumulated between the dura and the calvarium or spine. It is rare but can lead to severe neurologic dysfunction or death. There are two main subsets of epidural abscess: spinal epidural abscess (SEA) and intracranial epidural abscess (ICEA). Early diagnosis is key to minimizing complications. Back pain is the most common presentation of SEA, along with spinal tenderness. Treatment requires prolonged hospitalization, surgical drainage in most cases, and long-term antibiotics. Except in rare cases, patients with SEA and ICEA will require hospital admission. In the stable patient, antibiotics should be withheld until culture data can be obtained. If surgical treatment is not readily available, biopsy is often performed to obtain samples for culture before starting antibiotics.

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Surgical Treatment of a Rare Presentation of Bertolotti's Syndrome from Castellvi Type IV Lumbosacral Transitional Vertebra: Case Report and Review of the Literature

Journal of Neurological Surgery Reports ◽

10.1055/s-0038-1667172 ◽

2018 ◽

Vol 79 (03) ◽

pp. e70-e74 ◽

Cited By ~ 3

Author(s):

Ryan Adams ◽

Sarah Herrera-Nicol ◽

Arthur Jenkins

Keyword(s):

Back Pain ◽

Surgical Treatment ◽

Leg Pain ◽

Lumbosacral Spine ◽

Complete Fusion ◽

Type I ◽

Type Iii ◽

Transitional Vertebra ◽

Type Iv ◽

The Right

Background Advancements in radiological imaging and diagnostic criteria enable doctors to more accurately identify lumbosacral transitional vertebrae (LSTV) and their association with back and L5 distribution leg pain. It is considered the most common congenital anomaly of the lumbosacral spine with an incidence between 4 and 35%,3 although many practitioners describe 10 to 12% overall incidence. LSTVs include sacralization of the L5 vertebral body and lumbarization of the S1 segment while demonstrating varying morphology, ranging from broadened transverse processes to complete fusion.5 The most common types of LSTV that present with symptomatic Bertolotti's syndrome are the Castellvi type I and type II; type III and type IV variants rarely present with symptoms referable with confirmatory and provocative testing to the transitional vertebra itself, and therefore there is limited experience and no case reports of treatment toward this particular entity. Case Description We illustrated a case of a 37 years old female in which a computed tomography scan demonstrated type III LSTV on the left and a type I anomaly on the right. The patient presented with right-sided leg pain and left-sided sacroiliac (SI) region low back pain, worse with rotation and standing, for several years, and had been on daily narcotic pain medications for more than 2 years. The patient had temporary relief of her leg pain with a transverse/ALA injection on the right, but no improvement in her back pain, whereas a left-sided injection into the region around the type III interface on the left did transiently alleviate her SI pain without improvement in her leg pain. We proposed that this particular anomaly induced mechanical back pain on the left side by flexion of the bone bridge (a form of stress-fracture, with associated sclerotic changes in the interface in the transverse/ALA junction) with associated irritation of the right L5 nerve from the type I anomaly on the right in conjunction with her typical radiating leg pain on the right. A patent, but somewhat hypoplastic L5/S1 disk space was also present. Nonsegmental pedicle screw instrumentation with low-profile screws was implanted on the right side with fusion induced using allograft and off label use of infuse rh-BMP2 bone graft substitute, and the patient was discharged the same day. The patient noted immediate improvement in her preoperative symptoms, and by 2 weeks after her surgery noted complete resolution of the preoperative symptoms, and required no narcotic medications to control her incisional pain. Conclusion Patients who present with symptoms consistent with Bertolotti's syndrome, even if they have a type III or type IV LSTV, should be considered for surgical treatment of their LSTV. These patients can respond well, even if symptoms have been present for years. Given the prevalence of these anatomic variants in the general population (10–12% in most series), Bertolotti's syndrome should be considered in the differential diagnosis of any patient with a presentation of L5 radiculopathy and/or back pain.

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PS02.223: EFFECTIVENESS OF ETILEFRINE REGIMEN FOR CHYLOTHORAX AFTER ESOPHAGECTOMY WITH THORACIC DUCT RESECTION

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.223 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 185-185

Author(s):

Ryosuke Umino ◽

Yu Ohkura ◽

Masaki Ueno ◽

Harushi Udagawa

Keyword(s):

Surgical Treatment ◽

Treatment Group ◽

Conservative Treatment ◽

Thoracic Duct ◽

Conflicts Of Interest ◽

Early Stage ◽

Treatment Options ◽

Type I ◽

Subtotal Esophagectomy ◽

Toranomon Hospital

Abstract Background Management of postoperative chylothorax generally involves nutritional regimens as well as pharmacological and surgical therapies, but a clear consensus has yet to be reached. The aim of this study was to clarify the usefulness of an etilefrine regimen to broaden the medical treatment options for postoperative chylothorax after esophagectomy with resection of the thoracic duct. Methods A total of 371 consecutive patients with esophageal cancer were identified from a prospectively constructed database at the Department of Gastroenterological Surgery, Toranomon Hospital between January 2011 and February 2017. They were patients with squamous cell carcinoma or adenocarcinoma of the esophagus including Siewert type I, II tumor of the esophagogastric junction who underwent subtotal esophagectomy. Of these 371 patients, 19 patients who were diagnosed with chylothorax as a postoperative complication were enrolled in this study. Results Conservative treatment achieved cure in 16 patients among 19 patients. The duration of chylothorax tended to be longer in the no-etilefrine group (n = 5) than in the etilefrine group (n = 11) (27.8 vs. 11.6 days; P = 0.078). The 14 patients among 19 patients was resected the thoracic duct. Etilefrine was used in 12 of these 14 patients. Among these 12 patients, 3 required surgical treatment and the remaining 9 patients were cured with conservative treatment. The duration of chylothorax was shorter in the conservative treatment group than in the surgical treatment group (11.9 vs. 36.3 days; P = 0.052). And also, with the use of etilefrine as adjuvant therapy, cure was achieved in 9 patients (75%) without surgical intervention. Conclusion The findings of this study suggest the effectiveness of etilefrine in patients with chylothorax following esophagectomy. The drug was effective even in post-TDR chylothorax, an often intractable condition that is difficult to treat conservatively. However, when the effectiveness of etilefrine regimen is unexpectedly poor, it is important to switch from drug therapy to surgical treatment in the early stage of this complication. Disclosure All authors have declared no conflicts of interest.

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Alleviating Paravertebral Muscle Spasm after Radiofrequency Ablation Treatment of Hypersensitive Basivertebral and Sinuvertebral Nerves for Chronic Discogenic Back Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e883 ◽

2021 ◽

Vol 24 (6) ◽

pp. E883-E892

Keyword(s):

Back Pain ◽

Radiofrequency Ablation ◽

Muscle Spasm ◽

Paraspinal Muscle ◽

Multifidus Muscle ◽

Cross Sectional ◽

Paravertebral Muscle ◽

High Intensity Zone ◽

Endoscopic Video ◽

Muscle Cross Sectional Area

BACKGROUND: Paraspinal muscle spasm caused by pain from a lumbar degenerative disc is frequently investigated in patients with low back pain. Radiofrequency ablation (RFA) surgery could alleviate paraspinal muscle spasms. OBJECTIVES: We performed RFA surgery on the high-intensity zone (HIZ) and hypersensitive sinuvertebral and basivertebral nerves to evaluate its outcome. The paravertebral muscle cross-sectional area (CSA) was measured on magnetic resonance imaging (MRI) before and after surgery to evaluate the effect of RFA surgery on the paravertebral muscle. STUDY DESIGN: Prospective cohort study. SETTING: A single spine surgery center. METHODS: A comparative study was performed on 2 different uniportal spinal endoscopic surgery groups; 23 patients who underwent RFA surgery for chronic discogenic back pain and 45 patients who underwent posterior decompression surgery for lumbar spinal stenosis with 12 months of follow-up. Paravertebral muscle cross-sectional area, Schiza grade, Modic type, and HIZ size were measured on pre- and post-operative MRI. An endoscopic video review was performed to evaluate the presence of intraoperative twitching and grade the degree of epidural neovascularization and adhesion. Visual analog scale VAS, modified Oswestry Disability Index, ODI and MacNab’s criteria were evaluated for outcome measures. RESULTS: Intraoperative endoscopic video evaluation showed neovascularization and adhesion adjacent to the disc and pedicle. In the RFA surgery group, there were 7 patients (30.43%) with grade 2 and 16 (69.57%) with grade 3 neovascularization; intraoperative twitching was observed in 19 out of 23 patients (82.61%). After performing an RFA on the sinuvertebral and basivertebral nerves for the treatment of discogenic back pain, the results showed significant improvement in pain and disability scores. The mean CSA of the paraspinal muscle in the RFA surgery group was significantly increased after surgery at the L4–L5 and L5–S1 levels (L4–L5: 3901 ± 1096.7 mm² to 4167 ± 1052.1 mm², P = 0.000; L5-S1: 3059 ± 968.5 mm² to 3323 ± 1046.2 mm², P = 0.000) compared to preoperative CSA. LIMITATIONS: This study was limited by its small sample size. CONCLUSION: Hypersensitive sinuvertebral and basivertebral nerves are strongly associated with epidural neovascularization with adhesion and the pathological pain pathway in degenerative disc disease. Epidural neovascularization with adhesion reflects aberrant neurological connections, which are associated with reflex inhibitory mechanisms of the multifidus muscle, which induces spasm. RFA treatment of the region of epidural neovascularization with adhesion effectively treated chronic discogenic back pain and could induce paraspinal muscle spasm release. KEY WORDS: Discogenic back pain, high-intensity zone, sinuvertebral nerve, basivertebral nerve, radiofrequency ablation, multifidus muscle

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The Hip’s Influence on Low Back Pain: A Distal Link to a Proximal Problem

Journal of Sport Rehabilitation ◽

10.1123/jsr.18.1.24 ◽

2009 ◽

Vol 18 (1) ◽

pp. 24-32 ◽

Cited By ~ 28

Author(s):

Michael P. Reiman ◽

P. Cody Weisbach ◽

Paul E. Glynn

Keyword(s):

Decision Making ◽

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Conservative Treatment ◽

Hip Joint ◽

Future Research ◽

Low Back ◽

Contributing Factors ◽

Potential Link

Low back pain (LBP) is a multifactorial dysfunction, with one of the potential contributing factors being the hip joint. Currently, research investigating the examination and conservative treatment of LBP has focused primarily on the lumbar spine. The objective of this clinical commentary is to discuss the potential link between hip impairments and LBP using current best evidence and the concept of regional interdependence as tools to guide decision making and offer ideas for future research.

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