Man-in-the-barrel syndrome after thoracoilium fusion

2008 ◽  
Vol 9 (6) ◽  
pp. 566-569 ◽  
Author(s):  
Andrei F. Joaquim ◽  
Catherine C. Shaffrey ◽  
Charles A. Sansur ◽  
Christopher I. Shaffrey
Keyword(s):  
Back Pain ◽  
Cerebral Ischemia ◽  
Early Postoperative Period ◽  
Sagittal Imbalance ◽  
Lumbar Stenosis ◽  
Degenerative Scoliosis ◽  
Neurological Finding ◽  
Brachial Diplegia ◽  
Junctional Kyphosis ◽  
Difficulty Walking

The authors report a case of man-in-the-barrel (MIB) syndrome occurring after an extensive revision involving thoracoilium instrumentation and fusion for iatrogenic and degenerative scoliosis, progressive kyphosis, and sagittal imbalance. Isolated brachial diplegia is a rare neurological finding often attributed to cerebral ischemia. It has not been previously reported in patients undergoing complex spine surgery. This 70-year-old woman, who had previously undergone T11–S1 fusion for lumbar stenosis and scoliosis, presented with increased difficulty walking and with back pain. She had junctional kyphosis and L5–S1 pseudarthrosis and required revision fusion extending from T-3 to the ilium. In the early postoperative period, she experienced a 30-minute episode of substantial hypotension. She developed delirium and isolated brachial diplegia, consistent with MIB syndrome. Multiple studies were performed to assess the origin of this brachial diplegia. There was no definitive radiological evidence of any causative lesion. After a few days, her cognitive function returned to normal and she regained the ability to move her arms. After several weeks of rehabilitation, she recovered completely. Man-in-the-barrel syndrome is a rare neurological entity. It can result from various mechanisms but most commonly seems to be related to ischemia and is potentially reversible.

Poster 155 Characteristics of Persons With Clinical Lumbar Stenosis in Comparison With Age-Matched Back Pain and Asymptomatic Volunteers

PM&R ◽  
2012 ◽  
Vol 4 ◽  
pp. S243-S243
Author(s):  
Andrew J. Haig ◽  
Danielle Sandella ◽  
Christy Tomkins ◽  
Karen S. Yamakawa
Keyword(s):  
Back Pain ◽  
Lumbar Stenosis ◽  
Asymptomatic Volunteers

Abstract T P167: Emergent Identification of Type A Aortic Dissection as a Cause of Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tomoyuki Ohara ◽  
Kazunori Toyoda ◽  
Hiroyuki Yokoyama ◽  
Kenji Minatoya ◽  
Eijiro Tanaka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Back Pain ◽  
Cerebral Ischemia ◽  
Aortic Dissection ◽  
Intravenous Thrombolysis ◽  
Type A ◽  
Neurological Deficits ◽  
Diagnostic Tools ◽  
Acute Cerebral Ischemia ◽  
D Dimer

Background: Acute aortic dissection (AAD) sometimes presents with predominant neurological symptoms of acute cerebral ischemia. Fatal AAD patients after thrombolysis for stroke without noticing AAD were reported. The purpose of this study was to clarify the characteristics of AAD patients with acute cerebral ischemia and develop a score to emergently identify AAD for such patients. Methods: From the database of Stanford type A-AAD patients admitted in our hospital between 2007 and 2012, we selected those presenting with acute focal neurological deficits due to ischemic stroke/TIA. Patients presenting with shock state or cardiopulmonary arrest were excluded. Physiological, radiological, and blood examinations were assessed for AAD identification. Results: Of 187 AAD patients, 19 patients (10%) with focal neurological deficits as an initial presentation were studied. Involvement of one or more main branches of the aortic arch was observed in all of 19 patients. Stroke experts, not cardiovascular experts, were primarily called to ER in 18 patients, and 12 were potential candidates for intravenous thrombolysis. Left hemiparesis (14 patients, 74%) was the most common neurological symptom. Nine patients (47%) complained of chest or back pain. As components of the score, (1) systolic BP differential >20mmHg between upper extremities was present in 11 of 17 patients (65%), (2) mediastinal widening on chest radiography in 13/16 (81%), (3) occlusion or the intimal flap of the proximal common carotid artery on carotid ultrasonography in 14/16 (88%), (4) pericardial effusion on echocardiography in 10/19 (47%), and (5) abnormal elevation of D-dimer levels in all 19 (median 24.8 [range 4.2-406.2] μg/ml). Two components were positive in 4 patients, three in 6, four in 5, and all the five in 4. Conclusions: Only half of AAD patients with stroke/TIA complained of chest or back pain. All the AAD patients with stroke/TIA showed high D-dimer levels and one or more additional abnormal findings in physiological and radiological examinations. Combination of such handy diagnostic tools is helpful to identify AAD without long time delay and to avoid unnecessary thrombolysis for AAD patients.

scholarly journals Incidence of Iatrogenic Lumbar Spinal Instability after Laminectomy, Discectomy or Facetectomy

2021 ◽  
Vol 9 (B) ◽  
pp. 588-592
Author(s):  
Ahmed A. Hafez ◽  
Ahmed Hamdy Ashry ◽  
Ahmed Elsayed ◽  
Amr El Tayeb ◽  
Mohamed Badran Abdel Salam ElShenawy
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Prospective Study ◽  
Lumbar Spine Surgery ◽  
Spinal Instability ◽  
Lumbar Stenosis ◽  
University Hospitals ◽  
Lumbar Spinal ◽  
A Prospective Study ◽  
Postoperative Instability

OBJECTIVE: This thesis aim to report the incidence of iatrogenic spinal instability that occurs after laminectomy, discectomy or facetectomy in Lumbar spine surgery. METHODS: This is a prospective study of 50 cases of degenerative lumbar spondylosis complaining of various symptoms of claudication, sciatica and back pain which were surgically managed by laminectomy according to the level of stenosis in the period between October 2018 and October 2020 in the neurosurgery department at Cairo university hospitals. Mesial facetectomy was added according to the degree of stenosis if needed. Some patients needed discectomy if sciatica was an eminent symptom. RESULTS: Out of 50 patients included: 9 patients (18%) developed postoperative instability. The number of levels operated on and the degree of mesial facetectomy were found to be variables that may affect postoperative stability. CONCLUSION: Iatrogenic instability may result from large laminectomy and extensive facetectomy for lumbar stenosis in patients who do not have obvious pre-existing instability. Key words: Iatrogenic spinal instability - Laminectomy - conventional open discectomy - Mesial facetectomy.

scholarly journals Clinical principles for the diagnosis and treatment of musculoskeletal (non-specific) lower back pain

2021 ◽  
Vol 13 (3) ◽  
pp. 107-112
Author(s):  
V. A. Golovacheva ◽  
A. A. Golovacheva ◽  
T. G. Fateyeva
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Combination Therapy ◽  
Interdisciplinary Approach ◽  
Interventional Treatment ◽  
Low Back ◽  
Lumbar Stenosis ◽  
Red Flags ◽  
Lower Back ◽  
Symptoms And Signs

Low back pain (LBP) is one of the most common reasons for a neurologist visit. In 90–95% of cases, LBP is nonspecific (musculoskeletal). The diagnosis of nonspecific LBP based on symptoms, somatic and neurological examination data, the absence of «red flags» (symptoms and signs characteristic of specific causes of back pain, discogenic radiculopathy, or lumbar stenosis). We review the modern principles of acute, subacute, and chronic nonspecific LBP treatment. We also discuss interventional and non-interventional treatment approaches, emphasizing the importance of combination therapy and an interdisciplinary approach.

Robotic Sacroiliac Fixation Technique for Triangular Titanium Implant in Adult Degenerative Scoliosis Surgery: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Connor Berlin ◽  
Parantap Patel ◽  
Isador Lieberman ◽  
Mark Shaffrey ◽  
Avery Buchholz
Keyword(s):  
Back Pain ◽  
Sacroiliac Joint ◽  
Titanium Implants ◽  
Leg Pain ◽  
Definitive Treatment ◽  
Scoliosis Surgery ◽  
Corrective Surgery ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
K Wires

Abstract Corrective surgery remains a definitive treatment for adult spinal deformity, improving pain and disability. With these cases, instrumentation to the pelvis with iliac fixation is recommended. Whether iliac or S2-Alar-Iliac (S2AI) trajectories are used, sacroiliac joint pain and long-term sacroilitis can be common after long-fusion constructs.1-3 Sacroiliac fusion with triangular titanium implants during fusion can reduce back pain associated with sacroiliac joint degeneration,3 provides reduction in sacroiliac joint motion and stress when added to S2AI screws, and potentially enhances mechanical stability of fusion constructs.4 Here, we present a technique for placing triangular titanium sacroiliac implants (iFuse BedrockTM; SI-BONE Inc, Santa Clara, California) alongside S2AI screws using a robotic platform (Mazor X; Medtronic Sofamor Danek, Medtronic Inc, Dublin, Ireland). Navigated robotics allows reduction in human error with implant placement, and potentially decreased operative time/fluoroscopy.5-7 Key surgical steps include placement of K wires for S2AI and bilateral SI-implants, tapping, replacing SI-implant K wires with guide pins, placing S2AI screws, and finally placing the SI-implant. Final placement is verified with intraoperative fluoroscopy. The patient described is a 61-yr-old woman with worsening adult degenerative scoliosis, lower back pain, left leg radicular pain, and mild right leg pain who failed conservative treatment. Examination revealed diminished strength in both legs. Imaging was significant for moderate sigmoid scoliosis, discogenic disease, and osteoarthritis at all levels. She consented to undergo corrective surgery. Postoperatively, the patient experienced resolution of her leg weakness and pain. Imaging demonstrated appropriate positioning of hardware. Prospective studies on the efficacy of the SI-implant are underway.

Endoscopic decompression for the treatment of lumbar spinal stenosis: an updated systematic review and meta-analysis

2021 ◽  
pp. 1-9
Author(s):  
Roberto J. Perez-Roman ◽  
Wendy Gaztanaga ◽  
Victor M. Lu ◽  
Michael Y. Wang
Keyword(s):  
Systematic Review ◽  
Back Pain ◽  
Length Of Stay ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Meta Analysis ◽  
Lumbar Stenosis ◽  
Lumbar Spinal ◽  
Endoscopic Methods

OBJECTIVE Lumbar stenosis treatment has evolved with the introduction of minimally invasive surgery (MIS) techniques. Endoscopic methods take the concepts applied to MIS a step further, with multiple studies showing that endoscopic techniques have outcomes that are similar to those of more traditional approaches. The aim of this study was to perform an updated meta-analysis and systematic review of studies comparing the outcomes between endoscopic (uni- and biportal) and microscopic techniques for the treatment of lumbar stenosis. METHODS Following PRISMA guidelines, a systematic search was performed using the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Ovid Embase, and PubMed databases from their dates of inception to December 14, 2020. All identified articles were then systematically screened against the following inclusion criteria: 1) studies comparing endoscopic (either uniportal or biportal) with minimally invasive approaches, 2) patient age ≥ 18 years, and 3) diagnosis of lumbar spinal stenosis. Bias was assessed using quality assessment criteria and funnel plots. Meta-analysis using a random-effects model was used to synthesize the metadata. RESULTS From a total of 470 studies, 14 underwent full-text assessment. Of these 14 studies, 13 comparative studies were included for quantitative analysis, totaling 1406 procedures satisfying all criteria for selection. Regarding postoperative back pain, 9 studies showed that endoscopic methods resulted in significantly lower pain scores compared with MIS (mean difference [MD] −1.0, 95% CI −1.6 to −0.4, p < 0.01). The length of stay data were reported by 7 studies, with endoscopic methods associated with a significantly shorter length of stay versus the MIS technique (MD −2.1 days, 95% CI −2.7 to −1.4, p < 0.01). There was no significant difference with respect to leg visual analog scale scores, Oswestry Disability Index scores, blood loss, surgical time, and complications, and there were not any significant quality or bias concerns. CONCLUSIONS Both endoscopic and MIS techniques are safe and effective methods for treating patients with symptomatic lumbar stenosis. Patients who undergo endoscopic surgery seem to report less postoperative low-back pain and significantly reduced hospital stay with a trend toward less perioperative blood loss. Future large prospective randomized trials are needed to confirm the findings in this study.

Electromyographic and Magnetic Resonance Imaging to Predict Lumbar Stenosis, Low-Back Pain, and No Back Symptoms

2007 ◽  
Vol 89 (2) ◽  
pp. 358-366 ◽  
Author(s):  
Andrew J. Haig ◽  
Michael E. Geisser ◽  
Henry C. Tong ◽  
Karen S.J. Yamakawa ◽  
Douglas J. Quint ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Low Back Pain ◽  
Back Pain ◽  
Magnetic Resonance ◽  
Low Back ◽  
Lumbar Stenosis ◽  
Resonance Imaging

scholarly journals Therapeutic Strategy of Percutaneous Transforaminal Endoscopic Decompression for Stenosis Associated With Adult Degenerative Scoliosis

2020 ◽  
pp. 219256822095903
Author(s):  
Lin-Yu Jin ◽  
Kun Wang ◽  
Zhen-Dong Lv ◽  
Xin-Jin Su ◽  
Hai-Ying Liu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cobb Angle ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Lumbar Stenosis ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
Lateral Subluxation ◽  
The Mean ◽  
Transforaminal Endoscopic Surgery

Study Design: A retrospective study. Objective: To investigate the effects of percutaneous transforaminal endoscopic decompression (PTED) for lumbar stenosis associated with adult degenerative scoliosis and to analyze the correlation between preoperative radiological parameters and postoperative surgical outcomes. Methods: Two years of retrospective data was collected from 46 patients with lumbar stenosis associated with adult degenerative scoliosis who underwent PTED. The visual analog scale (VAS), Oswestry Disability Index, and modified MacNab criteria were used to evaluate the clinical outcomes. Multiple linear regression analysis was used to analyze the correlation between radiological parameters and surgical outcomes. Results: The mean age of the 33 female and 13 male patients was 73.5 ± 8.1 years. The mean follow-up was 27.6 ± 3.5 months (range from 24 to 36). The average coronal Cobb angle was 24.5 ± 8.2°. There were better outcomes of the VAS for leg pain and Oswestry Disability Index after surgery. Based on the MacNab criteria, excellent or good outcomes were noted in 84.78% of patients. Multiple linear regression analysis showed that Cobb angle and lateral olisthy may be the predictors for low back pain. Conclusion: Transforaminal endoscopic surgery may be an effective and safe method for geriatric patients with lumbar stenosis associated with degenerative scoliosis. The predictive factors of clinical outcomes were severe Cobb angle and high degree lateral subluxation. Transforaminal endoscopic surgery may not be recommended for patients with Cobb angle larger than 30° combined with lateral subluxation.

Surgical Approaches for Degenerative Lumbar Stenosis

2018 ◽  
Author(s):  
Doniel Drazin ◽  
Carlito Lagman ◽  
Christine Piper ◽  
Ari Kappel ◽  
Terrence T. Kim
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Diagnostic Imaging ◽  
Surgical Management ◽  
Surgical Approaches ◽  
Low Back ◽  
Lumbar Stenosis ◽  
Instrumented Fusion ◽  
Common Causes ◽  
Ancillary Studies

This chapter discusses the evaluation of patients presenting with low back pain and the surgical management of three common causes of low back pain in adults: stenosis, spondylolisthesis, and scoliosis. Components of the history and physical examination, diagnostic imaging, and ancillary studies are reviewed. Surgical management includes decompression including laminectomy or laminotomy, and instrumented fusion. Indications, contraindications, general procedural steps, and potential complications are covered. Recent published literature is reviewed when appropriate.

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