Spinal Subdural Hematoma With Paraplegia Mimicking Dorsolumbar Prolapsed Disc: A Case Report

Background and Importance: Spinal Subdural Hematoma (SSH) is a rare condition with an unknown incidence in the general population. Iatrogenic spinal subdural hematoma radiologically mimicking a prolapsed dorsolumbar disc has not been published in the literature. Case Presentation: A 65-year-old female presented with altered sensorium and generalized weakness for 3 days evaluated by a neurologist who diagnosed it as a metabolic encephalopathy with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) with severe anemia and hypothyroidism. She underwent a diagnostic lumbar puncture and following which, within 24 hours, she developed weakness of both the lower limbs. MRI of dorsolumbar spine was done which revealed D12-L1 extruded disc causing severe compression to the conus medullaris with D12-L2 subarachnoid lesion and cord edema. On opening the dura, a large organized hematoma on the anterior aspect of the conus was seen and evacuated. Conclusion: Spinal subdural hematoma presents with a spectrum of signs and symptoms. Although MRI is the investigation of choice but SSH presenting like a prolapsed intervertebral disc on MRI is one of its kinds and should be kept in mind since it carries a grave prognosis if not treated early with emergency decompression.

Management of Occult Spondylolisthesis in a Case of Low Back Pain

Spondylolisthesis is a condition of the spine that causes lower back pain. It is a vertebra slippage that occurs at the base of the spine, in most instances. We report a case of occult spondylolisthesis of a patient with grade 1 spondylolisthesis (L4 over L5). We presented the radiologic finding, diagnosis, and treatment here. A 45-year-old female was presented with the complaints of low back pain with sciatica for 4 years. The radiologic finding showed that she had dysaesthesia on both L5 dermatome and MRI of LS Spine revealed prolapsed disc at L4/5. The patient underwent decompression, stabilization via pedicle screw at L4 and L5 with fusion at L4/5 and after constant follow-ups, she was symptom-free with a full range of motion of the spine. Posterior fusion with instrumentation of the pedicle screw is commonly considered the gold standard method of lumbar spinal fusion. Non-surgical treatment is effective in relieving low back pain of the patient in most cases however, symptomatic patients need to be treated with the surgical method.

Outcome of Anterior Cervical Discectomy with PEEK Cage Fixation for Single Level Cervical Disc Disease

Objective: To assess the outcome of anterior cervical discectomy and fusion (ACDF) with PEEK cage. Material and Methods: This prospective study was conducted in the Departments of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar. Patients undergoing one level ACDF with PEEK cage fixation were enrolled in the study. Patients who needed multiple level ACDF or corpectomy with plating and redo cases were excluded from the study. A proforma, which included age, gender, address, level of prolapsed disc, sign and symptoms, pain score, MRI findings were filled. All patients were assessed on day of discharge and on follow-up visit after one month. Data was analyzed with SPSS version 22. Results: Total 95 patients were included out of which 58 (61%) were male and 37 (39%) were female. Range of patients` Age was from 27 years to 64 years with 50.4 years mean age. Most patients (65%) had C6 radiculopathy. 58 patients (61%) had right sided radicular pain. 5 patients (5.26%) had radiculomyelopathy. C5 – C6 was the most common level operated (68 patients). Excellent results were achieved in 75 patients (79%) while satisfactory results in the rest of patients using Odom’s criteria. Bony fusion occurred in 92% of patients at 6 months. Conclusion: ACDF with PEEK cage fixation is a safe and beneficial procedure in one level cervical prolapse disc disease

Preliminary clinical and radiographic outcomes of oblique lateral interbody fusion combined with percutaneous transforaminal endoscopic discectomy for degenerative lumbar disease accompanied by prolapsed disc herniation

Objective: To investigate the preliminary clinical and radiographic outcomes of oblique lateral interbody fusion (OLIF) combined with percutaneous transforaminal endoscopic discectomy (PTED) for the degenerative lumbar disease accompanied by prolapsed disc herniation.Methods: From March 2016 to December 2018, 15 patients with degenerative lumbar spondylolisthesis, lumbar spine instability or lumbar spinal stenosis accompanied by prolapsed disc herniation were underwent OLIF combined with PTED in our spine surgery center, including 6 males and 9 females, the mean age was 61.4±7.1 years. Clinical results, radiological parameters, and related complications were collected and analyzed.Results: All patients firstly received PTED with local anesthesia and then underwent OLIF with general anesthesia. All patients were followed up for an average of 14.6±3.7 months. Mean preoperative visual analog scale scores and Oswestry Disability Index scores were significantly improved postoperatively (P<0.05). The radiographic results include the intervertebral disc height, vertical diameter of intervertebral foramen, spinal canal anteroposterior diameter, segment angle and lumbar lordosis angle were significantly improved postoperatively, respectively (P<0.05). None major implant-related and other severe complications were happened.Conclusions: OLIF combined with PTED can successfully enables direct neural decompression without posterior decompressive procedures and might be an alternative minimally invasive surgical option for properly selected patients.

An Ayurvedic management of traumatic intervertebral disc prolapse- a case study

The term prolapsed disc means the protrusion or extrusion of the nucleus pulposus through a rent in the annulus fibrosus. A prolapsed disc is a common cause of low backache, especially the backache associated with sciatic pain. IVDP of lumbar spine mostly affects young adults and always presents with low backache with /without radicular pain to one/both lower limbs. In acute IVDP of lumbar spine there is increase in pain while bending forward, coughing, sneezing or turning in bed. There is no specific treatment in modern science for IVDP. If conservative treatment fails then surgical treatment like Laminectomy, Discectomy indicated for IVDP. Here in this case study a 30 year old male patient admitted to shalyatantra department with complaints of low backache, difficulty in sitting for long time, difficulty in walking since two months. He has history of fall from bike before two months. At that time MRI-LS spine done and revealed fracture of right transverse process of L1&L2 vertebral bodies with disc bulges at L3-L4 & L4-L5 with thecal sac indentation. Patient was treated with sarvanga Snehana, Swedana with majjabasti and some ayurvedic medicine like Ashwagandha shatavari churna and lakshadi guggulu. Here patient got completely relief in single sitting of majjabasti krama of 16 days.

Case Report: Sciatic nerve schwannoma - a rare cause of sciatica

Herein we report a rare case of a sciatic nerve schwannoma causing sciatica in a 69-year-old female. Sciatic nerve schwannoma is a rare entity. It should always be considered as a possible cause of sciatica in patients that present with symptoms of sciatica with no prolapsed disc in the lumbar spine and a negative crossed straight leg raise test. Timely diagnosis and complete excision of the lesion leads to complete resolution of the symptoms of such patients.

Variations in selective nerve root block technique

Introduction Much literature reports on selective nerve root blocks (SNRBs) in cases of lumbosacral radiculopathy. Unfortunately, authors only inconsistently reveal the exact needle tip position relative to the causative pathology at the time of injection. Different injection sites may provide different symptomatic benefits. We investigated the variation in injection techniques of practitioners working in the UK. Methods A clinical scenario was devised depicting a patient with radiculopathy secondary to an L4/5 vertebral disc prolapse. Participants were questioned on their chosen management of this patient, focusing particularly on SNRB technique. Questionnaires were sent to spinal surgeons, pain management specialists and musculoskeletal radiologists. Results A total of 100 responses were detailed enough for inclusion. The majority (83%) of respondents reported they would inject local anaesthetic and steroids, 4% would inject local anaesthetic alone and 13% would inject a different substance. Over half (53%) would target the L5 nerve root, 26% the L4 nerve root, 12% the prolapsed disc itself and 9% two separate vertebral levels. Variation was also noted in needle tip location relative to the neural sheath. Conclusions When treating lumbar radiculopathy, there are apparent variations in the use and positioning of SNRBs for a given level of disc pathology. Needle tip position may have a direct influence on clinical outcome following SNRBs. Caution is therefore required when considering the validity of previously published studies investigating SNRBs and different injectates.