Journal of neurosurgery. Spine
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Review Case Reports
Isolated unilateral hypoglossal nerve palsy secondary to an atlantooccipital joint juxtafacet synovial cyst.
Juxtafacet cysts of the atlantooccipital joint that present with isolated hypoglossal nerve palsy are rare and may mimic more common pathological entities. The authors report on the third such case in the literature and discuss the differential diagnosis, imaging hallmarks, preoperative recognition, and surgical management of this lesion, and provide a review of the literature. The authors discuss their experience with the treatment of a 67-year-old woman who presented with an isolated hypoglossal nerve palsy caused by a nonenhancing cystic septated lesion abutting the lateral medulla just medial to the left hypoglossal canal. ⋯ Failure to recognize this rare entity preoperatively resulted in unnecessary intradural exploration and cranial nerve morbidity. In retrospect, the preoperative diagnosis of this lesion was suggested by lack of central enhancement, absence of dumbbell formation and the presence of erosive synovial changes. Regardless, the extreme rarity of this lesion at this location will always make its recognition challenging.
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Review
The Spine Patient Outcomes Research Trial results for lumbar disc herniation: a critical review.
The long-anticipated results of the Spine Patient Outcomes Research Trial (SPORT) were recently published in the Journal of the American Medical Association. In this trial the investigators compared operative and nonoperative care in patients with symptomatic lumbar disc herniation. Despite the expenditure of several million dollars on this multicenter, prospective, randomized, controlled clinical trial, the SPORT investigators admitted, "conclusions about the superiority or equivalence of the treatments under study are not warranted based on the intent-to-treat analysis." In the present article the author provides a critical review of the SPORT formulation and hypothesis, study design and methodology, and results and interpretations in an attempt to explain why the authors of this study were unable to assess the study's only intended null hypothesis that there would be no difference in outcomes between operative and nonoperative management of herniated lumbar discs. Issues related to misrepresentation and misinterpretation of the SPORT results for herniated lumbar discs are also assessed.
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Review Case Reports
Inadvertent intrathecal vincristine administration: a neurosurgical emergency. Case report.
Vincristine has a high neurotoxicity level. If given intrathecally by accident, it can cause ascending radiculomyeloencephalopathy, which is almost always fatal. The authors report a rare case in which vincristine was accidentally injected intrathecally into a 32-year-old man. ⋯ The patient's first sensorimotor deficits occurred after 2 days, led to an incomplete sensorimotor dysfunction below T-9 within the next 17 days, but progressed no further. Supported by the scarce data culled from the reviewed literature, the authors hypothesize that prolonged CSF irrigation combined with antineurotoxic therapy contributed to the patient's satisfactory outcome. In conclusion, accidental intrathecal vincristine injection requires emergency and adequate neurosurgical therapy.
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Review Case Reports
Cervical myelopathy caused by dropped head syndrome. Case report and review of the literature.
The authors present a rare case of cervical myelopathy caused by dropped head syndrome. This 68-year-old woman presented with her head hanging forward. After 1 month, she was admitted to the medical service because of head drop progression. ⋯ The patient underwent a C3-4 laminectomy and occipitocervicothoracic fixation. Gait and hand coordination gradually improved, and she was able to walk with no support 1 month postoperatively. Surgical fixation was beneficial in this patient with dropped head syndrome, myelopathy, and cervical instability.
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Review Case Reports
Recurrence of hypertrophic spinal pachymeningitis. Report of two cases and review of the literature.
Hypertrophic spinal pachymeningitis (HSP) is a comparatively rare disease characterized by hypertrophic inflammation of the dura mater and clinical symptoms that progress from local pain to myelopathy. The authors report two cases of recurrent HSP and review the English- and Japanese-language literature focusing on the recurrence of HSP. In the first case, a man who presented at 67 years of age with lower-extremity numbness, gait disturbance, and bladder dysfunction experienced two recurrences of HSP during the 11 years of follow up after his initial laminectomy. ⋯ Data on the presence or absence of inflammatory signs were available for 84 patients. A chi-square analysis revealed a significantly increased rate of recurrence for patients who had at least one positive inflammatory sign before surgery (six [20%] recurrent cases of 30) compared with those who had no positive inflammatory signs before surgery (two [3.7%] recurrent cases of 54) (p < 0.05). The authors conclude that HSP recurrence occurs because of active inflammation of the dura before surgery and the influence of chronic inflammation, including residual arachnoiditis.