Spine
-
This case report illustrates the development of a cerebrospinal fluid fistula and pseudomeningocele in a patient after lumbar discectomy and fusion with instrumentation. ⋯ Postoperative pseudomeningocele and cerebrospinal fluid fistula in patients with spinal instrumentation can be treated successfully with epidural blood patch and a brief course (4 days) of spinal drainage. This combined treatment protocol may have some advantages to treatment with 7 days of cerebrospinal fluid diversion or to percutaneous epidural blood patch alone.
-
Case Reports
Cyclic sciatica. A manifestation of compression of the sciatic nerve by endometriosis. A case report.
A case of cyclic sciatica secondary to ovarian cyst endometriosis is presented. ⋯ Magnetic resonance imaging may permit a specific diagnosis of this unusual cause of sciatica by showing a hemorrhagic mass in the region of the sciatic nerve. Early recognition is necessary to prevent permanent damage to the sciatic nerve.
-
The Americans with Disabilities Act provides protection for equal access to services and employment opportunities for qualified persons with disabilities. Because hospital privileges are essential to physician practice, this article investigates the role of the Americans With Disabilities Act in acquiring and maintaining these privileges. Recent findings from the Act's case law support the concept that: 1) an employer employee relationship exists between the hospital and the non-staff physician for purposes of the Act's analysis, and thus, 2) the Act is applicable to questions of hospital privileges for non-staff physicians. Suggestions for ensuring patient welfare while maintaining compliance with the Act are discussed.
-
Rigid post-traumatic kyphosis after fracture of the thoracolumbar and lumbar spine represents a failure of initial management of the injury. Kyphosis moves the center of gravity anterior. The kyphosis and instability may result in pain, deformity, and increased neurologic deficits. Management for symptomatic post-traumatic kyphosis always has presented a challenge to orthopedic surgeons. ⋯ This method provides single-stage posterior decompression, correction, and stabilization on as definitive management for post traumatic kyphosis of the thoracolumbar and lumbar spine.
-
A report of a patient with cervical intramedullary cysticercosis is presented. ⋯ A preoperative diagnostic suspicion of cysticercosis is important in patients with intramedullary cystic lesions because specific drug treatment is available. Treatment with anthelmintics, particularly albendazole, should be considered in patients with intramedullary cysticercosis before surgery. Corticosteroids may be added to the therapeutic regimen because this may reduce the perilesional edema and prevent neurologic deterioration during the course of anthelmintic treatment.