Spine
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This article describes a patient with transdural lumbar disc herniation. The patient fits the average criteria for intradural lumbar disc herniations. ⋯ The volume of extruded matter was greater and caused greater neurologic damage than that observed in intradural disc herniations. The authors know no previous cases of transdural disc herniations.
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The clear and reversible relationship of spinal cord function to postoperative hypotension is illustrated in a case of revision scoliosis surgery in an adult patient. The correlation of spinal cord monitoring by both magnetic cortical motor evoked potentials and spinal somatosensory evoked potentials to the clinical status is shown, and the importance of close postoperative observation of the adult revision case is emphasized.
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Review Case Reports
Natural history of spinal cord infarction caused by nucleus pulposus embolism.
Nucleus pulposus embolism causing spinal cord infarction is exceptional. A 16-year-old girl was seen with sudden onset of interscapular pain and paraplegia from fatal ischemic transverse myelopathy due to arterial and venous occlusions by fibrocartilaginous embolism. In 32 cases of nucleus pulposus embolism, females predominated (69%) and age distribution was bimodal with peaks at 22 and 60 years (median, 38.5). ⋯ Schmorl's nodes, larger volume and vascularization of nucleus pulposus in the young, and spinal arteriovenous communications, trauma, and degenerative changes in older patients could be important pathogenetic factors. Diagnosis requires histopathologic confirmation. Nucleus pulposus embolism may be an underlying cause in cases diagnosed as transverse myelitis and ischemic infarction of spinal cord.
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Transthoracic discectomy and fusion were performed on 19 patients for a central or central-lateral herniated thoracic disc. At initial visit, 14 patients had evidence of myelopathy, 5 had bowel or bladder dysfunction, and 13 had pain. ⋯ Coexistent multiple sclerosis was diagnosed in two patients, who had an atypical postoperative course. The overall results of transthoracic discectomy and fusion in patients without prior laminectomy or coexistent multiple sclerosis were excellent in six, good in six, fair in one, and poor in one, demonstrating that it is a safe and effective procedure.
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The incidence of sciatic pain among 25-49 year-old men in three different types of work: machine operating, dynamic physical work (construction carpenters), and office work was assessed prospectively. Postal questionnaires both at the beginning and the end of the 3-year follow-up were answered by 1149 men who at baseline had no history of sciatic pain. ⋯ Previous history of severe lumbago or other low-back pain increased the risk fourfold. Frequent physical exercise and smoking were of borderline significance as predictors.