European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The etiology of low back pain (LBP) is complicated and the diagnosis can be difficult. Superior cluneal nerve entrapment neuropathy (SCN-EN) is a known cause of LBP, although the middle cluneal nerve (MCN) can be implicated in the elicitation of LBP. ⋯ The MCN consists of sensory branches from the dorsal rami of S1-S4. It sandwiches the sacral ligament between the posterior superior and inferior iliac spine as it courses over the iliac crest. Its entrapment at this hard orifice can lead to severe LBP with leg symptoms. An MCN block effect is diagnostically useful. Less invasive MCN neurolysis under local anesthesia is effective in patients who fail to respond to observation therapy.
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To present a case of aggressive sacral osteoblastoma (OB) treated with neoadjuvant denosumab therapy and en bloc resection. ⋯ A short course of denosumab caused tumour regression, ossification and conversion of an aggressive OB into a sclerotic, well-defined lesion thus aiding surgical resection and preservation of neural structures. Neoadjuvant therapy reduced osteoclast numbers but PET showed that the lesion remained FDG avid post-therapy.
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Case Reports
Intraoperative total spinal anesthesia as a complication of posterior percutaneous endoscopic cervical discectomy.
Percutaneous endoscopic cervical discectomy (PECD) is an emerging surgical treatment for cervical disc herniation in recent years, but the complications of PECD are rarely reported. In this case report, we aimed to report two cases of total spinal anesthesia, an unusual complication of PECD. ⋯ From these two cases, we concluded that the operation of anchoring during PECD should be cautious and standardized, intravenous anesthesia should be chosen to enhance intraoperative anesthesia to prevent intraoperative total spinal anesthesia.
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To report a case of anterior sacral meningocele with intralesional bleeding secondary to sacrococcygeal trauma. Likewise, there is a discussion about the physiopathology and the surgical approach to these types of lesions. ⋯ This report highlights a complication never seen in the literature of a relatively rare condition. In our case, the combined approach was effective for both clinical control and lesion regression.
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Lumbar spinal epidural lipomatosis (LEL) is a condition characterized by excessive deposition of epidural fat in the spinal canal. Metabolic abnormalities may be associated with LEL, but few validated reports exist. Thus, we investigated the association between LEL and metabolic disorders in this study. ⋯ LEL patients had significantly more visceral fat and increased levels of insulin, UA and ferritin, which are closely related with metabolic disorders. This study indicates that the increased epidural fat in the spinal canal seen in the LEL patients is associated with metabolic syndrome. These slides can be retrieved under Electronic Supplementary material.