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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Case Reports
Incarcerated herniation of the cervical spinal cord after laminectomy for an ossification of the yellow ligament.
A 74-year-old man showed a spastic gait and myelopathy in both the hands. Computed tomography revealed an OPLL on C3 and C4, bony spurs on the dorsal side of C4-C6, and an OYL on C3 and C4. We scheduled a two-stage decompression for both the OPLL and OYL. ⋯ The patient's myelopathy gradually improved. There have been no reports on postoperative neurological deterioration caused by spinal cord herniation associated with a dural defect at the laminectomy site, without dural tear in the surgery after the resection of a posteriorly located cervical OYL. The possibility of a dural defect in OYL cases should be considered when planning a laminectomy for the resection of the OYL.
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Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between the two radicular dura layers. ⋯ The mass was extirpated without cerebrospinal fluid outflow. The postoperative course was uneventful. Radicular interdural lumbar disc herniation should be suspected when a swollen, hard and immobile nerve root is present intraoperatively.
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Patients with fractures from the 11th thoracic to the 5th lumbar vertebra had a reconstruction of the anterior column with monocortical iliac crest autograft by using a single dorsal approach. The loss of correction was observed using X-rays pre- and post-operatively, at 3 months and after implant removal (IR). Successful fusion was assessed using computed tomography after the implant removal. ⋯ We had two epidural haematomas postoperatively with a neurological deterioration that had to be revised. We were able to decompress the neurological structures and restore the weight-bearing capability of the anterior column in a one-stage procedure. So we think that this technique can be an alternative procedure to combined operations regarding the presented radiological results of successful fusion and loss of correction.
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Surgery for thoracic disc herniations is still challenging, and the disc excision via a posterior laminectomy is considered risky. A variety of dorsolateral and ventral approaches have been developed. However, the lateral extracavitary and transthoracic approach require extensive surgical exposure. ⋯ A small paramedian dural incision was made over the disc space and the protruded disc fragment was removed. Neurological symptoms were improved, and no surgery-related complication was encountered. The posterior transdural approach may offer an alternative surgical option for selected patients with thoracic paracentral soft discs, while limiting the morbidity associated with the exposure.
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Review Case Reports
Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case.
Intradural spinal arachnoid cysts with cord compression are rare. When becoming symptomatic they cause variable symptoms involving gait disturbance, paraparesis or tetraparesis and neuropathic pain, decreasing significantly the patients' life quality. The extension of such cysts averages 3.7 vertebral bodies. ⋯ Surgical treatment with partial cyst resection in the compressed levels with an interlaminar approach brought similar results as complete resection. The patient was able to walk without help which was not possible before surgery. The cysts' extension is impressive as well as the minimal operative procedure.