Journal of spinal disorders
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The authors report a case of thoracic spinal cord stab injury with neurologic impairment that was treated surgically after injury. A literature review and case analysis indicate that surgical extraction of foreign bodies retained within the spinal canal is indicated to avoid infection, delayed myelopathy, and neurologic loss. The amount of motor and functional recovery for incomplete injuries after spinal cord stab wound can be strikingly good despite pathologic changes to severely damaged areas, and removal of retained intraspinal metallic fragment can improve this neurologic outcome. Open removal of the knife seems preferable to avoid bleeding and infection.
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Review Case Reports
Sudden sensorineural hearing loss after spinal surgery under general anesthesia.
Two patients, ages 72 and 71, who underwent lumbar decompressive surgery for spinal stenosis, were evaluated for postoperative sudden sensorineural hearing loss (SSHL). After two uncomplicated spinal procedures, both patients developed SSHL immediately after surgery. Hearing loss was moderate to profound in these two patients. ⋯ Further causes of postlumbar surgery SSHL may include microemboli or viral infections. SSHL is a rare but possible complication after nonotologic, noncardiac bypass surgery; only 26 cases of SSHL after this surgery have been reported. We encourage the continued reporting of sudden sensorineural hearing loss after spinal surgery.
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Epidural hematoma after epidural anesthesia is a rare and uncommon complication in patients with peripheral vascular disease who require perioperative anticoagulation therapy. A low index of suspicion makes its diagnosis difficult and often delayed. ⋯ In this article, the authors report a case of epidural hematoma with secondary paraplegia after epidural anesthesia. Also described is an original technique for evacuating the epidural space.
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Review Case Reports
Traumatic bilateral rotatory dislocation of the atlanto-axial joints: a case report and review of the literature.
Traumatic bilateral rotatory dislocation at the atlanto-axial joints is a rare injury in adults. Only three prior cases have been reported (1,2,3). Our case report, review of management, and pathophysiology from the literature is presented. This injury may be successfully treated by closed reduction and brace immobilization.
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Thirty-four patients with adolescent idiopathic thoracolumbar, lumbar, or lumbar components of double major curves between 20 and 55 degrees were identified. This study group was compared with an age- and sex-matched control group with regard to back pain, radicular symptoms, and perception of handicap. The objectives of this study were to define the natural history of moderate-range adolescent idiopathic thoracolumbar, lumbar, and double major curves with a lumbar component in this range. ⋯ None of the 34 study patients and 1 control patient underwent surgery for back pain. With an average follow-up of 22 years, the study group reported handicap scores comparable to those of the control group. The average age of the study patients was only 36 years, but it is encouraging that these individuals have continued to do well for at least 20 years past skeletal maturity.