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M Annertz

Publications and source records attributed to M Annertz.

14 recordsLinked to original sources
PubMed2006

Mondini-like malformation mimicking otosclerosis and superior semicircular canal dehiscence.

In 2003, it was reported that superior semicircular canal dehiscence can mimic otosclerosis because of low-frequency bone conduction hearing gain and dissipation of air-conducted acoustic energy through the dehiscence. We report the case of a 17-year-old girl with left-sided combined hearing loss thought to be due to otosclerosis. Bone conduction thresholds were -10 dB at 250 and 500 Hz and she had a 40 dB air-bone gap at 250 Hz. When a tuning fork was placed at her ankle she heard it in her left ear. Acoustic reflexes and vestibular evoked myogenic potentials could be elicited bilaterally. Imaging of the temporal bones showed no otosclerosis, superior semicircular canal dehiscence or large vestibular aqueduct, but a left-sided, Mondini-like dysplasia of the cochlea with a modiolar deficiency could be seen. Mondini-like cochlear dysplasia should be added to the causes of inner-ear conductive hearing loss.

Adolescent↗
PubMed2004

Selective diagnostic cervical nerve root block--correlation with clinical symptoms and MRI-pathology.

BACKGROUND: The aim of this study is to describe the method of a cervical selective diagnostic nerve root block (SNRB) technique and assess its ability to correlate clinical symptoms with MRI findings in patients with cervical radicular pain and a single level degenerative disease. METHODS: Twenty consecutive patients with cervical radiculopathy and correlating single level MRI pathology were studied. All patients underwent clinical investigation and neck and arm pain measurement with visual analog scales (VAS). The last 10 consecutive patients also underwent provocation with active neck motion when arm and neck pain were measured. They all underwent SNRB and 1 ml local-anesthesia (Mepivacaine 10 mg/ml) was injected, with the aid of fluoroscopy, close to the nerve-root. The VAS estimation and clinical investigation including provocation were repeated 30 minutes after the block. Criteria for a positive block response are a significant subjective pain reduction and at least 50% VAS pain reduction in the arm. FINDINGS: For the whole group mean VAS arm pain reductions were 86% and mean VAS neck pain reductions were 65%. When the results from the provocation were added all patients had a positive block. Eighteen were operated on by an anterior procedure and all 18 were free from radicular pain at follow up. INTERPRETATION: The block procedure seems relevant for revealing a relationship between radiological pathology and clinical symptoms and signs.

Adult↗
PubMed1999

Paragangliomas of the spinal canal.

We report the clinical MRI and histopathological features of five consecutive cases of spinal paraganglioma. Three intradural tumours were found in the typical location (two at the L4, one at the S2 level); one intradural extramedullary tumour arose at an unusual level, from the ventral C2 root, and one extradural tumour growing along the L5 nerve root sheath had an aggressive growth pattern with early, local paraspinal recurrence and, eventually, intradural metastatic spread. This type of growth pattern has not been described previously. Paragangliomas of the spinal canal are more common than previously thought and can be located anywhere along the spine, although the lumbosacral level is the most common. Their appearance on MRI can not distinguish them from other tumours in the spinal canal. Even though paragangliomas in general are benign and slowly growing their growth pattern can vary and be more aggressive, to the point of metastatic spread.

Adult↗
PubMed1997

A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: Clinical features related to radiographic findings.

STUDY DESIGN: A prospective study of consecutive patients undergoing surgery for central lumbar spinal stenosis. OBJECTIVES: To evaluate symptoms and signs in patients undergoing surgery for central spinal stenosis and to correlate the findings to age, preoperative duration of symptoms, and radiographically detected constriction. SUMMARY OF BACKGROUND DATA: The degree of constriction of the spinal canal considered to be symptomatic of lumbar canal stenosis is not clear, nor is the relation between the clinical appearance of the disease and the degree of radiographically verified constriction. MATERIAL AND METHODS: One hundred five consecutive patients scheduled for decompression surgery were included in a prospective study. The day before surgery, all patients were interviewed and examined, using a defined protocol that included data on age, gender, preoperative duration of symptoms, walking ability, and occurrence of pain at rest and at night. Included were data recording straight leg raising test results, reflex disturbance, and extensor hallucis longus muscle weakness. All radiographs were examined by a neuroradiologist. The anteroposterior diameters at each site from L1-L2 to L5-S1 were recorded. For the computer analysis, the site of and width at the narrowest site was registered, as well as the number of sites with an anteroposterior diameter of less than 10 mm. A statistical analysis was performed using chi-square analysis, nonparametric tests, analysis of variance, and logistic regression. RESULTS: Pain at rest and at night was reported by 68 and 60 patients, respectively, and was more common in younger patients (P = 0.065 and 0.015, respectively). A severe reduction of walking ability (< 0.5 km) was reported by 70 patients. The straight leg raising test results were negative in 70 patients, positive > 60 degrees in 16, positive 30-60 degrees in 14, and positive < 30 degrees in 5. Younger patients had a positive straight leg raising result (P = 0.028, analysis of variance) more often. Reflex disturbances correlated to patient age: Older patients had reflex disturbances more often. There was no correlation between preoperative duration and pain or neurologic disturbances: Patients with longer preoperative duration of symptoms did not demonstrate more severe symptoms. There was a total myelographic block of the spinal canal in 13 patients. The mean value of the antero-posterior diameter in the other patients was 6.8 mm (range, 4-11 mm). In patients younger than 70 years L4-L5 was the site for the most pronounced constriction, whereas L3-L4 was the narrowest site in the older patients. Degenerative spondylolisthesis was found in 32 patients, and they had a more pronounced constriction of the spinal canal (5.6 mm compared with 6.7 mm in those without displacement, P = 0.02). There was a (nonsignificant) tendency toward more walking disturbances in patients with a more pronounced constriction of the spine. There was no correlation between reflex disturbances or extensor hallucis longus weakness and radiographically detected constriction. CONCLUSION: Pain was more intense and positive straight leg raising test results were more common in younger patients, whereas reflex disturbances were more common in the elderly. The vertebral site for the lowest anteroposterior value was higher with higher age. Preoperative duration did not affect the severity of symptoms or signs. Patients with more pronounced stenosis tended to have a more severe reduction of walking ability. There was no correlation between symptoms and signs and radiographically detected constriction.

Aged↗
PubMed1997

A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: Five-year follow-up by an independent observer.

STUDY DESIGN: A prospective and consecutive study of surgical results obtained during serial follow-up investigations in patients who underwent surgery for central lumbar spinal stenosis. OBJECTIVES: To evaluate the result after surgical decompression for lumbar spinal stenosis, at regular intervals after surgery, and to correlate these results with values for preoperative parameters; special interest was focused on the results in relation to the degree of constriction of the spinal canal. SUMMARY OF BACKGROUND DATA: The outcome after surgery for spinal stenosis is debatable; long-term follow-up investigations have indicated deterioration with passing time. Results of studies in nonsurgical patients have demonstrated that the symptoms do not progress with time. Results of a meta-analysis of the literature on surgical results have demonstrated a wide variation of outcomes. MATERIAL AND METHODS: In a prospective study, 105 consecutive patients who underwent surgical decompression (laminectomy with facet-preserving technique, but no fusion) were evaluated at follow-up examinations 4 months and 1, 2, and 5 years after surgery. At the follow-up examinations, the patient's opinion on the surgical result was registered, using a four-grade scale. The occurrence of pain at rest and at night was registered, as well as the patient's walking ability. Statistical analysis was performed, relating the surgical results to patient age, gender, preoperative duration of symptoms and radiographically observed constriction as described in Part I of this study. The radiologist was blinded to patient outcome. Logistic regression analysis was performed. RESULTS: During the follow-up period, 19 patients underwent reoperation, consisting of fusion to treat lumbar pain (n = 4), repeat decompression because of progressive stenosis (n = 13), and repairs in response to surgical complications (n = 2). Follow-up results: The result, related to the recurrence of leg symptoms, deteriorated with passing time. Excellent results were reported by 63% to 67% at 4-month and 2-year follow-ups compared with 52% at the 5-year follow-up. There was a correlation between the constriction of the spinal canal and the outcome at all intervals. Patients with an anteroposterior diameter of 6 mm or less at the narrowest site had significantly better results. The logistic regression analysis demonstrated a significant correlation between a severe reduction of the anteroposterior diameter and excellent results and a tendency toward better results in patients with a shorter preoperative duration of symptoms. Improvement of walking ability was also associated with a pronounced constriction of the spinal canal. CONCLUSION: The results after surgical decompression in patients with central spinal stenosis deteriorated with time. There was a significant correlation between good result and pronounced constriction of the spinal canal. Patients with a preoperative duration of symptoms of less than 4 years and patients with no preoperative back pain tended to have better surgical outcomes. The reoperation rate was 18% within 5 years. When surgery for spinal stenosis is contemplated, these prognostic factors should be taken into consideration: The "ideal patient" has a pronounced constriction of the spinal canal, insignificant lower back pain, no concomitant disease affecting walking ability, and a symptom duration of less than 4 years.

Adult↗
PubMed1997

Fusion or stabilization alone for acute distractive flexion injuries in the mid to lower cervical spine?

Long-term pain problems and residual restricted mobility were evaluated for patients sustaining acute distractive flexion injuries to the cervical spine. To assess which of two alternative surgical approaches gives better long-term outcomes, 58 patients were studied, 29 in each group. The results of posterior wire stabilization without fusion according to Brandt were contrasted with those of the Cloward technique. We found significantly more late pain problems and restricted neck mobility in the group treated with wiring without fusion than in those managed with anterior fusion. We conclude that this continuing pain may be due to residual mobility in the damaged degenerated non-fused motion segment, and that the difference between the two groups may reflect the difference in the quality and rate of fusion achieved by the two surgical approaches.

Adolescent↗
PubMed1996

MR imaging as the primary modality for neuroradiologic evaluation of the lumbar spine. Effects on cost and number of examinations.

PURPOSE: To evaluate the effects on cost, and number of primary and supplementary neuroradiologic examinations, after introducing MR imaging as the primary modality in the evaluation of the lumbar spine. MATERIAL AND METHODS: Two 5-month periods were compared: period 1--before MR; and period 2--after introduction of a 2nd MR device. In period 1, patients were examined with myelography and/or CT after referral from specialists only, whereas in period 2 both specialists and general practitioners could refer patients for MR imaging. The direct cost (neuroradiologic methods and hospitalization) and indirect cost (sick-leave and estimated loss of production caused by the diagnostic procedure) were estimated. RESULTS AND CONCLUSION: In period 1, investigations were started in 75 patients (62 myelographies and 13 CT examinations); in period 2, in 227 patients (198 MR, 21 CT, and 8 myelographies). The estimated total cost increased from SEK 825,000 to 1,265,000 (53%), the cost per investigated patient decreasing from 11,000 to 5565 (50%), and the cost of preoperative investigation per operated patient decreasing from 8616 to 5563 (35%). The number of supplementary examinations was unchanged.

Costs and Cost Analysis↗
PubMed1996

MR imaging in recurrent pain after back surgery. A comparative study using standard and high doses of gadolinium contrast agents.

PURPOSE: To compare the diagnostic results following injection of (a) a high dose (0.3 mmol/kg b.w.) of gadodiamide injection and (b) the standard dose (0.1 mmol/kg b.w.) of Gd-DTPA, in patients with recurrent symptoms after surgery for lumbar disc herniation. MATERIAL AND METHODS: Twenty patients with recurrent or sustained symptoms after surgery for lumbar disc herniations were examined. MR imaging (0.3 T) was first performed before and after Gd-DTPA at 0.1 mmol/kg b.w., and then within one month (17 patients) or within 3 months (3 patients) before and after gadodiamide injection at 0.3 mmol/kg b.w. The examinations were first evaluated by 2 neuroradiologists blinded to dose but not to patient as the images were presented in pairs. Six months later the same investigators evaluated the examinations again, this time blinded to both dose and patient. RESULTS: At the evaluation in pairs (with the investigators blinded to dose only) the high-dose examinations were considered the most informative (p=0.05). However, at the later evaluation (with the investigators blinded both to dose and patient) no significant difference between high and standard dose was found regarding diagnosis or diagnostic certainty. CONCLUSION: In this study the high-dose contrast enhancement of MR imaging at 0.3 T did not increase the diagnostic information for differentiating between scar and recurrent hernia. The high-dose images were considered more informative when evaluated in pairs, but gave no additional or different information when evaluated separately. The study also indicated that comparisons in pairs should be interpreted with caution.

Adult↗
PubMed1995

No relationship between epidural fibrosis and sciatica in the lumbar postdiscectomy syndrome. A study with contrast-enhanced magnetic resonance imaging in symptomatic and asymptomatic patients.

STUDY DESIGN: Symptomatic patients were retrospectively analyzed and compared with a control group from an ongoing prospective and consecutive study. OBJECTIVES: To determine the presence and extent of epidural fibrosis in patients with and without recurrent sciatic pain after previous lumbar discectomy, contrast-enhanced magnetic resonance images were evaluated and correlated with surgical findings in the symptomatic patients. Recurrent hernia and bony stenosis were ruled out as the probable causative agent, as well as any morphologic explanation other than fibrosis. SUMMARY OF BACKGROUND DATA: Repeat surgical results for patients with the lumbar postdiscectomy syndrome with epidural fibrosis alone are often unfavorable. The pathogenic role of epidural fibrosis, however, has not been established. METHODS: The magnetic resonance images of eight patients with recurrent or persistent sciatic pain after lumbar discectomy were compared with those of eight asymptomatic patients constituting a control group. All were examined with magnetic resonance imaging on a 0.3 T unit before and after intravenous injection of gadolinium-DTPA, and clinically, 6 months to 4 years after surgery. The symptomatic patients subsequently underwent reoperation. RESULTS: Fourteen patients had focal or diffuse epidural fibrosis around the nerve root and/or the thecal sac at the operated level, whereas the postoperative findings for two patients were "normal," one in the operated and one in the control group. No difference between the groups regarding mass effect or affection of the nerve roots or thecal sac was noted. At reoperation of the eight symptomatic patients, fibrosis was the only pathologic finding in all cases except one, in which surgery confirmed the normal finding on magnetic resonance imaging. Six of the eight operated patients had recurrent or persistent symptoms within a year of the reoperation. CONCLUSION: No differences regarding the presence and extent of epidural fibrosis between the symptomatic and asymptomatic patients could be demonstrated with contrast-enhanced magnetic resonance imaging. The role of epidural fibrosis as the causative agent in the lumbar postdiscectomy syndrome is questioned.

Adult↗
PubMed1995

Serial MRI in the early postoperative period after lumbar discectomy.

The aim of this study was to determine MRI findings in patients successfully operated upon for lumbar disc herniation. We investigated 20 patients with a successful outcome after L4-5 or L5-S1 disc operations clinically and with MRI preoperatively, and at 5 days, 6 weeks, and 4 months after surgery. Postoperatively, T1- and T2-weighted images were obtained. At 4 months gadolinium-enhanced images were added. Pronounced intraspinal MRI changes were seen during follow-up. Deformation of the dural sac was seen in 13 patients preoperatively, in 19 at 5 days after operation, in 15 at 6 weeks, and in 12 at 4 months. Nerve root involvement was seen in all cases both preoperatively and at 5 days after operation, in 17 at 6 weeks, and in 15 at 4 months. No correlation between symptoms or the straight leg raising test and the size or nature of the abnormal tissue in the spinal canal postoperatively could be demonstrated. It was concluded that early postoperative MRI after lumbar discectomy must be interpreted carefully, and that oedema and scar formation are probable reasons for difficulties in interpretation.

Adult↗
PubMed1991

Posterior wiring without bony fusion in traumatic distractive flexion injuries of the mid to lower cervical spine. Long-term follow-up in 30 patients.

Thirty-four patients with traumatic distractive flexion injuries in the mid to lower cervical spine were treated with posterior wire stabilization without bony fusion from January 1981 through May 1987. Fifteen had cord involvement, and nine had root involvement. Ten were neurologically intact. Thirty patients were followed for a mean of 38 months. Two neurologically intact patients had root deficits postoperatively. One patient was reoperated because of redislocation due to a spinous process fracture. Mean loss of lordosis was 7.5 degrees. Eight patients had a wire break at follow-up, but no case of late instability was observed. Sixteen patients had signs of spontaneous anterior interbody fusion at follow-up, and 11 patients had signs of posterior fusion. Twenty-four patients complained of late--but in most cases--minor pain. These results indicate that simple posterior wiring without bony fusion is a reliable method to obtain good immediate stability in traumatic distractive flexion injuries of the mid to lower cervical spine. The wires provide sufficient stability during the time of soft tissue healing.

Adult↗
PubMed1990

Isthmic lumbar spondylolisthesis with sciatica. MR imaging vs myelography.

Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: normal nerve (n = 8); II: compressed nerve (n = 16); III: disappearance of fat, nerve not possible to identify (n = 9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information.

Adult↗
PubMed1988

Diagnostic lumbar nerve root block.

Lumbar nerve root anesthesia using a local anesthetic was performed in 100 cases of sciatica. The neurological state before and after nerve block was recorded and also the degree of pain alleviation caused by the block. Three indications for the block were used in the study: unilateral sciatic pain and normal findings on myelography and/or CT or MR (n = 51), minor myelographic findings that possibly but not necessarily explained the patient's symptom (n = 40), and multiple pathological findings on myelography (n = 9). In 87% of the patients, the nerve block inflicted temporary sensory and/or motor disturbance within the dermatome anesthesized. In total, 51% experienced total, 31 partial, and 18 no pain relief after injection. No side effects of the procedure were noted. Patients with pain alleviation after anesthesia were offered an operative nerve root decompression and short-term results of this decompression seem to be comparable to conventional disc surgery. Anesthetizing the lumbar nerve root outside the intervertebral foramen may be considered in the preoperative evaluation of patients with sciatic pain and minor or no radiographic findings.

Adult↗