STUDY DESIGN: A case report of a patient suffering from an intradural herniated disc associated with the presence of epidural gas. OBJECTIVE: To advise spine surgeons of the possible association of intradural disc herniation and epidural gas, to prevent overlooking intradural disc fragments during surgery. SUMMARY OF BACKGROUND DATA: Three cases of this rare association were published previously, something surprising given the relatively rare occurrence of intradural herniations and the presence of epidural gas. METHODS: A case is presented where such an association occurred, on the basis of preoperative examinations and intraoperative findings. The literature is reviewed for cases of herniated discs associated with epidural gas and for intradural herniations. RESULTS: During the open discectomy, after a negative epidural examination, an intradural examination was performed, revealing a disc herniation, which was removed. The patient's postoperative development was satisfactory. CONCLUSION: The possibility of an intradural herniated disc must always be considered when performing an open discectomy on a patient whose computed tomography scan reveals the presence of epidural gas. In the event that no clear disc herniation is found to justify the clinical symptoms or the previous radiologic findings, an intradural exploration may be indicated.

Diskectomy↗

PubMed1996

Intraoperative chemonucleolysis as an adjunct to lumbar discectomy.

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Chymopapain↗

PubMed1994

Disc herniation with gas.

SUMMARY OF BACKGROUND DATA: Intradiscal gas is associated with tumors, infection, trauma, therapeutic and diagnostic spinal procedures, deposit illnesses, and disc degeneration. The existence of gas within the spinal canal has been seen on 17 occasions, of which 13 were associated with discal hernias. METHODS: In this study, 19 additional patients with intraspinal gas corresponding to discal hernias are presented, six of whom required surgical treatment. The association of intraspinal gas with intradural hernias frequently is reported in the literature, although this has not been proven in our group. Intrahernial gas is associated with patients who have chronic problems and with advanced age. CONCLUSION: Intrahernial gas is much more common than is indicated in the literature. This finding often goes unnoticed, and the association between intradiscal gas and intradural hernias should be kept in mind.

Adult↗

PubMedDate not supplied

Chronic exertional compartment syndrome of the legs in adolescents.

We present our experience in the management and treatment of chronic exertional compartment syndrome (CECS) of the legs in 23 adolescents. Twenty-one patients were affected in the anteroexternal compartment, one in the deep posterior compartment, and one in both. Seventeen of the patients were in-line competitive skaters; the rest practiced soccer or athletics. Mean age at the time of diagnosis was 16 (range, 14-18) years, and the age at the onset of symptoms was 15 (range, 13-17) years. After a careful differential diagnosis, the diagnosis was established on the basis of clinical signs and symptoms and confirmed by intracompartmental pressure (ICP) measurements. Based on our results, the following criteria are considered to be adequate: baseline ICP (at rest) >10 mm Hg, >20 mm Hg 1 minute after stopping exercise, >20 mm Hg 5 minutes later, and >15 minutes to achieve ICP normalization. All patients but one accepted surgical treatment (complete subcutaneous fasciotomy). No major complication was observed and only one minor complication occurred. All patients returned to the practice of their sports without any symptomatology 6 weeks after the surgery (mean follow-up, 4.8 years). To date there have been no relapses.

Adolescent↗