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At least 343 records · Page 19Linked to original sources
PubMed2003

Primary care management of carpal tunnel syndrome.

Carpal tunnel syndrome of mild to moderate severity can often be effectively treated in a primary care environment. Workplace task modification and wrist splints can reduce or defer referral to hospital for surgical decompression. Nerve and tendon gliding exercises may also be of benefit. Steroid injections to the mouth of the carpal tunnel are particularly useful for symptomatic women in the third trimester of pregnancy. However inadvertent neural injection may cause disabling chronic pain. Referral to a minority of practitioners trained in the technique would ensure sufficient patient numbers to maintain skill levels.

Carpal Tunnel Syndrome↗
PubMed2003

A prospective study of outcome following mini-open carpal tunnel release.

Mini-open carpal tunnel release has been the focus of recent attention for surgical decompression of carpal tunnel syndrome. Other techniques such as standard open carpal tunnel release and endoscopic release have been well established, and outcomes, complications and results for these operations have been published widely. Our study uses the validated Levine Katz questionnaire for carpal tunnel syndrome to measure patient subjective outcomes at one year follow-up after mini-open carpal tunnel release. Thirty-four consecutive hands were enrolled prospectively with preoperative and postoperative questionnaires. Mean symptom severity scores per question improved from 2.8 to 1.3 and mean function severity scores per question improved from 2.6 to 1.3. Comparing our data to the historical cohort of Levine et al., there was a statistically significant improvement in postoperative outcomes in our population (p < 0.0001).

Adult↗
PubMed2001

Clinical significance of cervicomedullary deformity in Chiari II malformation.

OBJECTIVE: The purpose of this study was to determine if there is a difference in the caudal extent of brain stem herniation and the degree of cervicomedullary deformity between symptomatic and asymptomatic Chiari II patients. METHODS: Magnetic resonance imaging and the clinical presentation of 14 symptomatic and 59 asymptomatic patients were analyzed. The level of the cervicomedullary deformity below the foramen magnum was measured in both groups. The level of the deformity was identified by the cervical vertebral body or disc space level. RESULTS AND CONCLUSION: Review of our results shows no obvious relationship between the level of cervicomedullary deformity and the presenting symptoms or the outcome after surgical decompression. We conclude that the level of herniation and the cervicomedullary deformity is not a reliable marker to determine which patients may become symptomatic and require decompression or to determine prognosis.

Arnold-Chiari Malformation↗
PubMed2001

Surgery for expansion of spinal tuberculoma during antituberculous chemotherapy: a case report.

We report a case of intramedullary spinal tuberculoma in a girl aged 2 years and 6 months. At the age of 18 months, the patient was hospitalized for 2 months with tuberculous meningitis. Tuberculomas then appeared in the thoracic spinal cord, and the patient developed paraparesis despite continuation of chemotherapy. Spinal magnetic resonance imaging demonstrated multiple ring-enhanced lesions in the cord on the T1-weighted image; on the T2-weighted image, the lesions had a bright core surrounded by a hypointense rim. Laminectomy and partial excision were performed, and the paraparesis improved. In addition to antituberculous chemotherapy and dexamethasone, surgical decompression was needed to treat the expansion of the spinal tuberculoma.

Antitubercular Agents↗
PubMed2006

Typewriter tinnitus: a carbamazepine-responsive syndrome related to auditory nerve vascular compression.

Six subjects with similar unilateral tinnitus that was fully suppressed by carbamazepine have been identified. Their ages at the time of the sudden onset of their tinnitus ranged from 39 to 87 years (mean 67). The 3 men had right ear tinnitus. Two of the 3 women had left ear tinnitus. All 6 described a staccato quality of their intermittent tinnitus ('like a typewriter in the background, pop corn, Morse code'). Five of the 6 subjects had no other hearing or vestibular complaints; their audiograms were symmetric and consistent with their ages. Vascular compression of the auditory nerve ipsilateral to the tinnitus was detected in 4 of the 5 subjects imaged. The similarities between typewriter tinnitus and other cranial nerve syndromes associated with vascular compression (trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia) suggest that surgical decompression of the auditory nerve can relieve medication-refractive cases of typewriter tinnitus.

Adult↗
PubMed1998

Paraspinal abscess associated with epidural in labour.

A 24-year-old presented in labour requesting an epidural. She had been diagnosed as having "pelvic arthropathy" at 37 weeks. After an uneventful epidural and instrumental delivery, she discharged herself home. She re-presented 19 days later with left hip pain and abnormal neurological signs in the lower limbs. On MRI, there was a large paraspinal abscess with an epidural granulation mass compressing her spinal cord. She had an urgent surgical decompression. In hindsight, it is likely that the paraspinal mass was present at the time of epidural insertion. The discussion highlights that complications are sometimes not what they seem.

Abscess↗
PubMed2006

Variant of a lumbar disc cyst in a 13-year-old girl: a case report.

A disc cyst is a rare entity with a clinical presentation that closely mimics an intervertebral disc herniation. Disc cysts are ventrally located, intraspinal, extradural cystic lesions that communicate with the parent intervertebral disc through a ruptured annulus. We present the clinical features, magnetic resonance imaging, intra-operative and histopathological findings of a variant of a lumbar intervertebral disc cyst in a 13-year-old girl who presented with a 6-month history of unilateral radiculopathy following an injury. Magnetic resonance imaging revealed a large posterocentral, fluid-filled cyst occupying the L5-S1 interspace and bulging into the spinal canal. The cyst was confined within an intact bulging annulus fibrosis and extended directly from the parent disc. The cyst was surgically decompressed, resulting in complete symptomatic relief.

Adolescent↗
PubMed2004

The anterior surgical approach to the cervical spine for intervertebral disc disease.

THE ANTERIOR SURGICAL APPROACH to the cervical spine in patients with discogenic compressive pathological findings causing radiculopathy or myelopathy is a commonly performed operation with several technical variations. We describe the normal and pathological anatomy and the techniques of surgical decompression of the dura with autograft fusion, which we have used for the past 35 years.

Bone Transplantation↗
PubMed2005

Surgical outcome in rheumatoid Ranawat Class IIIb myelopathy.

OBJECTIVE: Rheumatoid arthritis frequently affects the craniovertebral junction (CVJ) and may lead to severe neck pain, quadriparesis, and respiratory dysfunction. Surgery in rheumatoid nonambulatory (Ranawat Class IIIb) patients carries a significant risk. This study presents the surgical outcome of Class IIIb patients with CVJ rheumatoid myelopathy and reviews the literature. METHODS: One hundred twelve consecutive patients with rheumatoid cervical myelopathy underwent surgical decompression and stabilization. Thirty-two of the patients (mean age, 66.81 +/- 10.25 yr) with CVJ rheumatoid arthritis were in Class IIIb, and all had atlantoaxial subluxation. A halo brace was applied before surgery and continued during surgery. Eleven patients with reducible atlantoaxial subluxation underwent direct posterior fusion. Twenty-one patients with fixed atlantoaxial subluxation underwent transoral decompression and then posterior fusion while they were under anesthesia. RESULTS: At a mean follow-up of 39 months, four patients improved to Class II and 14 improved to Class IIIa, whereas six remained in Class IIIb. Neck pain was relieved in all patients. There was one perioperative death after transoral surgery (posterior fusion not done), and seven other patients died subsequently of causes unrelated to surgery. The morbidity of surgery included construct failure, cerebrospinal fluid leak, superficial wound or graft donor site infection, transient dysphagia, and lung infection. CONCLUSION: A large subset of patients with CVJ rheumatoid myelopathy may reach Class IIIb. These patients have unique management considerations. Surgery (despite high morbidity) often remains the best therapeutic option available to them. Improvement of even one grade in their Ranawat score from Class IIIb to Class IIIa brought about by surgery confers on them a significant benefit in terms of their quality of life and survival.

Adult↗
PubMed2005

Factors associated with outcome after hemicraniectomy for large middle cerebral artery territory infarction.

OBJECTIVE: Large or malignant middle cerebral artery infarction is associated with a high mortality rate. Hemicraniectomy reduces intracranial pressure and has been demonstrated to increase survival. Questions remain regarding selection of patients for surgery and functional outcomes. METHODS: We retrospectively reviewed the charts, operative reports, and images of patients who underwent hemicraniectomy for cerebral infarction at our institution between 1990 and 2002. Stroke volume and craniectomy area image analyses were performed with National Institutes of Health Image J software. Short-term outcome was measured with the Glasgow Outcome Scale. The requirement for second surgical decompression was also used as a measure of short-term outcome. Outcome 1 year after stroke was assessed with mailed self-report questionnaires to patients or providers with answers yielding information pertinent to the Barthel Index for physical disability, the Reintegration to Normal Living Index, and the Zung Depression Index. Univariate and multivariate logistic regression analyses were used to consider factors associated with outcome. RESULTS: Thirty-eight patients with large hemispheric infarcts (average volume, 407 cm3) were treated with hemicraniectomy during the study period. Thirty-two patients survived more than 1 year after surgery. Twenty patients responded to a questionnaire scoring late physical disability (Barthel Index), quality of life (Reintegration to Normal Living Index), and depression (Zung Depression Index). The average Barthel Index score was 67. Barthel Index score and ability to walk were strongly correlated with age but not time to surgery, volume of infarction, or craniectomy size. Patients exhibited moderate to severe decrements in quality of life and increased incidence of depression across all age groups. Reoperation, an indicator for early operative failure, was required in six patients. These patients were significantly younger and had significantly higher volumes of cerebral infarction. CONCLUSION: Hemicraniectomy is life-saving treatment for large middle cerebral artery infarction. Good functional outcomes can be obtained but are less likely in older patients. Younger patients with large-volume strokes may benefit from multiple decompressions, if necessary.

Activities of Daily Living↗
PubMed2005

Crystal arthropathy of the lumbar spine: a series of six cases and a review of the literature.

There have been very few reports in the literature of gout and pseudogout of the spine. We describe six patients who presented with acute sciatica attributable to spinal stenosis with cyst formation in the facet joints. Cytopathological studies confirmed the diagnosis of crystal arthropathy in each case. Specific formation of a synovial cyst was identified pre-operatively by MRI in five patients. In the sixth, the diagnosis was made incidentally during decompressive surgery. Surgical decompression alone was undertaken in four patients. In one with an associated degenerative spondylolisthesis, an additional intertransverse fusion was performed. Another patient had previously undergone a spinal fusion adjacent to the involved spinal segment, and spinal stabilisation was undertaken as well as a decompression. In addition to standard histological examination material was sent for examination under polarised light which revealed deposition of urate or calcium pyrophosphate dihydrate crystals in all cases. It is not possible to diagnose gout and pseudogout of the spine by standard examination of a fixed specimen. However, examining dry specimens under polarised light suggests that crystal arthropathy is a significant aetiological factor in the development of symptomatic spinal stenosis associated with cyst formation in a facet joint.

Aged↗
PubMed2006

Spinal epidural abscess due to Mycobacterium tuberculosis in a patient with AIDS: case report and review of the literature.

Spinal epidural abscess (SEA) is a rare infectious disorder that often has delayed diagnosis and is associated with significant morbidity and mortality rates. We present a case of an AIDS patient with a SEA due to Mycobacterium tuberculosis. This type of SEA in AIDS patients is characterized by localized spinal pain and prolonged fever. Magnetic resonance imaging is the method of choice in the diagnostic process. Early diagnosis, followed by specific therapy (surgical decompression combined with antituberculous drugs), is necessary to improve the prognosis of these kinds of patients.

AIDS-Related Opportunistic Infections↗
PubMed2002

Intramedullary spinal cord damage associated with intervertebral disk material in a dog.

Intervertebral disk extrusions into the spinal cord are rarely reported in veterinary medicine, and only necropsy findings are described in previous reports. It is hypothesized that a disk lesion results in forceful injection of disk material into the spinal cord. In the 3-year-old Miniature Doberman Pinscher of our report, acute clinical signs and results of magnetic resonance imaging were consistent with this disease and helped determine the extent and character of the lesions. Alteration in the appearance of the nucleus pulposus was important in determining that intervertebral disk disease may have been present in this dog. However, a definitive diagnosis of intramedullary disk extrusion can be made only via histologic examination of a biopsy specimen or at necropsy. The dog improved substantially after surgical decompression of the spinal cord, and histologic findings in a biopsy specimen of material found within the spinal cord were consistent with mature degenerate intervertebral disk material.

Animals↗
PubMed1996

Incidence and natural history of touch allodynia after open carpal tunnel release.

Open surgical decompression is believed to be a safe treatment with few complications. However, it was our subjective impression that its morbidity had been underestimated. Fifty one consecutive patients with carpal tunnel syndrome were evaluated prospectively for three years after operation. Twenty one patients (41%) experienced allodynia of the operated hand at one month after surgery, 13 (25%) at three months, and three (6%) at 12 months. These were confirmed by significantly lowered pressure-pain thresholds over both the thenar and hypothenar eminences (p < 0.005). During the first month after operation all patients were relieved of nocturnal pain, and all clinical signs had disappeared at three months in all 51 patients. Our results confirm that open carpal tunnel decompression has a high success rate, but highlights a previously underestimated morbidity of postoperative allodynia.

Adult↗
PubMed2004

Chiari Type II malformation: past, present, and future.

OBJECT: The Chiari Type II malformation (CM II) is a unique hindbrain herniation found only in patients with myelomeningocele and is the leading cause of death in these individuals younger than 2 years of age. Several theories exist as to its embryological evolution and recently new theories are emerging as to its treatment and possible prevention. A thorough understanding of the embryology, anatomy, symptomatology, and surgical treatment is necessary to care optimally for children with myelomeningocele and prevent significant morbidity and mortality. METHODS: A review of the literature was used to summarize the clinically pertinent features of the CM II, with particular attention to pitfalls in diagnosis and surgical treatment. CONCLUSIONS: Any child with CM II can present as a neurosurgical emergency. Expeditious and knowledgeable evaluation and prompt surgical decompression of the hindbrain can prevent serious morbidity and mortality in the patient with myelomeningocele, especially those younger than 2 years old. Symptomatic CM II in the older child often presents with more subtle findings but rarely in acute crisis. Understanding of CM II continues to change as innovative techniques are applied to this challenging patient population.

Abnormalities, Multiple↗
PubMed2000

Bilateral median nerve compression at the level of Struthers' ligament. Case report.

Struthers' ligament syndrome is a rare cause of median nerve entrapment. Bilateral compression of the median nerve is even more rare. It presents with pain, sensory disturbance, and/or motor function loss at the median nerve's dermatomal area. The authors present the case of a 21-year-old woman with bilateral median nerve compression caused by Struthers' ligament. She underwent surgical decompression of the nerve on both sides. To the authors' knowledge, this case is the first reported bilateral compression of the median nerve caused by Struthers' ligament. The presentation and symptomatology of Struthers' ligament syndrome must be differentiated from median nerve compression arising from other causes.

Adult↗
PubMed2002

Rotational vertebral artery occlusion from occipital bone anomaly: a rare cause of embolic stroke. Case report.

Vertebral artery (VA) occlusion by rotation of the head is uncommon, but can result from mechanical compression of the artery, trauma, or atlantoaxial instability. Occipital bone anomalies rarely cause rotational VA occlusion, and patients with nontraumatic intermittent occlusion of the VA usually present with compromised vertebrobasilar flow. A 34-year-old man suffered three embolic strokes in the vertebrobasilar system within 2 months. Magnetic resonance imaging demonstrated multiple infarcts in the vertebrobasilar territory. Angiography performed immediately after the third attack displayed an embolus in the right posterior cerebral artery. Radiographic and three-dimensional computerized tomography bone images exhibited an anomalous osseous process of the occipital bone projecting to the posterior arch of the atlas. Dynamic angiography indicated complete occlusion of the left VA between the osseous process and the posterior arch while the patient's head was turned to the right. Surgical decompression of the VA resulted in complete resolution of rotational occlusion of the artery. An occipital bone anomaly can cause rotational VA occlusion at the craniovertebral junction in patients who present with repeated embolic strokes resulting from injury to the arterial wall.

Adult↗