Intervertebral Disc Characteristic on Progressive Neurological Deficit

Objective: To examine the intervertebral disc characteristic on magnetic resonance imaging (MRI) in lumbar herniated disc (LHD) patients with progressive neurological deficit.Methods: Patients were collected retrospectively from Dr. Hasan Sadikin General Hospital Database from 2011–2013 with LHD, had neurological deficit such as radiculopathy and cauda equine syndrome for less than four weeks with a positive sign confirmed by neurological examination and confirmatory with MRI examination.Results: A total of 14 patients with lumbar herniated disc disease (10 males, 4 females) suffered from progressive neurological deficit with an average age of (52.07±10.9) years old. Early disc height was 9.38±0.5 mm and progressive neurological deficit state disc height was 4.03±0.53 mm, which were significantly different statisticaly (p<0.01). Symptoms of radiculopathy were seen in 11 patients and cauda equine syndrome in three patients. Modic changes grade 1 was found in five patients, grade 2 in eight patients,grade 3 in one patient, Pfirmman grade 2 in eleven patients and grade 3 in three patients. Thecal sac compression 1/3 compression was seen in four patients and 2/3 compression in ten patients.Conclusions: Neurosurgeon should raise concerns on the characteristic changes of intervertebral disc in magnetic resonance imaging examination to avoid further neural injury in lumbar herniated disc patients.Keywords: Lumbar herniated disc, magnetic resonance imaging, progressive neurological deficit DOI: 10.15850/ijihs.v5n2.1042 

Penetrating Wound in the Skull by a Sharp Metal Object

Objective: Penetrating skull injury (PSI) is a neurosurgical emergencies. Most PSI cases reported were caused by gunshot wounds. Although the diagnosis and management of those cases has been described, the actual cases, especially in our center, were quite rare.Methods: A craniectomy debridement with a supine position was performed and removal of the object was achieved. Intraoperatively, we succed control the bleeding as expected.Results: The patient was operated and hospitalized in our center; physical examination revealed neurologically intact before and after the removal of the object. The patient was sent home without any neurological deficits or other complications.Conclusions: We reported a case of penetrating skull injury in a 5-year-old girl caused by a scissors. Penetrating skull injuries were interesting due to its mechanism, management and complications. Early diagnosis and appropriate treatment should resulted in good outcomes.Keywords: Penetrating skull injury, a sharp metal object DOI: 10.15850/ijihs.v3n2.58

Controversies in Traumatic Brain Injury: Neurotrauma Experience in Bandung Indonesia

Objective: Despite progress in the management TBI, several controversies and questions such as the best use of technological advances and the data obtained from multimodality monitoring, the use of mannitol and hypertonic saline, decompressive craniectomy and barbiturate coma, therapeutic hypothermia, anemia and the role of blood transfusion, and venous thromboembolism prophylaxis in TBI. Our Hospital implementing the multimodal treat- ment for TBI patients.Materials and Methods: This is a multicenter study, conducted at Spine Research Working Group, Division of Neurospine, Pain and Peripheral Nerve Department of Neurosurgery, Faculty of Medicine Universitas Pad- jadjaran – Dr. Hasan Sadikin Hospital, Bandung, Division of Neurotrauma, Department of Neurosurgery, Faculty of Medicine Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia. The duration of study 1 year from Jan. 2011 to Dec. 2012.Results: In our hospital, within 1 year, the total number of cases of TBI were 2069, or 173 cases / month. The caused of TBI is dominated by traffic accident 1498 (73%) from total cases. Male were more dominant 1537 (74%) compare to female 532 (26%). There were 1488 (72%) cases of mild head injury, 401 (19%) of moderate head injury and 180 (9%) cases of severe head injury. Among the traffic accidents motorbike accidents were predominant, 1132 (55%) cases, followed by pedestrian 322 (16%) cases, falling down 293 (14%) cases, cars 44 (0.2%) cases, crimes 27 (0.1%) cases and others like house family abuse and so on, in 251 (14.7%) cases respec- tively. Time interval from the occurrence site to the hospital was &lt; 4 hours 1008 cases and the rest are &gt; 4 hours. Clinically, we found 1953 (94%) with pupil equal. The mortality rate caused by Traumatic Brain Injury (TBI) in Indonesia on 2011 is 6.2 – 11.2% which is two times compare to the international literature (3 – 8%). Most of them are young adult. However there are still controversies in term of management of TBI.Conclusion: There have been many controversies in the management of TBI. It is depend on the resource and experience of the trauma centre itself. Nevertheless it has to be focus on patient priority and outcomes

Morphometric Analysis of the Corpus, Spinal Canal and Torg Ratio Using Midsagittal Cervical Vertebrae Computed Tomography Scan: Indonesian Population

Objective: To determine the normal ranges of cervical spinal canal morphometry in Indonesian population and to compare the acquired data collected from other populationsMethods: Computed tomography measurements on the diameter of midsagital spinal canal and corpus of cervical vertebrae and its Torg ratio from the lower cervical (C3-C7) canal from 24 normal Indonesian adults were performed at the Radiology Department of Dr. Hasan Sadikin General Hospital. Patients who had cervical spine disorders and those under 20 years old were exluded.  We used computed tomography scan midsagittal view to measure the aforementioned parameters.    Results: The average diameter for the cervical spinal canals for the Indonesian population is comparable with those of other Asian populations such as Hongkong and India, albeit with smaller Torg ratio.     Conclusions: This study reports the normal radiological anatomy of the midsagital spinal canal and corpus of cervical vertebrae as well as Torg ratio from the lower cervical vertebrae among Indonesian population. The measurements result of this study shows that, although slightly smaller, the measurement results for those parameters are identical with other Asian populations.    Keywords: Corpus cervical vertebrae, midsagittal cervical spinal canal, Torg ratio DOI: 10.15850/ijihs.v2n1.28

Fetus inside Brain - Mature Cystic Teratoma in Posterior Fossa

Objective: To describe a rare case of posterior fossa cystic teratoma in central nervous system. Methods: A 2-year old boy was admitted with a chief complaint of decreased consciousness with tonic clonic seizure. Non-Contrast Head Computed Tomography (NCCT) scan showed acute hydrocephalus and a well-defined extra-axial cystic lesion mass, 3.4x3.9x4.2 cm in size, in the posterior fossa.Results: Patient underwent a total resection of the tumor. No systemic complication was found in ten days following the surgery. There was no evidence of tumor recurrence one year after the surgery. The histopathologycal diagnosis of the tumor was cystic teratoma.Conclusions: Mature cyst teratoma located in the posterior fossa is a rare case. Total resection and long-term follow up is the treatment of choice for mature teratoma.Keywords: Hydrocephalus, posterior fossa, teratoma DOI: 10.15850/ijihs.v4n1.68

Aseptic Spondylodiscitis Resulting from Intradiscal Radiofrequency Ablation (IDRA) in Patients with Herniated Disc Disease: A Report of Ten Cases

Objective The purpose of this study was to investigate the clinical presentation, radiological features, management, and outcomes of aseptic spondylodiscitis after Intradiscal radiofrequency ablation (IDRA). Methods Between 2014 and 2015, ten patients were diagnosed with aseptic spondylodiscitis due to significant back pain after IDRA and were assessed with medical record review, telephone interviews, and imaging. The follow-up period was 12 months. Results The patients developed significant axial pain after the procedure (VAS, 2±1.6 to 8±0.7, p<0.001). Laboratory findings, including WBC, ESR, and CRP, were nonspecific. Magnetic Ressonance Imaging (MRI) showed low intensity on T1-weighted images, heterogeneous intensity on T2-weighted images, and contrast enhancement on the subchondral area adjacent to the endplate. All patients were treated conservatively with non-steroidal anti-inflammatory drugs. Back pain improved gradually in 3 months (VAS, 5.5±1.3, p<0.01).All patients had no sequelae at final follow up. Conclusion IDRA may cause thermal injury to adjacent vertebrae. If a patient complains of significant back pain after IDRA and show osteonecrosis characteristic on MRI, aseptic spondylodiscitis should be considered. To prevent this complication, the correct location of the IDRA tip distant from the endplate should be confirmed by fluoroscopy during the procedure

Myelopathy Caused by Ossification of Thoracic Ligamentum Flavum

Hypertrophy of the posterior spinal elements leading to compromise of the spinal canal and its neural elements is a well-recognized pathological entity affecting the lumbar or cervical spine. Such stenosis of the thoracic spine in the absence of a generalized rheumatological,metabolic, or orthopedic disorder, or a history of trauma is generally considered to be rare. Spinal ligaments, such as the ligamentum flavum (LF), are prone to degeneration and can lead to back pain and nerve dysfunction. Ossification of ligamentum flavum (OLF) is a pathological condition that cause neurological symptoms and usually occurs in the thoracic spine and less frequently in the cervical spine. However the disease is now being increasingly recognized as acause of thoracic myelopathy. We report a rare case of thoracic myelopathy caused by OLF. A 48-year-old male presented with a chief complaint of weakness of bilateral lower extremities. Neurological examination revealed sensory deficit at Th 11 level below. Magnetic resonance imaging and computed tomography demonstrated OLF at the right T9–11 level. Thoracicmyelopathy caused by OLF was consider and surgical intervention was performed. Posterior decompression and laminoplasty has been performed for this patient

Myelopathy caused by Ossification of Thoracic Ligamentum Flavum

Hypertrophy of the posterior spinal elements leading to compromise of the spinal canal and its neural elements is a well-recognized pathological entity affecting the lumbar or cervical spine. Such stenosis of the thoracic spine in the absence of a generalized rheumatological,metabolic, or orthopedic disorder, or a history of trauma is generally considered to be rare. Spinal ligaments, such as the ligamentum flavum (LF), are prone to degeneration and can lead to back pain and nerve dysfunction. Ossification of ligamentum flavum (OLF) is a pathological condition that cause neurological symptoms and usually occurs in the thoracic spine and less frequently in the cervical spine. However the disease is now being increasingly recognized as acause of thoracic myelopathy. We report a rare case of thoracic myelopathy caused by OLF. A 48-year-old male presented with a chief complaint of weakness of bilateral lower extremities. Neurological examination revealed sensory deficit at Th 11 level below. Magnetic resonance imaging and computed tomography demonstrated OLF at the right T9–11 level. Thoracicmyelopathy caused by OLF was consider and surgical intervention was performed. Posterior decompression and laminoplasty has been performed for this patient. Keywords: ossification of ligamentum flavum, thoracic myelopathy, laminoplast

Trans-Sacral Epiduroscopic-Assisted 1,414-nm Nd:YAG Laser Decompression for Lumbar Discal Cyst: A Report of 9 Cases

Prevalence of lumbar discal cyst is very low, it can cause low back pain and radiating leg pain when present. Currently, trans-sacral epiduroscopic-assisted, 1,414-nm Nd:YAG laser decompression (SELD) is commonly used for spinal pathologies. However, the use of the laser for spinal procedures can be limited due to the risk of thermal injury. We reviewed nine consecutive patients who underwent SELD ablation for discal cyst between 2014 and 2015. Each patient underwent diagnostic imaging, including simple radiographs, computed tomography with discography, and magnetic resonance imaging (MRI). Pain relief and clinical outcome assessment of patient satisfaction was the primary outcome measure. All patients presented with back pain and unilateral radiating pain. The discal cyst was located in the lumbar region in all patients. Preoperative MRI showed a connection between the cyst and the involved intervertebral disc. All patients obtained immediate relief of symptoms after the discal cyst was treated with a SELD-assisted, 1,414-nm Nd:YAG laser. The mean visual analogue scale (VAS) for back pain was 7.89±0.78 preoperatively, 1.67±1.50 at the 1-month follow up, and 0.38±0.5 at the final follow up (p<0.01). All patients obtained excellent or good outcomes according to the modified MacNab's criteria. There were no complications. These cases demonstrated that trans-sacral, epiduroscopic-assisted, 1,414-nm Nd:YAG laser decompression was a safe, viable, and efficacious option for treating lumbar discal cyst because it lowers the risk of muscle injury and can be performed under local anesthesia