36 research outputs found
Pathological femoral neck fracture caused by an echinococcus cyst of the vastus lateralis - case report
<p>Abstract</p> <p>Background</p> <p>Musculoskeletal hydatid cysts are rare, but being locally invasive, can potentially cause significant deformity or pathological fracture.</p> <p>Case presentation</p> <p>A 39 y.o. male presented to our orthopaedic outpatient clinic complaining of severe right hip pain, and inability to ambulate. Symptoms were not preceded by trauma. Subsequent imaging confirmed a large, 17 × 3 × 5 cm echinococcus cyst in the vastus lateralis, causing erosion of the proximal metaphysis of the femur. As a consequence the patient suffered a non-traumatic pathological intertrochanteric femur fracture. The patient was treated with an en-bloc excision of the lesion - the affected soft tissue envelope containing the large cyst - and as a second surgical step a cemented total hip replacement (THR) was implanted under the same anaesthetic.</p> <p>The manuscript reviews the literature regarding musculoskeletal hydatid disease.</p
Whole body bone scintigraphy in osseous hydatosis: a case report
Hydatid disease is common in many parts of the world, and causes considerable health and economic loss. This disease may develop in almost any part of the body
Minimum Two-Year Follow-Up of Cases with Recurrent Disc Herniation Treated with Microdiscectomy and Posterior Dynamic Transpedicular Stabilisation
The objective of this article is to evaluate two-year clinical and radiological follow-up results for patients who were treated with microdiscectomy and posterior dynamic transpedicular stabilisation (PDTS) due to recurrent disc herniation. This article is a prospective clinical study. We conducted microdiscectomy and PDTS (using a cosmic dynamic screw-rod system) in 40 cases (23 males, 17 females) with a diagnosis of recurrent disc herniation. Mean age of included patients was 48.92 ± 12.18 years (range: 21-73 years). Patients were clinically and radiologically evaluated for follow-up for at least two years. Patients’ postoperative clinical results and radiological outcomes were evaluated during the 3rd, 12th, and 24th months after surgery. Forty patients who underwent microdiscectomy and PDTS were followed for a mean of 41 months (range: 24-63 months). Both the Oswestry and VAS scores showed significant improvements two years postoperatively in comparison to preoperative scores (p<0.01). There were no significant differences between any of the three measured radiological parameters (α, LL, IVS) after two years of follow-up (p > 0.05). New recurrent disc herniations were not observed during follow-up in any of the patients. We observed complications in two patients. Performing microdiscectomy and PDTS after recurrent disc herniation can decrease the risk of postoperative segmental instability. This approach reduces the frequency of failed back syndrome with low back pain and sciatica
Meta-analysis of pre-clinical studies of early decompression in acute spinal cord injury:a battle of time and pressure
The use of early decompression in the management of acute spinal cord injury (SCI) remains contentious despite many pre-clinical studies demonstrating benefits and a small number of supportive clinical studies. Although the pre-clinical literature favours the concept of early decompression, translation is hindered by uncertainties regarding overall treatment efficacy and timing of decompression.We performed meta-analysis to examine the pre-clinical literature on acute decompression of the injured spinal cord. Three databases were utilised; PubMed, ISI Web of Science and Embase. Our inclusion criteria consisted of (i) the reporting of efficacy of decompression at various time intervals (ii) number of animals and (iii) the mean outcome and variance in each group. Random effects meta-analysis was used and the impact of study design characteristics assessed with meta-regression.Overall, decompression improved behavioural outcome by 35.1% (95%CI 27.4-42.8; I(2)=94%, p<0.001). Measures to minimise bias were not routinely reported with blinding associated with a smaller but still significant benefit. Publication bias likely also contributed to an overestimation of efficacy. Meta-regression demonstrated a number of factors affecting outcome, notably compressive pressure and duration (adjusted r(2)=0.204, p<0.002), with increased pressure and longer durations of compression associated with smaller treatment effects. Plotting the compressive pressure against the duration of compression resulting in paraplegia in individual studies revealed a power law relationship; high compressive forces quickly resulted in paraplegia, while low compressive forces accompanying canal narrowing resulted in paresis over many hours.These data suggest early decompression improves neurobehavioural deficits in animal models of SCI. Although much of the literature had limited internal validity, benefit was maintained across high quality studies. The close relationship of compressive pressure to the rate of development of severe neurological injury suggests that pressure local to the site of injury might be a useful parameter determining the urgency of decompression
Surgical management for instability and paraplegia caused by spinal sarcoidosis - A case report
Study Design. Report of a patient with paraplegia caused by vertebral
sarcoidosis. Objectives. To report a rare case of vertebral sarcoidosis
accompanied by progressive neurologic symptoms from the lower
extremities, and to discuss the diagnostic and therapeutic approach to
its management.
Summary of Background Data. Vertebral sarcoidosis is a rare condition,
and only a few case reports exist in the literature, A needle or open
biopsy is required to establish the diagnosis. In most cases, treatment
with steroids improves associated neurologic symptoms. Operative
intervention is necessary in cases with progressive vertebral
destruction, spinal instability, and impending or progressive neurologic
deterioration.
Methods. Operative treatment by a two-stage anterior vertebrectomy and
fusion followed by posterior stabilization was given to a patient with
vertebral sarcoidosis and progressive neurologic deterioration of the
lower extremities.
Results, After surgery, the patient had a complete neurologic recovery
and satisfactory spinal fusion.
Conclusions. In the absence of any spinal instability, neurologic
symptoms associated with vertebral sarcoidosis respond satisfactorily to
nonoperative treatment with steroids. Progressive neurologic
deterioration or spinal instability caused by bone destruction requires
operative intervention. Anterior vertebrectomy and fusion combined with
posterior stabilization provided a satisfactory result for the patient
in this report
Hydatid disease of bones and joints - 8 cases followed for 4-16 years
Hydatid disease is a rare parasitic disease that seldom involves the
skeleton. Treatment is difficult because of problems with the
preoperative diagnosis, the invasive nature of the bony involvement and
the variable anaphylactic reaction to the cyst fluid antigen. We present
8 cases with osseous hydatidosis who were treated over a period of 11
years. The spine was involved in 2 cases, the ilium in 2, the hip in 2,
the tibia in 1 and the humerus in 1. We point out that diagnosis is
difficult and the prognosis is often poor
Evaluation of pedicle screw position in thoracic and lumbar spine fixation using plain radiographs and computed tomography - A prospective study of 35 patients
Study Design. This was a prospective study of 35 consecutive patients in
whom pedicle screw position was assessed after surgery, using lateral
radiographs and computed tomography.
Objective. To evaluate the accuracy of plain radiographs and computed
tomography in assessment: of pedicle screw position.
Summary of Background Data. Imaging techniques, such as postoperative
anteroposterior and lateral plain radiographs and computed tomography,
are currently the primary means of assessing pedicle screw placement.
Methods. Postoperative radiographs and computed tomographic scans were
used to evaluate the position of 220 pedicle screws inserted in the
spines of 35 consecutive patients who underwent thoracic and lumbar
spine fusion and instrumentation. No recognized neurologic complication
resulted from pedicle screw placement. Screw position was graded as in,
out, or questionable. All observations were performed independently by
three observers. The authors also analyzed the position of the screws
according to the underlying spinal disease.
Results. More misplaced screws were clearly seen on computed tomographic
scans than on plain radiographs; however, this difference was not
statistically significant. Interobserver differences were not
statistically significant. Intraobserver differences approached
statistical significance when the results of the two tests were
compared.
Conclusions. Although the accuracy of computed tomographic imaging is
better than that of plain radiographs, the difference does not reach
statistical significance. Postoperative use of plain radiographs remains
a reliable method for evaluation of pedicle screw insertion in the
absence of neurologic deficit