The Treatment of Morton’s Neuroma, a Significant Cause of Metatarsalgia for People Who Exercise

Morton’s Neuroma is a common metatarsalgia in athletes created due to the entrapment of the inter-digital nerve inside the transverse inter-metatarsal ligament. The purpose of the present study is to draw the necessary conclusions from the use of a particular surgical treatment to release the digital nerve, accompanied by neurolysis in adults who exercise. On the whole, twenty five patients with twenty-five suffering extremities were treated. Five of them simultaneously had a Hallux Valgus type deformity and that supports the belief of the mechanical induce of this condition. Both ultrasonography and Magnetic Resonance Imaging (MRI) were used for the clinical evaluation of this condition. The pain was estimated via the Visual Analogue Scale (VAS). The patients were re-examined after three (1st postoperative), twelve (2nd postoperative) and twenty-four (3rd postoperative) months. A significant improvement (p < 0.0001) was noticed from the correlation between the pain before the surgery and the pain after the surgery via the Visual Analogue Scale (VAS). Most patients (15/25) did not display any discomfort or sensory disorder after surgery. The correct clinical evaluation as well as the correct and effective surgical intervention with the simultaneous repair of all the mechanical deformities of the foot provided better post-surgery progress in patients and increased the percentage of their rehabilitation of their previous activities

Pathophysiology and Biomechanics of the Aging Spine

Aging of the spine is characterized by two parallel but independent processes: the reduction of bone mineral density and the development of degenerative changes. The combination of degeneration and bone mass reduction contribute, to a different degree, to the development of a variety of lesions. This results in a number of painful and often debilitating disorders. The present review constitutes a synopsis of the pathophysiological processes that take place in the aging spine as well as of the consequences these changes have on the biomechanics of the spine. The authors hope to present a thorough yet brief overview of the process of aging of the human spine

Treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty

<p>Abstract</p> <p>Background</p> <p>In oncologic patients with metastatic spinal disease, the ideal treatment should be well tolerated, relieve the pain, and preserve or restore the neurological function.</p> <p>The combination of fluoroscopic guided radiofrequency ablation (RFA) and kyphoplasty may fulfill these criteria.</p> <p>Methods</p> <p>We describe three pathological vertebral fractures treated with a combination of fluoroscopic guided RFA and kyphoplasty in one session: a 62-year-old man suffering from a painful L4 pathological fracture due to a plasmocytoma, a 68-year-old man with a T12 pathological fracture from metastatic hepatocellular carcinoma, and a 71-year-old man with a Th12 and L1 pathological fracture from multiple myeloma.</p> <p>Results</p> <p>The choice of patients was carried out according to the classification of Tomita. Visual analog score (VAS) and Oswestry disability index (ODI) were used for the evaluation of the functional outcomes. The treatment was successful in all patients and no complications were reported. The mean follow-up was 6 months. Marked pain relief and functional restoration was observed.</p> <p>Conclusion</p> <p>In our experience the treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty is safe and effective for immediate pain relief in painful spinal lesions in neurologically intact patients.</p

The Value of Cryosurgery in Treating a Case of Thoracic Chondrosarcoma

Chondrosarcomas of the spine are rare and difficult to treat. In this paper a case of thoracic chondrosarcoma is presented. Chondrosarcomas of the spine are generally smaller, more difficult to excise and are followed by higher local recurrence compared with chondrosarcomas of the peripheral skeleton. The tumor is radio- and chemoresistant, making the surgical treatment of utmost importance. The most important prognostic factor for local control is wide or marginal tumor resection. Our patient was treated in two stages, with total excision of the tumor, using cryosurgery. Liquid nitrogen was used to freeze the damaged tissue at a cellular level and made the excision more efficient

Posterior Instrumentation for Occipitocervical Fusion

Since 1995, 29 consecutive patients with craniocervical spine instability due to several pathologies were managed with posterior occipitocervical instrumentation and fusion. Laminectomy was additionally performed in nineteen patients. The patients were divided in two groups: Group A which included patients managed with screw-rod instrumentation, and Group B which included patients managed with hook-and-screw-rod instrumentation. The patients were evaluated clinically and radiographically using the following parameters: spine anatomy and reconstruction, sagittal profile, neurologic status, functional level, pain relief, complications and status of arthrodesis. The follow-up was performed immediately postoperatively and at 2, 6, 12 months after surgery, and thereafter once a year. Fusion was achieved in all but one patient. One case of infection was the only surgery related complication. Neurological improvement and considerable pain relief occurred in the majority of patients postoperatively. There were neither intraoperative complications nor surgery related deaths. However, the overall death rate was 37.5% in group A, and 7.7% in group B. There were no instrument related failures. The reduction level was acceptable and was maintained until the latest follow-up in all of the patients. No statistical difference between the outcomes of screw-rod and hook-and-screw-rod instrumentation was detected. Laminectomy did not influence the outcome in either group. Screw-rod and hook-and-screw-rod occipitocervical fusion instrumentations are both considered as safe and effective methods of treatment of craniocervical instability

Spinal Chondrosarcoma: A Review

Chondrosarcoma is the third most common primary malignant bone tumor. Yet the spine represents the primary location in only 2% to 12% of these tumors. Almost all patients present with pain and a palpable mass. About 50% of patients present with neurologic symptoms. Chemotherapy and radiotherapy are generally unsuccessful while surgical resection is the treatment of choice. Early diagnosis and careful surgical staging are important to achieve adequate management. This paper provides an overview of the histopathological classification, clinical presentation, and diagnostic procedures regarding spinal chondrosarcoma. We highlight specific treatment modalities and discuss which is truly the most suitable approach for these tumors. Abstracts and original articles in English investigating these tumors were searched and analyzed with the use of the PubMed and Scopus databases with “chondrosarcoma and spine” as keywords

Bilateral gluteal metastases from a misdiagnosed intrapelvic gastrointestinal stromal tumor

<p>Abstract</p> <p>Background</p> <p>The location of gastrointestinal stromal tumors (GIST) outside of the gastrointestinal system is a rare event.</p> <p>Case presentation</p> <p>A 56-year old woman presented with a GIST of the pelvis was misdiagnosed and treated as a uterine leiomyosarcoma. The diagnosis was made after the CD117 (KIT) positivity in the biopsy of the excised bowel mass four years from the first presentation. During this period she presented a bilateral muscle and subcutaneous metastasis in the gluteal area.</p> <p>Conclusion</p> <p>The correct diagnosis of the extra-gastrointestinal stromal tumor is a challenge even for experienced pathologists. CD117 (KIT) positivity is the most important immunohistochemical feature in the histological diagnosis. To our knowledge a metastatic EGIST (extra-gastrointestinal stromal tumor) to the skeletal muscle bilaterally has not been described previously in the English medical literature.</p