3-Ethyl­sulfanyl-5-methyl-1-phenyl-7-(pyrrolidin-1-yl)-1H-pyrimido[4,5-e][1,3,4]thia­diazine

In the crystal structure of the title compound, C18H21N5S2, the thia­diazine six-membered ring and pyrrolidine five-membered ring display boat and envelope conformations, respectively. The crystal structure contains weak C—H⋯N and C—H⋯S hydrogen bonding

Painful torticollis due to tubercular atlantoaxial rotatory fixation: A case report

Background: Tubercular atlantoaxial, rotary dislocation warranting fixation (AARF) is an extremely rare event. Case Description: AARF was suspected in a 23-year-old female with painful torticollis. When diagnostic studies documented unilateral destruction of the left lateral mass of the atlas, she underwent removal of the lateral mass, reduction of the deformity, and C1-C2 fusion/reconstruction utilizing an iliac bone graft. Laboratory tests and the pathologic surveys were all consistent with the diagnosis of underlying tuberculosis. Conclusion: We present a case of tubercular atlantoaxial, rotary dislocation (AARF) in a patient who warranted C1-C2 decompression, reduction, and fusion. © 2020 Published by Scientific Scholar on behalf of Surgical Neurology International

Paraganglioma of the filum terminal: Case report and review of the literature

Paraganglioma of the filum terminal/cauda equina is a rare slow growing tumor which originates from the ectopic sympathetic neurons. Surgically, total excision may be difficult for this well demarcated tumor surrounded by couple of rootlets but is usually possible in nearly all cases. Actually, final diagnosis cannot be determined intraoperatively, but is possible only after an immunohistochemical staining. Herein, the authors present a middle age woman whose initial symptoms were lower back pain and radiculopathy. Her MRI was found to be compatible with a cauda equina tumor. During her excisional surgery a hard and relatively vascular tumor was fully removed. The Immunohistochemical results were compatible with paraganglioma of the filum terminale. In addition to case presentation, thorough review of the literature is also done. © 202

Unstable os odontoideum contributing to cervical myelopathy and obstructive sleep apnea

Background: Sleep apnea is characterized by repetitive cessation of breathing during sleep. It may be attributed to obstructive, central, or mixed pathologies close to the upper airway resulting in a decreased diameter of the oropharyngeal tract. Case Description: A 36-year-old male with progressive cervicomedullary myelopathy/quadriparesis exhibited obstructive sleep apnea (OSA) attributed to an anteriorly displaced os odontoideum (OO). Atlantoaxial screw-rod stabilization resulted in improvement of both neurological function and OSA. Conclusion: A symptomatic unstable OO may contribute to suboccipital pain, progressive quadriparesis, vertebrobasilar insufficiency, and OSA. Appropriate operative intervention utilizing atlantoaxial screw-rod stabilization may help to resolve these deficits. © 2019 Published by Scientific Scholar on behalf of Surgical Neurology Internationa

Acute traumatic sequestrated thoracic disc herniation: A case report and review

Background: Pure sequestrated thoracic disc herniations secondary to a traumatic event are rare. Case Description: Elderly male presented with the sudden onset of severe paraparesis following a fall. The MR showed a left-sided extruded disc at the T10-T11. The patient underwent a thoracic interlaminar laminectomy, removal of one large, and several smaller sequestrated disc fragments utilizing a transfacet corridor requiring placement of an interbody Peek cage, and bilateral T10 and T11 pedicle screw instrumentation. At 6 postoperative months, he sustained a good recovery. Conclusion: Acute thoracic disc herniations without attendant fracture/dislocation are rare. When they result in major neurological deficits, timely surgical excision is warranted. © 2021 Published by Scientific Scholar on behalf of Surgical Neurology International

Triple-level degenerative spondylolisthesis and the importance of spinopelvic parameters: Case report

Background: Lumbar degenerative spondylolisthesis typically occurs at a single vertebral level and infrequently at two separate levels. However, a triple level lumbar degenerative anterolisthesis is an extremely rare clinical scenario. The preservation or restoration of sagittal balance with the consideration of the observed spinopelvic parameters is of a cardinal importance in multilevel level DS than in single level DS. Presentation of the case: An evaluation of a middle-aged woman with persistent radiculopathy and neurogenic claudication revealed a three-level degenerative anterolisthesis from L3 to S1. With the placement of Iliac to L3 screw rod fixation in association with a decompressive laminectomy, a three-level interbody fusion and three level Smith Petersen osteotomies; a desirable lordosis and sagittal balance was preserved. She is ambulating well at a 9-month follow-up encounter. Conclusion: Three level continuous degenerative anterior spondylolisthesis of the lumbar spine is a very rare clinical scenario being reported in only one previous instance throughout medical literature. The key initiative in the management of this condition is the preservation or correction of any sagittal imbalance present. © 202

Symptomatic pulmonary cement embolism after pedicle screw polymethylmethacrylate cement augmentation: A case report and review

Background: In osteoporotic patients, a useful technique for significantly enhancing the strength of a pedicle screw is augmentation with polymethylmethacrylate cement. However, a rare complication of this procedure is a symptomatic pulmonary cement embolism. Case Description: A pedicle screw cement augmentation was performed in a middle-aged female for the failed back syndrome. When she developed symptomatic pulmonary cement emboli, she was successfully managed with conservative measures, including anticoagulation. Conclusion: Despite the increased use of cement augmentation for pedicle screw placement and the relatively high incidence of cement leakage into the prevertebral venous system, symptomatic cement pulmonary embolism remains rare. The management of such symptomatic CPE should be evaluated and treated based on both the size and location of the embolism. Here, we presented this case while reviewing three symptomatic and four asymptomatic cases from the literature. © 2020 Scientific Scholar. All rights reserved

Comparative study of the effect of warming at various temperatures on biochemical, hematologic, and hemodynamic parameters during spinal fusion surgery under intravenous anesthesia

Background: Perioperative inadvertent hypothermia (PIH) commonly occurs after major surgical procedures under local or general anesthesia and increases the risk of complications such as organ failure, hypoperfusion, and peripheral vasoconstriction, as well as adverse postoperative outcomes, such as wound infection and increased surgical bleeding. Objectives: We hypothesized that the intra-operative warming may affect these complications and thus, we aimed to compare the most appropriate temperature of the warmer to decrease patients� complications. Methods: The present randomized clinical trial investigated 90 patients undergoing total intravenous anesthesia in posterior spinal fusion surgery, randomly divided into two groups of 45. The warmer was set at 38°C for group �A� during surgery and at 40°C for group �B.� Patient�s demographic characteristics, the serum level of hemoglobin, hematocrit, and platelet counts, mean core temperature, systolic blood pressure (BP), heart rate, and respiratory rate were recorded before and after the surgery. Variables were compared between the two groups at three time intervals (during induction, during operation, and during recovery). Results: The mean temperature was not different between the two groups at the three time intervals. Other laboratory serum tests, vital signs, and oxygen consumption were maintained within the normal range although they did not improve significantly in two groups at the three time intervals. Conclusions: There was no significant difference in warming of the patients during operation at 38 or 40°C to prevent hypothermia-induced complications during induction, operation, and recovery. © 2018, Author(s)