Confusion after spine injury: cerebral fat embolism after traumatic rupture of a Tarlov cyst: Case report

<p>Abstract</p> <p>Background</p> <p>Acute low back pain is a very common symptom and reason for many medical consultations. In some unusual circumstances it could be linked to a rare aetiology.</p> <p>Case presentation</p> <p>We report a 70-year-old man with an 8-month history of left posterior thigh and leg pain who had sudden confusion after a fall from standing. It was due to cerebral fat embolism suspected by computed tomography scan, later confirmed by brain magnetic resonance imaging (MRI). A spinal MRI scan was then performed and revealed a sacral fracture which drained into an unknown perineurial cyst (Tarlov cyst). Under medical observation the patient fully recovered within three weeks.</p> <p>Conclusions</p> <p>Sacral perineurial cysts are rare, however they remain a potential cause of lumbosacral radiculopathy.</p

Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes

Object Adult degenerative scoliosis can be a cause of intractable pain, decreased mobility, and reduced quality of life. Surgical correction of this problem frequently leads to substantial clinical improvement, but advanced age, medical comorbidities, osteoporosis, and the rigidity of the spine result in high surgical complication rates. Minimally invasive surgery is being applied to this patient population in an effort to reduce the high complication rates associated with adult deformity surgery. Methods A retrospective study of 23 patients was undertaken to assess the clinical and radiographic results with minimally invasive surgery for adult thoracolumbar deformity surgery. All patients underwent a lateral interbody fusion followed by posterior percutaneous screw fixation and possible minimally invasive surgical transforaminal lumbar interbody fusion if fusion near the lumbosacral junction was necessary. A mean of 3.7 intersegmental levels were treated (range 2–7 levels). The mean follow-up was 13.4 months. Results The mean preoperative Cobb angle was 31.4°, and it was corrected to 11.5° at follow-up. The mean blood loss was 477 ml, and the operative time was 401 minutes. The mean visual analog scale score improvement for axial pain was 3.96. Clear evidence of fusion was seen on radiographs at 84 of 86 treated levels, with no interbody pseudarthroses. Complications included 2 returns to the operating room, one for CSF leakage and the other for hardware pullout. There were no wound infections, pneumonia, deep venous thrombosis, or new neurological deficits. However, of all patients, 30.4% experienced new thigh numbness, dysesthesias, pain, or weakness, and in one patient these new symptoms were persistent. Conclusions The minimally invasive surgical treatment of adult deformities is a promising method for reducing surgical morbidity. Numerous challenges exist, as the surgical technique does not yet allow for all correction maneuvers used in open surgery. However, as the techniques are advanced, the applicability of minimally invasive surgery for this population will likely be expanded and will afford the opportunity for reduced complications

The MiSLAT Algorithm: Minimally Invasive Evaluation and Treatment for Adult Degenerative Deformity

The goals of adult spinal deformity treatment are to reduce pain, arrest progression of the deformity, restore sagittal and coronal balance, improve neurological function, and improve cosmesis. Traditional open approaches can achieve these goals. However, surgical treatment of adult spinal deformity is associated with substantial surgical risks, especially due to the increased age and associated medical comorbidities of many patients with adult spinal deformity. Open scoliosis surgery is associated with prolonged operative times and significant blood loss. Complication rates of adult deformity surgery are as high as 41.2 % [1]. A recent International Spine Study Group (ISSG) study reviewed a total of 953 adult spinal deformity patients with minimum 2-year follow-up to identify patients with major perioperative complications. Ninety-nine major complications were observed in 72 patients (7.6 %). The most common complications were excessive blood loss (>4 L) and deep wound infection requiring reexploration of the wound and pulmonary embolism [2]. Minimally invasive approaches for adult spinal deformity surgery have been developed to address the high perioperative morbidity of traditional open approaches [3–6]