Spinal Diseases
Spinal Neoplasms
Intervertebral Disc Degeneration
Spondylitis, Ankylosing
Spinal Cord
Lumbar Vertebrae
Spinal Cord Injuries
Injections, Spinal
Spinal Nerves
Spinal Cord Diseases
Spinal Nerve Roots
Spinal Cord Neoplasms
Spinal Cord Compression
Spinal epidural abscess associated with epidural catheterization: report of a case and a review of the literature. (1/1040)
We describe a 53-year-old man who developed a catheter-related epidural abscess 8 days after left upper lobectomy for lung cancer. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus. Magnetic resonance imaging was essential for the diagnosis of epidural abscess and for determining the extent of spread. The patient was treated by laminectomy and administration of appropriate antibiotics, with almost complete recovery, except for urinary retention. A literature search yielded 29 additional cases of catheter-related epidural abscess. The median duration of catheterization was 4 days and the median time to onset of the clinical symptoms after catheter placement was 8 days. Eleven of the 30 patients had some underlying disorders, including malignancy or herpes zoster, or were receiving steroids. Nine of the 10 patients with thoracic epidural abscess had persistent neurological deficits, whereas 12 of the 15 patients with lumbar epidural abscess showed a full recovery after treatment. Surgical decompression was not required in six patients without significant neurological deficits, who recovered following antibiotic treatment (four patients) or percutaneous drainage (two patients). Thoracic catheters are associated with a disproportionately high incidence of epidural abscess and persistent neurological sequelae following treatment. (+info)A five-year assessment of controlled trials of in-patient and out-patient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Masan and Pusan, Korea. Fifth report of the Medical Research Council Working Party on tuberculosis of the spine. (2/1040)
In two centres in Korea 350 patients with a diagnosis of tuberculosis of the thoracic and/or lumbar spine were allocated at random: in Masan to in-patient rest in bed (IP) for six months followed by out-patient treatment or to ambulatory out-patient treatment (OP) from the start; in Pusan to out-patient treatment with a plaster-of-Paris jacket (J) for nine months or to ambulatory treatment without any support (No J). All patients recieved chemotherapy with PAS with isoniazid for eighteen months, either supplemented with streptomycin for the first three months (SPH) or without this supplement (PH), by random allocation. The main analysis of this report concerns 299 patients (eighty-three IP, eighty-three OP, sixty-three J, seventy No J; 143 SPH, 156 PH). Pre-treatment factors were similar in both centres except that the patients in Pusan had, on average, less extensive lesions although in a greater proportion the disease was radiographically active. One patient (J/SPH) died with active spinal disease and three (all No J/SPH) with paraplegia. A fifth patient (IP/PH) who died from cardio respiratory failure also had pulmonary tuberculosis. Twenty-three patients required operation and/or additional chemotherapy for the spinal lesion. A sinus or clinically evident abscess was either present initially or developed during treatment in 41 per cent of patients. Residual lesions persisted in ten patients (four IP, two OP, one J, three No J; six SPH, four PH) at five years. Thirty-two patients had paraparesis on admission or developing later. Complete resolution occurred in twenty on the allocated regimen and in eight after operation or additional chemotherapy or both. Of the remaining four atients, all of whom had operation and additional chemotherapy, three died and one still had paraparesis at five years. Of 295 patients assessed at five years 89 per cent had a favourable status. The proportions of the patients responding favourably were similar in the IP (91 per cent) and OP (89 per cent) series, in the J (90 per cent) and No J (84 per cent) series and in the SPH (86 per cent) and PH (92 per cent) series. (+info)Extradural inflammation associated with annular tears: demonstration with gadolinium-enhanced lumbar spine MRI. (3/1040)
Annular tears are manifest on MRI as the high-intensity zone (HIZ) or as annular enhancement. Patients with annular tears may experience low back pain with radiation into the lower limb in the absence of nerve root compression. Inflammation of nerve roots from leak of degenerative nuclear material through full-thickness annular tears is a proposed mechanism for such leg pain. The aim of this study is to illustrate the appearance of extradural enhancement adjacent to annular tears in patients being investigated for low back pain with radiation into the lower limb(s). Sagittal T1- and T2-weighted spin echo and axial T1-weighted spin echo sequences were obtained in eight patients being investigated for low back and leg pain. In all patients, the T1-weighted sequences were repeated following intravenous gadopentetate dimeglumine (Gd-DTPA). Annular tears were identified at 12 sites in eight patients. Extradural inflammation appeared as a region of intermediate signal intensity replacing the fat between the posterior disc margin and the theca, which enhanced following Gd-DTPA. The inflammatory change was always associated with an annular tear, and in four cases directly involved the nerve root. Enhancement of the nerve root was seen in two cases. The findings may be relevant in the diagnosis of chemical radiculopathy secondary to inflammation at the site of an annular leak from a degenerating disc. (+info)Can autologous bone culture predict spinal fusion capacity? (4/1040)
The capacity of the individual patient to initiate osteoblast proliferation as a predictor for successful lumbar spinal fusion has not yet been reported. The objectives of this study were, first, to analyze the relationship between in vitro osteoblast proliferation and clinical bony fusion in the individual patient in order to predict the fusion outcome and, second, to measure the effect of preoperative tobacco smoking on osteoblast proliferation. Sixty-one patients (mean age 46 years) underwent posterolateral lumbar fusion in the period 1994-1995. Thirty-eight patients received CD pedicle screw implants and 23 received posterolateral fusions alone. During surgery, autogenous iliac bone was harvested and 1 g of trabecular bone without blood or bone marrow was then isolated for cell culturing. The cultures were classified as excellent (confluence within 4 weeks), good (confluence between 4 and 6 weeks) and poor (no or poor growth). Spine fusion was evaluated by two independent observers from plain anterior-posterior, lateral, and flexion/extension radiographs taken 1 year postoperatively, and the functional outcome was measured by the Dallas Pain Questionnaire (DPQ). Twenty-three patients had excellent, 19 good, and 19 poor in vitro osteoblast proliferation. Bony fusion was obtained in 77% of patients: 83% in the CD instrumentation group and 70% in the non-instrumentation group (NS). There was no significant correlation between osteoblast proliferation and spinal fusion or functional outcomes when analyzing the CD instrumentation and non-instrumentation groups together or separately. Elderly patients had a significantly poorer osteoblast proliferation than younger patients (P < 0.008). Preoperative tobacco consumption had no discernible effect on osteoblast proliferation, and no correlation between smoking and fusion was found. Further refinement of autologous osteoblast culturing may provide a biological tool for selection of patients who require biological enhancement of their bone fusion capacity. The poorer osteoblast proliferation related to advanced age supports the important negative biological influence of age on bony fusion. However, with more sensitive testing and better discrimination, other results are possible - or can in any event not be excluded. (+info)Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. (5/1040)
A pulmonary embolus of acrylic cement was present in a 41-year-old woman with Langerhans' cell vertebral histiocytosis (LCH) after percutaneous vertebroplasty. Chest radiograph and CT confirmed pulmonary infarction and the presence of cement in the pulmonary arteries. She was treated with anticoagulants, and responded favorably. This rare complication occurred because perivertebral venous migration was not recognized during vertebroplasty. Adequate preparation of cement and biplane fluoroscopy are recommended for vertebroplasty. (+info)Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in three cases. (6/1040)
The MR imaging findings of fungal spinal osteomyelitis in three recipients of organ transplants showed hypointensity of the vertebral bodies on T1-weighted sequences in all cases. Signal changes and enhancement extended into the posterior elements in two cases. Multiple-level disease was present in two cases (with a total of five intervertebral disks involved in three cases). All cases lacked hyperintensity within the disks on T2-weighted images. In addition, the intranuclear cleft was preserved in four of five affected disks at initial MR imaging. MR features in Candida and Aspergillus spondylitis that are distinct from pyogenic osteomyelitis include absence of disk hyperintensity and preservation of the intranuclear cleft on T2-weighted images. Prompt recognition of these findings may avoid delay in establishing a diagnosis and instituting treatment of opportunistic osteomyelitis in the immunocompromised patient. (+info)Segmental spinal dysgenesis: neuroradiologic findings with clinical and embryologic correlation. (7/1040)
BACKGROUND AND PURPOSE: Segmental spinal dysgenesis (SSD) is a rare congenital abnormality in which a segment of the spine and spinal cord fails to develop properly. Our goal was to investigate the neuroradiologic features of this condition in order to correlate our findings with the degree of residual spinal cord function, and to provide insight into the embryologic origin of this disorder. We also aimed to clarify the relationship between SSD and other entities, such as multiple vertebral segmentation defects, congenital vertebral displacement, and caudal regression syndrome (CRS). METHODS: The records of patients treated at our institutions for congenital spinal anomalies were reviewed, and 10 cases were found to satisfy the inclusion criteria for SSD. Plain radiographs were available for review in all cases. MR imaging was performed in eight patients, one of whom also underwent conventional myelography. Two other patients underwent only conventional myelography. RESULTS: Segmental vertebral anomalies involved the thoracolumbar, lumbar, or lumbosacral spine. The spinal cord at the level of the abnormality was thinned or even indiscernible, and a bulky, low-lying cord segment was present caudad to the focal abnormality in most cases. Closed spinal dysraphisms were associated in five cases, and partial sacrococcygeal agenesis in three. Renal anomalies were detected in four cases, and dextrocardia in one; all patients had a neurogenic bladder. CONCLUSION: SSD is an autonomous entity with characteristic clinical and neuroradiologic features; however, SSD and CRS probably represent two faces of a single spectrum of segmental malformations of the spine and spinal cord. The neuroradiologic picture depends on the severity of the malformation and on its segmental level along the longitudinal embryonic axis. The severity of the morphologic derangement correlates with residual spinal cord function and with severity of the clinical deficit. (+info)Epidurography and therapeutic epidural injections: technical considerations and experience with 5334 cases. (8/1040)
BACKGROUND AND PURPOSE: Even in experienced hands, blind epidural steroid injections result in inaccurate needle placement in up to 30% of cases. The use of fluoroscopy and radiologic contrast material provides confirmation of accurate needle placement within the epidural space. We describe our technique and experience with contrast epidurography and therapeutic epidural steroid injections, and review the frequency of systemic and neurologic complications. METHODS: Epidural steroid injections were performed in 5489 consecutive outpatients over a period of 5 1/2 years by three procedural neuroradiologists. In 155 cases (2.8%), the injections were done without contrast material owing to either confirmed or suspected allergy. The remaining 5334 injections were performed after epidurography through the same needle. Patients and referring clinicians were instructed to contact us first regarding complications or any problem potentially related to the injection. In addition, the referring clinicians' offices were instructed to contact us regarding any conceivable procedure-related complications. RESULTS: Only 10 patients in the entire series required either oral (n = 5) or intravenous (n = 5) sedation. Four complications (0.07%) required either transport to an emergency room (n = 2) or hospitalization (n = 2). None of the complications required surgical intervention, and all were self-limited with regard to symptoms and imaging manifestations. Fluoroscopic needle placement and epidurography provided visual confirmation of accurate needle placement, distribution of the injectate, and depiction of epidural space disease. CONCLUSION: Epidurography in conjunction with epidural steroid injections provides for safe and accurate therapeutic injection and is associated with an exceedingly low frequency of untoward sequelae. It can be performed safely on an outpatient basis and does not require sedation or special monitoring. (+info)Spinal diseases refer to a range of medical conditions that affect the spinal column, which is made up of vertebrae (bones), intervertebral discs, facet joints, nerves, ligaments, and muscles. These diseases can cause pain, discomfort, stiffness, numbness, weakness, or even paralysis, depending on the severity and location of the condition. Here are some examples of spinal diseases:
1. Degenerative disc disease: This is a condition where the intervertebral discs lose their elasticity and height, leading to stiffness, pain, and decreased mobility.
2. Herniated disc: This occurs when the inner material of the intervertebral disc bulges or herniates out through a tear in the outer layer, causing pressure on the spinal nerves and resulting in pain, numbness, tingling, or weakness in the affected area.
3. Spinal stenosis: This is a narrowing of the spinal canal or the neural foramen (the openings where the spinal nerves exit the spinal column), which can cause pressure on the spinal cord or nerves and result in pain, numbness, tingling, or weakness.
4. Scoliosis: This is a curvature of the spine that can occur in children or adults, leading to an abnormal posture, back pain, and decreased lung function.
5. Osteoarthritis: This is a degenerative joint disease that affects the facet joints in the spine, causing pain, stiffness, and decreased mobility.
6. Ankylosing spondylitis: This is a chronic inflammatory disease that affects the spine and sacroiliac joints, leading to pain, stiffness, and fusion of the vertebrae.
7. Spinal tumors: These are abnormal growths that can occur in the spinal column, which can be benign or malignant, causing pain, neurological symptoms, or even paralysis.
8. Infections: Bacterial or viral infections can affect the spine, leading to pain, fever, and other systemic symptoms.
9. Trauma: Fractures, dislocations, or sprains of the spine can occur due to accidents, falls, or sports injuries, causing pain, neurological deficits, or even paralysis.
Spinal neoplasms refer to abnormal growths or tumors found within the spinal column, which can be benign (non-cancerous) or malignant (cancerous). These tumors can originate in the spine itself, called primary spinal neoplasms, or they can spread to the spine from other parts of the body, known as secondary or metastatic spinal neoplasms. Spinal neoplasms can cause various symptoms, such as back pain, neurological deficits, and even paralysis, depending on their location and size. Early diagnosis and treatment are crucial to prevent or minimize long-term complications and improve the patient's prognosis.
Intervertebral disc degeneration is a physiological and biochemical process that occurs in the spinal discs, which are located between each vertebra in the spine. These discs act as shock absorbers and allow for movement and flexibility of the spine.
The degenerative process involves changes in the structure and composition of the disc, including loss of water content, decreased production of proteoglycans (which help to maintain the disc's elasticity), and disorganization of the collagen fibers that make up the disc's outer layer (annulus fibrosus). These changes can lead to a decrease in the disc's height and mobility, as well as the development of tears or cracks in the annulus fibrosus.
In advanced stages of degeneration, the disc may herniate or bulge outward, causing pressure on nearby nerves and potentially leading to pain, numbness, tingling, or weakness in the affected area. It's worth noting that while intervertebral disc degeneration is a normal part of aging, certain factors such as injury, smoking, obesity, and repetitive stress can accelerate the process.
Ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine, although other joints can also be involved. It causes swelling in the spinal joints (vertebrae) that can lead to stiffness and pain. Over time, some of these joints may grow together, causing new bone formation and resulting in a rigid spine. This fusion of the spine is called ankylosis.
The condition typically begins in the sacroiliac joints, where the spine connects to the pelvis. From there, it can spread up the spine and potentially involve other areas of the body such as the eyes, heart, lungs, and gastrointestinal system.
Ankylosing spondylitis has a strong genetic link, with most people carrying the HLA-B27 gene. However, not everyone with this gene will develop the condition. It primarily affects males more often than females and tends to start in early adulthood.
Treatment usually involves a combination of medication, physical therapy, and exercise to help manage pain, maintain mobility, and prevent deformity. In severe cases, surgery may be considered.
The spinal cord is a major part of the nervous system, extending from the brainstem and continuing down to the lower back. It is a slender, tubular bundle of nerve fibers (axons) and support cells (glial cells) that carries signals between the brain and the rest of the body. The spinal cord primarily serves as a conduit for motor information, which travels from the brain to the muscles, and sensory information, which travels from the body to the brain. It also contains neurons that can independently process and respond to information within the spinal cord without direct input from the brain.
The spinal cord is protected by the bony vertebral column (spine) and is divided into 31 segments: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. Each segment corresponds to a specific region of the body and gives rise to pairs of spinal nerves that exit through the intervertebral foramina at each level.
The spinal cord is responsible for several vital functions, including:
1. Reflexes: Simple reflex actions, such as the withdrawal reflex when touching a hot surface, are mediated by the spinal cord without involving the brain.
2. Muscle control: The spinal cord carries motor signals from the brain to the muscles, enabling voluntary movement and muscle tone regulation.
3. Sensory perception: The spinal cord transmits sensory information, such as touch, temperature, pain, and vibration, from the body to the brain for processing and awareness.
4. Autonomic functions: The sympathetic and parasympathetic divisions of the autonomic nervous system originate in the thoracolumbar and sacral regions of the spinal cord, respectively, controlling involuntary physiological responses like heart rate, blood pressure, digestion, and respiration.
Damage to the spinal cord can result in various degrees of paralysis or loss of sensation below the level of injury, depending on the severity and location of the damage.
The lumbar vertebrae are the five largest and strongest vertebrae in the human spine, located in the lower back region. They are responsible for bearing most of the body's weight and providing stability during movement. The lumbar vertebrae have a characteristic shape, with a large body in the front, which serves as the main weight-bearing structure, and a bony ring in the back, formed by the pedicles, laminae, and processes. This ring encloses and protects the spinal cord and nerves. The lumbar vertebrae are numbered L1 to L5, starting from the uppermost one. They allow for flexion, extension, lateral bending, and rotation movements of the trunk.
Spinal cord injuries (SCI) refer to damage to the spinal cord that results in a loss of function, such as mobility or feeling. This injury can be caused by direct trauma to the spine or by indirect damage resulting from disease or degeneration of surrounding bones, tissues, or blood vessels. The location and severity of the injury on the spinal cord will determine which parts of the body are affected and to what extent.
The effects of SCI can range from mild sensory changes to severe paralysis, including loss of motor function, autonomic dysfunction, and possible changes in sensation, strength, and reflexes below the level of injury. These injuries are typically classified as complete or incomplete, depending on whether there is any remaining function below the level of injury.
Immediate medical attention is crucial for spinal cord injuries to prevent further damage and improve the chances of recovery. Treatment usually involves immobilization of the spine, medications to reduce swelling and pressure, surgery to stabilize the spine, and rehabilitation to help regain lost function. Despite advances in treatment, SCI can have a significant impact on a person's quality of life and ability to perform daily activities.
Spinal injections, also known as epidural injections or intrathecal injections, are medical procedures involving the injection of medications directly into the spinal canal. The medication is usually delivered into the space surrounding the spinal cord (the epidural space) or into the cerebrospinal fluid that surrounds and protects the spinal cord (the subarachnoid space).
The medications used in spinal injections can include local anesthetics, steroids, opioids, or a combination of these. The purpose of spinal injections is to provide diagnostic information, therapeutic relief, or both. They are commonly used to treat various conditions affecting the spine, such as radicular pain (pain that radiates down the arms or legs), disc herniation, spinal stenosis, and degenerative disc disease.
Spinal injections can be administered using different techniques, including fluoroscopy-guided injections, computed tomography (CT) scan-guided injections, or with the help of a nerve stimulator. These techniques ensure accurate placement of the medication and minimize the risk of complications.
It is essential to consult a healthcare professional for specific information regarding spinal injections and their potential benefits and risks.
Spinal nerves are the bundles of nerve fibers that transmit signals between the spinal cord and the rest of the body. There are 31 pairs of spinal nerves in the human body, which can be divided into five regions: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. Each spinal nerve carries both sensory information (such as touch, temperature, and pain) from the periphery to the spinal cord, and motor information (such as muscle control) from the spinal cord to the muscles and other structures in the body. Spinal nerves also contain autonomic fibers that regulate involuntary functions such as heart rate, digestion, and blood pressure.
Spinal cord diseases refer to a group of conditions that affect the spinal cord, which is a part of the central nervous system responsible for transmitting messages between the brain and the rest of the body. These diseases can cause damage to the spinal cord, leading to various symptoms such as muscle weakness, numbness, pain, bladder and bowel dysfunction, and difficulty with movement and coordination.
Spinal cord diseases can be congenital or acquired, and they can result from a variety of causes, including infections, injuries, tumors, degenerative conditions, autoimmune disorders, and genetic factors. Some examples of spinal cord diseases include multiple sclerosis, spina bifida, spinal cord injury, herniated discs, spinal stenosis, and motor neuron diseases such as amyotrophic lateral sclerosis (ALS).
The treatment for spinal cord diseases varies depending on the underlying cause and severity of the condition. Treatment options may include medication, physical therapy, surgery, and rehabilitation. In some cases, the damage to the spinal cord may be irreversible, leading to permanent disability or paralysis.
Spinal anesthesia is a type of regional anesthesia that involves injecting local anesthetic medication into the cerebrospinal fluid in the subarachnoid space, which is the space surrounding the spinal cord. This procedure is typically performed by introducing a needle into the lower back, between the vertebrae, to reach the subarachnoid space.
Once the local anesthetic is introduced into this space, it spreads to block nerve impulses from the corresponding levels of the spine, resulting in numbness and loss of sensation in specific areas of the body below the injection site. The extent and level of anesthesia depend on the amount and type of medication used, as well as the patient's individual response.
Spinal anesthesia is often used for surgeries involving the lower abdomen, pelvis, or lower extremities, such as cesarean sections, hernia repairs, hip replacements, and knee arthroscopies. It can also be utilized for procedures like epidural steroid injections to manage chronic pain conditions affecting the spine and lower limbs.
While spinal anesthesia provides effective pain relief during and after surgery, it may cause side effects such as low blood pressure, headache, or difficulty urinating. These potential complications should be discussed with the healthcare provider before deciding on this type of anesthesia.
Spinal nerve roots are the initial parts of spinal nerves that emerge from the spinal cord through the intervertebral foramen, which are small openings between each vertebra in the spine. These nerve roots carry motor, sensory, and autonomic fibers to and from specific regions of the body. There are 31 pairs of spinal nerve roots in total, with 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal pair. Each root has a dorsal (posterior) and ventral (anterior) ramus that branch off to form the peripheral nervous system. Irritation or compression of these nerve roots can result in pain, numbness, weakness, or loss of reflexes in the affected area.
Spinal cord neoplasms refer to abnormal growths or tumors within the spinal cord. These can be benign (non-cancerous) or malignant (cancerous). They originate from the cells within the spinal cord itself (primary tumors), or they may spread to the spinal cord from other parts of the body (metastatic tumors). Spinal cord neoplasms can cause various symptoms depending on their location and size, including back pain, neurological deficits, and even paralysis. Treatment options include surgery, radiation therapy, and chemotherapy.
The spinal canal is the bony, protective channel within the vertebral column that contains and houses the spinal cord. It extends from the foramen magnum at the base of the skull to the sacrum, where the spinal cord ends and forms the cauda equina. The spinal canal is formed by a series of vertebral bodies stacked on top of each other, intervertebral discs in between them, and the laminae and spinous processes that form the posterior elements of the vertebrae. The spinal canal provides protection to the spinal cord from external trauma and contains cerebrospinal fluid (CSF) that circulates around the cord, providing nutrients and cushioning. Any narrowing or compression of the spinal canal, known as spinal stenosis, can cause various neurological symptoms due to pressure on the spinal cord or nerve roots.
Spinal cord compression is a medical condition that refers to the narrowing of the spinal canal, which puts pressure on the spinal cord and the nerves that branch out from it. This can occur due to various reasons such as degenerative changes in the spine, herniated discs, bone spurs, tumors, or fractures. The compression can lead to a range of symptoms including pain, numbness, tingling, weakness, or loss of bladder and bowel control. In severe cases, it can cause paralysis. Treatment options depend on the underlying cause and may include physical therapy, medication, surgery, or radiation therapy.
Spinal stenosis is a narrowing of the spinal canal or the neural foramina (the openings through which nerves exit the spinal column), typically in the lower back (lumbar) or neck (cervical) regions. This can put pressure on the spinal cord and/or nerve roots, causing pain, numbness, tingling, or weakness in the affected areas, often in the legs, arms, or hands. It's most commonly caused by age-related wear and tear, but can also be due to degenerative changes, herniated discs, tumors, or spinal injuries.
Spinal fusion is a surgical procedure where two or more vertebrae in the spine are fused together to create a solid bone. The purpose of this procedure is to restrict movement between the fused vertebrae, which can help reduce pain and stabilize the spine. This is typically done using bone grafts or bone graft substitutes, along with hardware such as rods, screws, or cages to hold the vertebrae in place while they heal together. The procedure may be recommended for various spinal conditions, including degenerative disc disease, spinal stenosis, spondylolisthesis, scoliosis, or fractures.