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ABSTRACT: Post-operative visual loss (POVL) following spinal surgery is a rare but devastating complication. Although a number of intra-operative and post-operative factors have been implicated, the exact etiology may still remain unclear.
To report a unique case of transient bilateral POVL in a patient who had undergone lumbar surgery in the prone position.
This patient was followed up prospectively for 1 year.
Prospective follow-up of a single patient following spinal surgery, who developed transient bilateral POVL.
This patient's visual loss improved within 48 h.
This is the only documented case of POVL to have resolved completely within 48 h.
European Spine Journal 12/2011; 21 Suppl 4:S495-8. · 1.97 Impact Factor
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Nasir A Quraishi
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ABSTRACT: Transforaminal epidural injection of steroids is used to treat lumbar radicular pain. However, there are only a few well-designed randomized, controlled studies on the effectiveness of steroid injection.
Hence, this study aims to assess the effectiveness of steroid injection to treat lumbar radicular pain using a meta-analysis of transforaminal epidural injection therapy for low back and lumbar radicular pain. The comparison was based on the mean difference in the Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) from baseline to the specified followed up.
The available literature of lumbar transforaminal epidural injections in managing low back and radicular pain was reviewed. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to 2009, and manual searches of the bibliographies of known primary and review articles. Finally, the search included the Current Controlled Trials Register and the Cochrane Database of Controlled Trials.
The initial search identified 126 papers. After screening, five randomised controlled trials (RCTs) were studied for analysis and only three of these had followed-up patients systematically with pain and disability outcome scores to 3 months and of these, only one had follow up to 12 months. A total of 187 patients ('treatment group' receiving local anaesthetic/steroid injection) were compared with 181 patients ('control' group, receiving local anaesthetic only or saline injection). Improvement in pain (standardised mean difference in VAS 0.2 in favour of 'treatment'; 95%CI: -0.41 to 0.00, p = 0.05, I squared 0%) but not disability (standardised mean difference in ODI 0; 95%CI: -0.21 to 0.20, p = 0.99, I squared 0%) was observed between 'treatment' and 'control' groups; these differences were not significant. Additionally, the one study following patients to 12 months did not find any significant difference in VAS and ODI between treatment and control groups.
The current meta-analysis shows that transforaminal epidural steroid injections, when appropriately performed, should result in an improvement in pain, but not disability. The three RCTs that followed patients to 3 months (and the single study to 12 months) have found no benefit by the addition of steroids. The limitations of this study include the paucity of the available literature.
European Spine Journal 09/2011; 21(2):214-9. · 1.97 Impact Factor
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ABSTRACT: Unstable cervical fractures commonly require fusion surgery. We present a case of an unstable cervical fracture (AO classification A2.2) affecting the fifth cervical vertebra which was managed by kyphoplasty to achieve a pain-free, functional and stable outcome. The decision to undertake a kyphoplasty procedure was made in the hope of preserving motion and limiting the degree of future adjacent segment disease. We believe this to be the first case of the use of kyphoplasty to be published in the literature in relation to a traumatic cervical fracture. Additionally, at one-year follow-up the patient reports no pain, a near full range of motion in the cervical spine and no neurological deficit.
European Spine Journal 07/2011; 20(10):1589-92. · 1.97 Impact Factor
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BMJ (Clinical research ed.). 01/2011; 342:d2402.
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ABSTRACT: Myxopapillary ependymomas rarely present as a primary intrasacral lesion, and extensive sacral osteolysis is unusual. The authors report a case series of 6 patients with these complex tumors causing extensive sacral destruction, who underwent resection, lumbopelvic reconstruction, and fusion. The operative procedure, complications, and outcome are summarized after a mean follow-up of 3.55 years (range 18-80 months).
Journal of neurosurgery. Spine 02/2010; 12(2):154-9. · 1.61 Impact Factor
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ABSTRACT: A retrospective analysis of prospectively collected data of 102 consecutive adult patients who underwent intraoperative neurophysiological monitoring (IOM) during spinal deformity corrective surgery.
To report the sensitivity and specificity of combined IOM in this study population using the postoperative neurologic examination as the "gold standard."
IOM is recommended during corrective spinal surgery and has been widely used in the pediatric deformity population. However, there are limited data describing the application of IOM in adults undergoing spinal deformity corrective surgery.
The study group consisted of 102 patients undergoing spinal deformity corrective surgery between 2001 and 2004. Patients were monitored using at least 2 or more electrophysiological methods including somatosensory-evoked potentials (SSEP), motor-evoked potentials (MEP), and electromyography (EMG).
The mean age of patients was 41.5 years (+/-17). The majority of the operative procedures involved instrumented fusion from thoracic to lumbar/sacral spine (n = 55), thoracic-pelvis fusion (n = 26), and a combined total of 32 osteotomies (including 25 pedicle subtraction osteotomies and 7 Smith-Peterson osteotomies). SSEPs were recorded successfully in 101 (99%), EMGs in 89 of 102 (87%), and MEPs in 12 of 16 (75%). Five cases were true positives (4.95%), and these were all detected by combined monitoring (2-SSEP, 2-EMG, 1-MEP). There were no false positives with SSEPs, but EMG resulted in 30 of 89 (34%) false positives. There were 4 false negatives with SSEPs, which reduced its sensitivity to 33%. There was 1 false negative with EMG, and 0 with MEPs. When these results were collated, the overall sensitivity of combined multimodality IOM in this adult deformity series was 100%, specificity 84.3%, PPV 13.9%, and NPV 97%. The combined sensitivity in the osteotomy group (n = 32) was 67%, specificity 98%, PPV 80%, and NPV 96%. In comparison, there were no IOM abnormalities in those patients who had in situ/minor corrective procedures (n = 18; largely adult degenerative scoliosis).
Multimodality IOM of spinal cord sensory and motor function during surgical correction of adult spinal deformity is feasible and provides useful neurophysiological data with an overall sensitivity of 100% and a specificity of 84.3% (67% and 98%, respectively in patients undergoing major deformity correction).
Spine 07/2009; 34(14):1504-12. · 2.08 Impact Factor
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ABSTRACT: CASE REPORT: A 32-year-old African male presented with 10 hours of severe back pain. Initial computed tomography scan of the back showed no abnormality, and initial laboratory investigations were consistent with rhabdomyolysis. Despite stopping potential causative medications, aggressive intravenous hydration, and urine alkalinization, his creatinine kinase continued to steadily climb. Thirty-six hours after admission, a magnetic resonance imaging of his back was done because of new swelling over the right paraspinal muscles and loss of sensation in this region. Marked swelling of the right erector spinae muscles was observed, and right and left compartment pressure measurements were 108 and 21 mm Hg, respectively. He had urgent fasciotomy after which his rhabdomyolysis and pain recovered. CONCLUSION: Our case highlights the need for early consideration of compartment syndrome as a possible cause of back pain in the setting of rhabdomyolysis. Rhabdomyolysis can present in the absence of late complications such as neurological and vascular compromise.
Journal of General Internal Medicine 07/2008; 23(6):871-4. · 2.83 Impact Factor
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ABSTRACT: In this report, the authors describe a unique case of intermittent high cervical cord compression caused by a prolapsing neurofibroma at the C1-2 level. This 21-year-old man with known neurofibromatosis Type 1 presented with a mass between the anterior arch of the atlas and the odontoid peg, causing atlantoaxial dissociation and cord compression. The cervicomedullary compression appeared to be caused in part by the neurofibroma but also by the abnormal alignment and thickening of the ligaments between the clivus and C-2. Preoperative imaging repeated on the morning of surgery revealed that the atlantoaxial dissociation had reduced with relief of cord compression and the lesion prolapsed inferiorly. The authors discuss this unusual lesion and describe the associated operative findings and surgical management.
Journal of Neurosurgery Spine 04/2008; 8(3):288-91. · 1.53 Impact Factor
