536 results on '"SPINAL nerve roots"'
Search Results
2. Interventionelle Maßnahmen beim Therapieren eines CRPS: Welche Therapie ist evidenzbasiert?
- Author
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Legat, Martin
- Subjects
- *
DRUG therapy , *DIPHOSPHONATES , *STEROID drugs , *SPINAL cord , *SPINAL injections , *PHYSICAL therapy , *OPERATIVE surgery , *EVIDENCE-based medicine , *NERVE block , *DYSTONIA , *SPINAL nerve roots , *BACLOFEN , *COMPLEX regional pain syndromes , *SYMPATHETIC nervous system , *NEURAL stimulation - Abstract
Initial the therapy of a CRPS is based on functional procedures like physiotherapy. In the acute phase medication with steroids and bisphosphonats got their place. If the syndrome prolongs psychological, comorbidities had to be evaluated and treated. Additionally invasive procedures can be proved. Sympathetic blocks and spinal cord stimulation are possibilities. The stimulation of the dorsal root ganglion shows even better results in newer studies than the SCS. Neurostimulation of peripheral nerves is only proved in case reports. The application of Baclofen intrathecal is recommended in cases of CRPS with dystonia. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
3. Injektionstherapie beim Zervikalsyndrom.
- Author
-
Grifka, J. and Boluki, D.
- Abstract
Copyright of Der Orthopäde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2013
- Full Text
- View/download PDF
4. Die therapierefraktäre überaktive Blase : Alternative Therapieansätze.
- Author
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Knüpfer, S., Hamann, M., Naumann, C.M., Melchior, D., Jünemann, K.-P., Knüpfer, S, and Jünemann, K-P
- Subjects
CYSTOTOMY ,OVERACTIVE bladder ,BLADDER innervation ,ADRENALINE ,ALTERNATIVE medicine ,BOTULINUM toxin ,COMBINATION drug therapy ,COMPARATIVE studies ,ELECTROTHERAPEUTICS ,IONTOPHORESIS ,LIDOCAINE ,RESEARCH methodology ,MEDICAL cooperation ,PARASYMPATHOMIMETIC agents ,QUALITY of life ,RESEARCH ,SPINAL nerve roots ,DISEASE relapse ,EVALUATION research ,TREATMENT effectiveness ,DEXAMETHASONE ,INTRAVESICAL administration ,CYSTECTOMY ,FERRANS & Powers Quality of Life Index ,THERAPEUTICS - Abstract
Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2011
- Full Text
- View/download PDF
5. [Bipolar stimulation may improve the efficacy of the percutaneous nerve evaluation test of sacral neuromodulation]
- Author
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André, Reitz, Tanja, Hüsch, Regula, Doggweiler, Stephan, Buse, and Axel, Haferkamp
- Subjects
Adult ,Male ,Neurologic Examination ,Sacrum ,Middle Aged ,Urination Disorders ,Urodynamics ,Treatment Outcome ,Transcutaneous Electric Nerve Stimulation ,Humans ,Female ,Peripheral Nerves ,Spinal Nerve Roots ,Urinary Tract ,Aged - Published
- 2017
6. [Radiation-Induced Radiculopathy with Paresis of the Neck and Autochthonous Back Muscles with Additional Myopathy]
- Author
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G, Ellrichmann, C, Lukas, I A, Adamietz, C, Grunwald, C, Schneider-Gold, and R, Gold
- Subjects
Adult ,Male ,Neurologic Examination ,Photons ,Electromyography ,Back Muscles ,Radiotherapy Dosage ,Comorbidity ,Hodgkin Disease ,Muscular Dystrophies ,Spinal Curvatures ,Diagnosis, Differential ,Muscular Atrophy, Spinal ,Paresis ,Neck Muscles ,Humans ,Dose Fractionation, Radiation ,Lymph Nodes ,Particle Accelerators ,Polyradiculopathy ,Radiation Injuries ,Radiculopathy ,Spinal Nerve Roots ,Spleen ,Neoplasm Staging - Abstract
Radiation-induced tissue damage is caused by ionizing radiation mainly affecting the skin, vascular, neuronal or muscle tissue. Early damages occur within weeks and months while late damages may occur months or even decades after radiation.Radiation-induced paresis of the spine or the trunk muscles with camptocormia or dropped-head syndrome are rare but have already been described as long-term sequelae after treatment of Hodgkin's lymphoma. The differential diagnosis includes limb-girdle muscular dystrophy, fascioscapulohumeral muscular dystrophy (FSHD) or lysosomal storage diseases (e. g. Acid Maltase Deficiency). We present the case of a patient with long lasting diagnostics over many months due to different inconclusive results.
- Published
- 2016
7. [Complex regional pain syndrome in nerve root compression and after spinal surgery]
- Author
-
T, Wolter, S, Knöller, and O, Rommel
- Subjects
Causalgia ,Postoperative Complications ,Germany ,Incidence ,Nerve Compression Syndromes ,Humans ,Spinal Diseases ,Spinal Nerve Roots ,Complex Regional Pain Syndromes - Abstract
Complex regional pain syndrome (CRPS) is an extremely painful and partially disabling disease. It often occurs secondary to trauma, but also spontaneously. The emergence of CRPS has been reported following nerve root compression and/or spinal surgery, but its incidence is unknown. In this article, the present knowledge about the incidence of CRPS in the context of nerve root compression and spine surgery is reviewed and therapeutic and diagnostic consequences are discussed.
- Published
- 2016
8. [Utility of coronal oblique slices in cervical spine MRI: Improved detection of the neuroforamina]
- Author
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W, Freund, S, Klessinger, M, Mueller, M-E, Halatsch, G, Hoepner, F, Weber, and B, Schmitz
- Subjects
Adult ,Male ,Observer Variation ,Reproducibility of Results ,Middle Aged ,Image Enhancement ,Sensitivity and Specificity ,Patient Positioning ,Spinal Stenosis ,Cervical Vertebrae ,Humans ,Female ,Radiculopathy ,Spinal Nerve Roots ,Aged ,Retrospective Studies - Abstract
Angulated projections are standard in conventional radiography of the cervical spine, but rarely used in magnetic resonance imaging (MRI). As neuroforaminal pathology plays an important role in the etiology of radicular syndromes and may influence an operative approach, the utility of coronal oblique slices in MRI is explored.In a retrospective setting, 25 consecutive patients with neurologically diagnosed cervical monoradiculopathy were identified. T2-weighted sagittal, coronal oblique, and transversal slice orientations were anonymized. Two radiologists and two neurosurgeons independently assessed the cases. Criteria were site, cause, and grading of the neuroforaminal stenosis and the level of confidence on a 100-point visual analog scale (VAS). We computed interrater agreement, sensitivity, and t tests.Using only one slice orientation, the sensitivity in detecting the relevant neuroforamen was 0.40 for transversal, 0.68 for sagittal, and 0.64 for coronal oblique scans. A combination of the different angulations increased sensitivity and in 4 cases only the coronal oblique scans proved diagnostic. The readers felt significantly more confident in attributing the cause of the pathology on coronal oblique planes (a mean of 72 VAS points, p = 0.0003 vs 58 (sagittal) vs 64 (transversal)). Interrater agreement was significantly better for experienced (kappa 0. 48) than for inexperienced readers (0.32, p = 0.02).Adding coronal oblique planes in cervical spine MRI increases sensitivity and confidence in attributing the cause of neuroforaminal pathology. They are regarded as useful by all the readers.
- Published
- 2015
9. [Traumatic plexus lesion with cervicothoracic root avulsions and vertical laceration of the spinal cord]
- Author
-
P B, Sporns, T, Fortmann, S, Zimmer, T, Zoubi, and W, Schwindt
- Subjects
Adult ,Male ,Reoperation ,Multiple Trauma ,Laminectomy ,Decompression, Surgical ,Magnetic Resonance Imaging ,Thoracic Vertebrae ,Cervical Vertebrae ,Humans ,Spinal Fractures ,Brachial Plexus ,Radiculopathy ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Nerve Transfer ,Spinal Cord Injuries - Published
- 2015
10. [Radiating pain: disc herniation is a rare cause only]
- Author
-
Wilhelm J, Schulte-Mattler
- Subjects
Diagnosis, Differential ,Neurologic Examination ,Nerve Compression Syndromes ,Humans ,Spinal Diseases ,Spinal Nerve Roots ,Low Back Pain ,Magnetic Resonance Imaging ,Intervertebral Disc Displacement - Published
- 2013
11. [Spontaneous regression of lumbar and cervical disc herniations - a well established phenomenon]
- Author
-
Oliver P, Gautschi, Martin N, Stienen, and Karl, Schaller
- Subjects
Adult ,Male ,Neurologic Examination ,Lumbar Vertebrae ,Nerve Compression Syndromes ,Remission, Spontaneous ,Cervical Vertebrae ,Humans ,Middle Aged ,Spinal Nerve Roots ,Magnetic Resonance Imaging ,Intervertebral Disc Displacement ,Follow-Up Studies - Abstract
Symptomatic lumbar (LDH) and cervical disc herniations (CDH) are highly prevalent diseases that neurosurgeons and orthopaedic surgeons face every day. If symptom control cannot be achieved by nonsurgical means or in cases with severe or progressive neurological deficits, a surgical therapy is generally recommended. Nevertheless, the majority of patients will improve significantly or even completely without surgery over weeks until months after symptom onset. Still, when a recommendation is to be made concerning the further treatment in affected patients, it has to be kept in mind that the nonsurgical therapy may be associated with disabling pain and persisting neurological deficits with influence on the functional capacity, quality of life and ability to work for a variable period. Today, it is almost impossible to predict which patient will profit from nonsurgical therapy and which patient will require surgery during the clinical course because of incomplete alleviation. In this work, we present two current cases of patients with spontaneous regression of a LDH and a CDH.Lumbale (LDH) und zervikale Diskushernien (CDH) sind prävalente Krankheitsbilder. Falls es unter Ausschöpfung konservativer Therapiemassnahmen nur zu einer unzureichenden Befundverbesserung kommt oder eine eindeutige Operationsindikation besteht, wird in der Regel eine operative Intervention empfohlen. Bei der Mehrzahl der Patienten kommt es jedoch ebenfalls nach Wochen bis Monaten unter konservativer Therapie zu einer deutlichen Beschwerderegredienz. Zu bedenken gilt jedoch, dass betroffene Patienten während einem variablen Zeitraum z. T. an invalidisierenden Schmerzen und/oder sensomotorischen Defiziten leiden, was einen negativen Einfluss auf die funktionelle Kapazität, Lebensqualität und Arbeitsfähigkeit hat. Die vorliegende Arbeit zeigt zwei aktuelle Patientengeschichten mit einer klinischen und radiologischen Spontanregression einer LDH und einer CDH.
- Published
- 2013
12. [Improved magnetic resonance myelography using image fusion]
- Author
-
K, Eberhardt, O, Ganslandt, and A, Stadlbauer
- Subjects
Male ,Lumbar Vertebrae ,Fourier Analysis ,Nerve Compression Syndromes ,Middle Aged ,Image Enhancement ,Magnetic Resonance Imaging ,Sensitivity and Specificity ,Diagnosis, Differential ,Imaging, Three-Dimensional ,Spinal Stenosis ,Spinal Cord ,Cervical Vertebrae ,Image Processing, Computer-Assisted ,Humans ,Female ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Spinal Cord Compression ,Intervertebral Disc Displacement ,Myelography ,Aged - Abstract
To demonstrate that the disadvantage of missing anatomical information in heavily T2-weighted MR myelography images can be eliminated by image fusion and phase encoding in the coronal direction of the source images, resulting in MR myelography images comparable to the gold standard, i. e., post-myelography CT.This study included 110 patients suffering from extradural pathologies of the cervical and lumbar spine. All patients were investigated using 3D MR myelography and post-myelography CT. The MRI data were post-processed using image fusion and reconstruction algorithms and were compared to the corresponding images of post-myelography CT.Our approach for visualization (3D MR myelography) was able to depict intradural structures in high spatial resolution and without artifacts. The results of our visualization approach were comparable to the gold standard - post-myelography CT. Anatomical correlation was reached by image fusion of different MR data sets. The required post-processing steps were performed quickly and were available on a commercial workstation.Image fusion of different MR data sets allows for visualization of 3D data sets with enhanced quality. The results for the visualization of MR myelography in particular are comparable to conventional myelography and post-myelography CT. The missing anatomical information in heavily T2-weighted MR myelography images can be compensated by image fusion with conventional MRI.
- Published
- 2013
13. Spontanregression lumbaler und zervikaler Diskusherniationen – ein bekanntes Phänomen
- Author
-
Oliver Gautschi, Martin N. Stienen, and Karl Lothard Schaller
- Subjects
Adult ,Male ,medicine.medical_specialty ,Nerve root ,Remission, Spontaneous ,Lumbar vertebrae ,Lumbar ,Quality of life ,medicine ,Humans ,Symptom onset ,Nerve Compression Syndromes/diagnosis/therapy ,Intervertebral Disc Displacement/diagnosis/therapy ,Ability to work ,ddc:616 ,Neurologic Examination ,Lumbar Vertebrae ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,Magnetic Resonance Imaging ,Surgery ,ddc:616.8 ,medicine.anatomical_structure ,Cervical Vertebrae ,business ,Spinal Nerve Roots ,Cervical vertebrae ,Follow-Up Studies - Abstract
Symptomatic lumbar (LDH) and cervical disc herniations (CDH) are highly prevalent diseases that neurosurgeons and orthopaedic surgeons face every day. If symptom control cannot be achieved by nonsurgical means or in cases with severe or progressive neurological deficits, a surgical therapy is generally recommended. Nevertheless, the majority of patients will improve significantly or even completely without surgery over weeks until months after symptom onset. Still, when a recommendation is to be made concerning the further treatment in affected patients, it has to be kept in mind that the nonsurgical therapy may be associated with disabling pain and persisting neurological deficits with influence on the functional capacity, quality of life and ability to work for a variable period. Today, it is almost impossible to predict which patient will profit from nonsurgical therapy and which patient will require surgery during the clinical course because of incomplete alleviation. In this work, we present two current cases of patients with spontaneous regression of a LDH and a CDH.
- Published
- 2013
14. [Long-term effects of interventional treatment on chronic pain of the musculoskeletal system. Retrospective outcome study of repeated in-patient treatment]
- Author
-
K, Niemier
- Subjects
Adult ,Aged, 80 and over ,Complementary Therapies ,Male ,Injections, Epidural ,Nerve Block ,Middle Aged ,Combined Modality Therapy ,Injections ,Disability Evaluation ,Back Pain ,Musculoskeletal Pain ,Irritants ,Humans ,Female ,Peripheral Nerves ,Chronic Pain ,Spinal Nerve Roots ,Aged ,Autonomic Nerve Block ,Pain Measurement ,Retrospective Studies - Abstract
Interventional procedures are frequently used for treatment of musculoskeletal pain syndromes but current scientific evidence does not show successful outcome in chronic cases. In this study the effect of repeated interventional treatment on the long-term outcome of patients with chronic musculoskeletal pain was examined.In order to prepare for a retrospective outcome study (RCT) on proliferation therapy the clinical records of 38 patients who had been repeatedly treated (minimum 5 times) with an interventional treatment concept were examined.Patients were treated on average 10 times with approximately 107 single injections during each treatment cycle. In the long term the chronic pain syndrome showed a statistically significant deterioration with a generalization of the pain as well as an increase in pain medication, surgery and psychosocial impairment..Repeated treatment cycles of interventional pain therapy did not lead to an improvement in the treated pain syndromes and in the long term the pain syndromes deteriorated further. It seems likely that the interventional approach promoted this adverse development but the data of this study are not sufficient to conclusively prove this thesis.
- Published
- 2012
15. [Peripartal sacrum fracture - a rare cause of peripartal lumbar sciatica]
- Author
-
T L, Witton-Davies, J, Zentner, and K, Pfadenhauer
- Subjects
Adult ,Hematoma ,Sacrum ,Fractures, Stress ,Nerve Compression Syndromes ,Puerperal Disorders ,Magnetic Resonance Imaging ,Obstetric Labor Complications ,Sciatica ,Young Adult ,Imaging, Three-Dimensional ,Pregnancy ,Image Processing, Computer-Assisted ,Humans ,Spinal Fractures ,Female ,Spinal Nerve Roots ,Low Back Pain - Published
- 2011
16. [Different pathoanatomic circumstances in bony lumbar foraminal stenosis have no influence on surgical outcome]
- Author
-
J, Weber and C, Schönfeld
- Subjects
Adult ,Male ,Reoperation ,Lumbar Vertebrae ,Nerve Compression Syndromes ,Middle Aged ,Decompression, Surgical ,Zygapophyseal Joint ,Postoperative Complications ,Spinal Fusion ,Treatment Outcome ,Humans ,Female ,Prospective Studies ,Spondylosis ,Radiculopathy ,Spinal Nerve Roots ,Aged ,Pain Measurement - Abstract
The purpose of this prospective observational study was to evaluate the clinical efficacy of nerve decompression in bony foraminal stenosis in different pathoanatomical circumstances.Thirty-three consecutive patients (mean age: 63 years) were evaluated. All had leg-dominant monoradicular pain and were treated via a midline approach (lateral foraminotomy, with caudal resection of the pedicle in selected cases). Thirteen patients (39 %) had undergone prior lumbar surgery. The patients were divided into four pathoanatomic groups: (A) facet joint hypertrophy, n = 16; (B) dorsolateral spondylosis, n = 7; (C) height reduction of intervertebral disc, n = 3; (D) mixed group, n = 7. The clinical outcome was graded using a modified Prolo scale (pain and medication) and a visual analogue scale (VAS) after 2 and 12 months.Based on the Prolo scale score, an excellent (n = 18) or good (n = 12) outcome was achieved in 91 % of the patients. There were no outcome differences among the four pathoanatomic groups. However, the groups B, C and D are small. Three patients in group B required revision surgery because of osteophytes in the transition area of the intra- and extraforaminal regions. All but one (97 %) of the patients experienced significant leg pain reduction following surgery as assessed by VAS (including the three revisions). No statistically significant associations were found between back pain, symptom duration, previous surgery, segment level, or pediculotomy and the outcome. There were no surgery-related complications.Foraminal decompression alone for leg-dominant symptoms is a clinically effective procedure in the majority of patients without differences in the four pathoanatomic groups.
- Published
- 2011
17. [Analgesic interventions for spinal diseases]
- Author
-
W, Reith and U, Yilmaz
- Subjects
Pain, Postoperative ,Vertebroplasty ,Nerve Block ,Magnetic Resonance Imaging ,Zygapophyseal Joint ,Treatment Outcome ,Surgery, Computer-Assisted ,Back Pain ,Image Interpretation, Computer-Assisted ,Humans ,Spinal Fractures ,Kyphoplasty ,Anesthetics, Local ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Injections, Spinal - Abstract
As a rule vertebroplasty and kyphoplasty can prevent further collapse of a previously broken vertebra. Pain is probably caused by collapse of the porous bone resulting in instability of the vertebra. Stabilization of the vertebra by injecting cement results in a clear improvement in the complaint and a clear reduction in pain resulting in better mobilization. Recent results have, however, cast doubt on the effectiveness of this therapy. Diagnostic nerve blocks on the spinal column are important because the pain is mostly clinically uncharacteristic, the innervation is complex and the pain is subjective. An exact classification can be made using special nerve blocks. Prerequisites for the use of diagnostic nerve blocks are an extensive clinical history and examination of the patient before nerve blocks are carried out. In approximately 15-45% of patients the zygapophyseal joint is the cause of the back pain. Anesthesia of the zygapophyseal joint can be carried out by direct intra-articular application of a local anesthetic or by a block of the medial branch of the posterior branch of each of two spinal nerves. The simplest method is by computed tomography-guided zygapophyseal block.
- Published
- 2011
18. [Therapy-refractory overactive bladder: alternative treatment approaches]
- Author
-
S, Knüpfer, M, Hamann, C M, Naumann, D, Melchior, and K-P, Jünemann
- Subjects
Complementary Therapies ,Epinephrine ,Urinary Bladder, Overactive ,Urinary Bladder ,Lidocaine ,Electric Stimulation Therapy ,Iontophoresis ,Cystectomy ,Cholinergic Antagonists ,Dexamethasone ,Administration, Intravesical ,Recurrence ,Quality of Life ,Humans ,Drug Therapy, Combination ,Treatment Failure ,Botulinum Toxins, Type A ,Spinal Nerve Roots - Abstract
The treatment of patients with overactive bladder (OAB) refractory to conventional treatment is gaining clinical significance. This article intends to review alternative therapy options for patients with OAB refractory to conventional treatment. A search of the PubMed database as well as the abstracts presented at the European Association of Urology and the American Urological Association annual meetings was conducted. Keywords used during this search included overactive bladder (OAB) refractory to conventional treatment, electromotive drug administration (EMDA), sacral neuromodulation, augmentation cystoplasty and cystectomy. Eighteen articles with an adequate number of patients were identified. All articles published before 2001 were not included in this analysis. Because of first-line treatment failure, 30% of the patients required alternative treatment. This included EMDA, botulinum toxin injections into the detrusor, sacral neuromodulation, augmentation cystoplasty or cystectomy. Based on this review it appears that a significant improvement in micturition parameters, continence and in quality of life was achieved. Overall EMDA, intradetrusor injections of botulinum toxin and sacral neuromodulation seem to be highly effective and safe. Augmentation cystoplasty or cystectomy remains the last choice of treatment in refractory cases.Overall EMDA, intradetrusor injections of botulinum toxin and sacral neuromodulation seem to be highly effective and safe. Augmentation cystoplasty or cystectomy remains to be the last choice of treatment in refractory cases.
- Published
- 2011
19. [Tips, tricks and pitfalls in the diagnostic imaging of traumatic spinal cord injuries]
- Author
-
C, Schueller-Weidekamm
- Subjects
Diagnosis, Differential ,Spinal Cord ,Image Processing, Computer-Assisted ,Hematoma, Subdural, Spinal ,Humans ,Tissue Adhesions ,Atrophy ,Hematoma, Epidural, Spinal ,Spinal Nerve Roots ,Magnetic Resonance Imaging ,Sensitivity and Specificity ,Spinal Cord Injuries ,Syringomyelia - Abstract
Over the last several decades the survival rate for acute spinal cord lesions has improved, which has resulted in an increased number of chronic spinal cord injuries. Magnetic resonance imaging (MRI) plays an essential role in imaging of the spinal cord, as it allows a detailed depiction of neural structures. However, the correct radiologic diagnosis is often complicated by the multitude of differential diagnoses. This article provides tips and tricks to achieve an accurate imaging report and details potential pitfalls in the interpretation of MR images. Acute spinal cord injuries show different characteristics which range from edema to intramedullary bleeding and to transsection. The spectrum of chronic spinal cord injuries encompasses myelomalacia, syrinx, cystic myelopathia and myeloatrophy. In addition to typical morphological features this article concentrates on the pathogenesis of injury patterns, on the use of appropriate contrast-enhanced MR sequences and on new MR techniques for the differentiation of individual pathologies.
- Published
- 2010
20. [Muscle weakness: differential diagnosis and assessment]
- Author
-
Stephanie, Schwager, Michel, Hochuli, and Hans H, Jung
- Subjects
Male ,Neurologic Examination ,Muscle Weakness ,Biopsy ,Peripheral Nervous System Diseases ,Neuromuscular Diseases ,Dermatomyositis ,Diagnosis, Differential ,Muscular Atrophy ,Young Adult ,Muscular Diseases ,Humans ,Motor Neuron Disease ,Medical History Taking ,Muscle, Skeletal ,Spinal Nerve Roots ,Physical Examination - Published
- 2010
21. [Spinal cord stimulation - evidence and personal experience]
- Author
-
P, Klein-Weigel
- Subjects
Epidural Space ,Leg ,Evidence-Based Medicine ,Sympathetic Nervous System ,Foot ,Arterial Occlusive Diseases ,Prognosis ,Electrodes, Implanted ,Oxygen ,Vasodilation ,Implantable Neurostimulators ,Spinal Cord ,Ischemia ,Animals ,Humans ,Spinal Nerve Roots - Abstract
Spinal cord stimulation (SCS) has been successfully used to treat chronic pain syndromes for decades. For this purpose, an electrode is implanted into the epidural space under local anaesthesia and connected to a neurostimulator which applies a weak direct current to the dorsal roots of the spinal column. Besides pain control, SCS increases the blood supply in the stimulated area. This effect is mediated by a sympathicolytic effect and the liberation of vasodilatators within the stimulated skin area. A Cochrane meta-analysis has revealed a significantly increased limb salvage rate in patients with non-reconstructable critical limb ischaemia (CLI) treated with SCS. The effect of SCS in CLI might be predicted by the measurement of forefoot transcutaneous pO (2) in supine and dependent positions, which renders trial stimulation unnecessary in many cases.
- Published
- 2010
22. [Cushing syndrome after steroid-infiltration in two HIV-patients with antiretroviral therapy]
- Author
-
M A, Herold and H F, Günthard
- Subjects
Adult ,Male ,Ritonavir ,Hydrocortisone ,Anti-HIV Agents ,Anti-Inflammatory Agents ,HIV Infections ,Triamcinolone Acetonide ,Cytochrome P-450 Enzyme Inhibitors ,Humans ,Drug Interactions ,Drug Therapy, Combination ,Radiculopathy ,Spinal Nerve Roots ,Cushing Syndrome ,Injections, Spinal - Abstract
The introduction of antiretroviral treatment with at least three active drugs has caused a substantial reduction of morbidity and mortality. Some antiretroviral drugs have the potential of interactions with other drugs. With the so calledboostedprotease inhibitors the cytochrom-P450 inhibition by Ritonavir is used to increase the plasma level of the protease inhibitor. This strategy results in prolonged dosage intervals and reduced tablet intake due to a reduced overall dose that is needed. The interaction potential of Ritonavir originates from this cytochrom P450-inhibition. All drugs that are CYP450-metabolized can potentially be affected. Here we report two cases that were affected by the little-known interaction of Ritonavir and Triamcinolonacetonide. In both cases, Cushing symptoms emerged after infiltrations with this steroid drug in usual doses. Here we want to emphasize on this rarely encountered but potentially serious drug-drug interaction potential that is not well known to date. When initiating any new drug in HIV-Patients under antiretroviral treatment, potential interactions should be checked. The Website www.hiv-druginteractions.org is a very useful instrument for this purpose.
- Published
- 2010
23. [Development of a severe multiphase disseminated encephalomyelitis in Guillain-Barre syndrome--MRI findings]
- Author
-
A, Korn, E, Huberle, and A, Bornemann
- Subjects
Adult ,Neurologic Examination ,Magnetic Resonance Spectroscopy ,Cauda Equina ,Encephalomyelitis, Acute Disseminated ,Cranial Nerves ,Brain ,Guillain-Barre Syndrome ,Magnetic Resonance Imaging ,Spinal Cord ,Humans ,Female ,Energy Metabolism ,Spinal Nerve Roots ,Myelin Sheath ,Follow-Up Studies - Published
- 2010
24. [Surgical treatment of damage in the intervertebral disc]
- Author
-
Michael, Janka and Alexander, Schuh
- Subjects
Neurologic Examination ,Lumbar Vertebrae ,Nerve Compression Syndromes ,Laminectomy ,Decompression, Surgical ,Magnetic Resonance Imaging ,Prosthesis Implantation ,Spinal Fusion ,Humans ,Diskectomy, Percutaneous ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Intervertebral Disc Displacement ,Diskectomy - Published
- 2010
25. [A rare cause of a space occupying lesion in the dorsal lumbar spinal canal]
- Author
-
P, v Gottberg, A, Wrede, and S, Kantelhardt
- Subjects
Epidural Space ,Male ,Microsurgery ,Lumbar Vertebrae ,Cauda Equina ,Nerve Compression Syndromes ,Middle Aged ,Decompression, Surgical ,Magnetic Resonance Imaging ,Diagnosis, Differential ,Foreign-Body Migration ,Back Pain ,Humans ,Spinal Nerve Roots ,Intervertebral Disc Displacement - Published
- 2009
26. [Diagnosis and therapy of a spontaneous cerebrospinal fluid leak syndrome]
- Author
-
F, Bode, A, Bink, E, Hattingen, and R, du Mesnil de Rochemont
- Subjects
Adult ,Gadolinium DTPA ,Headache ,Contrast Media ,Magnetic Resonance Imaging ,Spinal Puncture ,Subdural Effusion ,Thoracic Vertebrae ,Diagnosis, Differential ,Hematoma, Subdural ,Triiodobenzoic Acids ,Cervical Vertebrae ,Humans ,Female ,Spinal Nerve Roots ,Tomography, X-Ray Computed - Published
- 2009
27. [First description of an intradural disc herniation at the C7-T1 level]
- Author
-
D, Woischneck, B, Schmitz, and T, Kapapa
- Subjects
Neurologic Examination ,Microsurgery ,Nerve Compression Syndromes ,Intervertebral Disc Degeneration ,Magnetic Resonance Imaging ,Thoracic Vertebrae ,Diagnosis, Differential ,Cervical Vertebrae ,Humans ,Female ,Dura Mater ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Spinal Cord Compression ,Intervertebral Disc Displacement ,Aged ,Follow-Up Studies - Abstract
41 cases of cervical intradural disc herniation have been reported in the literature, none at the C7-T1 level. We describe a case of myelopathy after a fall. The female patient suffered an ataxia of the legs in combination with unilateral C8 cervicocephalgia and hypaesthesia. Magnetic resonance imaging revealed a space-occupying lesion at C7-T1, so we suspected a tumour. After a dorsolateral approach, an intradural disc herniation was found. Six months after the operation, the patient is free of complaints.
- Published
- 2009
28. [Neuroablative procedures in pain therapy]
- Author
-
V M, Tronnier and D, Rasche
- Subjects
Causalgia ,Microsurgery ,Pain, Postoperative ,Laminectomy ,Radiosurgery ,Ganglionectomy ,Pain, Intractable ,Rhizotomy ,Postoperative Complications ,Cordotomy ,Trigeminal Ganglion ,Neoplasms ,Electrocoagulation ,Humans ,Peripheral Nerves ,Spinal Nerve Roots ,Follow-Up Studies - Abstract
Although surgical ablative procedures can be effective in the management of chronic pain of malignant and non-malignant origin, they are often disregarded as treatment options due to the fact that in the past these procedures were associated with high complication rates. The complications include the development of new neurological deficits and in cases of long-term follow-up, the occurrence of the old or new pain syndromes by deafferentation. On the other hand there exist many less invasive, e.g. neuromodulatory procedures or non-invasive measures (systemic oral or transdermal opioids) which are able to considerably reduce chronic pain. Nevertheless, there remain certain very restricted indications for the use of neuroablative procedures for the treatment of chronic pain even today.
- Published
- 2009
29. [Angle of needle position for the epidural-perineural injection at the lumbar spine]
- Author
-
T, Theodoridis, R, Mamarvar, J, Krämer, M, Wiese, and W, Teske
- Subjects
Microsurgery ,Lumbar Vertebrae ,Nerve Compression Syndromes ,Humans ,Injections, Epidural ,Spondylosis ,In Vitro Techniques ,Spinal Nerve Roots - Abstract
The aim of this study was to find the correct angle of the needle position for the epidural perineural injection at the lumbar spine without any help by imaging.In 11 human cadaver lumbar spines besides dura, nerve roots and bones all soft tissue had been removed to allow us to look into the anterior lateral epidural spaces between L3 and S1 in different angles with an operation microscope. The area between the dura (medial), facet joint (lateral) and the laminae (cranial and caudal) were photographed and planimetrically measured. This area is called the width of the injection canal.Degenerative lumbar spines show a width of the injection canal of 29.61 mm(2) in L5/S1 with an angle of the needle position of 15 degrees to the midline. The optimal angle position of the needle brought a width of the injection canal in L4/5 only for 7.3 mm(2) and in L3/4 for 3.5 mm(2). In non-degenerative spines the injections canals were much wider.The epidural-perineural injection into the anterolateral epidural space only makes sense in the segment L5/S1. Here the L5 nerve root is reached as well as the S1 root - the main causes of sciatica. In upper segments the injection canal is far smaller even at optimal injection angles. In case of nerve root compression at L4 and upwards other epidural injection techniques should be used such as the epidural dorsal loss of resistance technique or the transforaminal technique.With some training it is possible to perform epidural-perineural injection for sciatica without the help of imaging.
- Published
- 2009
30. [Pathophysiology of migraine and clinical implications]
- Author
-
M, Schürks and H-C, Diener
- Subjects
Analgesics ,Serotonin ,Neuronal Plasticity ,Cyclooxygenase 2 Inhibitors ,Migraine Disorders ,Cortical Spreading Depression ,Migraine with Aura ,Brain ,Nociceptors ,Tryptamines ,Serotonin Receptor Agonists ,Vasodilation ,Meninges ,Risk Factors ,Neural Pathways ,Humans ,Trigeminal Nerve ,Spinal Nerve Roots ,Dihydroergotamine - Abstract
Migraine pathophysiology is determined by genetic and environmental factors. Based on altered cerebral habituation and low serotonin levels, certain triggers can elicit a migraine attack. Following initial unspecific prodromi, an aura follows in many patients which most often consists of visual symptoms. Cortical spreading depression is the electrophysiological correlate of the aura and can activate the trigemino-vascular system. This is one potential mechanism initiating the pain process. The characteristic unilateral pulsating headache is caused by a neurogenic inflammation in the meninges. Neck pain as reported by some patients is a migraine-specific feature, the anatomical basis being the trigemino-cervical complex. Functional changes in the pain processing system maintain the headache. Among these are sensitization of trigeminal nucleus caudalis neurons and an altered antinociception descending from the periaquaductal grey. Triptans have a peripheral and central mode of action, but they are no longer effective once central sensitization has occurred.
- Published
- 2008
31. [Emergency scenario: cauda equina syndrome--assessment and management]
- Author
-
O P, Gautschi, D, Cadosch, and G, Hildebrandt
- Subjects
Neurologic Examination ,Sacrum ,Lumbar Vertebrae ,Nerve Compression Syndromes ,Laminectomy ,Decompression, Surgical ,Prognosis ,Combined Modality Therapy ,Magnetic Resonance Imaging ,Adrenal Cortex Hormones ,Back Pain ,Risk Factors ,Acute Disease ,Humans ,Emergencies ,Polyradiculopathy ,Spinal Nerve Roots ,Diskectomy - Abstract
Acute low back pain is one of the most frequent reason for an emergency or primary care physician visit. Up to 90% of all adults will experience an episode of back pain at some point during their lifetime. Although the majority of patients have uncomplicated benign presentation and 80-90% recover within 4 to 6 weeks, there is a small subset who has an underlying potential life-threatening etiology. Among them are aortic dissection, ruptured abdominal aortic aneurysm, vertebral osteomyelitis, spinal epidural abscess and the cauda equina syndrome (CES). The latter entails a compression of the nerve roots of the cauda equina. These patients usually present post-traumatically with the clinical triad of saddle anesthesia, bowel or bladder dysfunction and muscular weakness of the lower extremeties. A delayed diagnosis can result in a significantly increased morbidity. Therefore, early diagnosis and the initiation of the appropriate therapeutic steps are essential. A thourough anamnesis and physical examination are leading to the suspected diagosis. Below, clinical presentation, diagnosis and relevant treatment of the CES are discussed.
- Published
- 2008
32. [Computer-assisted navigation system for interventional CT-guided procedures: results of phantom and clinical studies]
- Author
-
M, Meier-Meitinger, M, Nagel, W, Kalender, W A, Bautz, and U, Baum
- Subjects
Phantoms, Imaging ,Biopsy, Needle ,Contrast Media ,Equipment Design ,Sensitivity and Specificity ,Bone and Bones ,Spine ,Esophagus ,Liver ,Surgery, Computer-Assisted ,Neoplasms ,Humans ,Artifacts ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Lung ,Pancreas ,Software ,Anesthesia, Local - Abstract
To evaluate the technical applicability and accuracy of a navigation system for CT-guided interventional procedures in a phantom and a patient study.A novel navigation tool (CAPPA IRAD, CAS innovations AG, Erlangen, Germany) was employed for CT-guided biopsies in a phantom and in patients. The entire system consists of a PC, navigation software, an optical tracking system and a patient frame. For the phantom study, a spine phantom in wax was used. The phantom as well as the patients were placed on the CT table in a stable position and fixed within a double vacuum device. The patient frame equipped with optical and CT markers was placed above the target region, followed by acquisition of a planning scan. All data were transferred to the navigation system inside the scanning room, and with the aid of the above mentioned navigation software, the biopsy pathway was planned. Hereafter, the needle holder was aligned accordingly, and a coaxial biopsy needle was pushed forward to the planned target. An additional control scan confirmed needle position, and the navigation software was used to evaluate the distance between the target and needle tip.In the phantom study (n = 60) the average deviation between the planned and documented needle tip position was 1.1 mm. In the clinical study (n = 15), we performed biopsies of the lung, the mediastinal area, the pancreas and liver and some bone biopsies as well as a therapeutic nerve root infiltration. 12 of 15 cases required oblique needle access. In 9 / 15 cases merely a single planning and control scan were required, whereas in 5 / 15 cases additional safety or correction scans were performed. In the case of pancreas biopsy, the lesion (diameter 1 centimeter) visible during the arterial phase only could not be punctured even following repeated corrections due to severe breathing artifacts and pronounced peristaltic movement of the adjacent bowel. The time between planning CT and correct needle position was about 30 minutes.The navigation system allows for safe interventions in case of angulated needle access with high accuracy and little tissue trauma. However, insufficient corrections for respiration movement constitute a substantial limitation of the tool.
- Published
- 2008
33. [Progress in diagnostics of anorectal disorders. Part I: anatomic background and clinical and neurologic procedures]
- Author
-
F G, Bader, R, Bouchard, R, Keller, L, Mirow, R, Czymek, J K, Habermann, H, Fritsch, H-P, Bruch, and U J, Roblick
- Subjects
Anus Diseases ,Electromyography ,Rectal Neoplasms ,Rectum ,Anal Canal ,Intestinal Polyps ,Anus Neoplasms ,Evoked Potentials, Motor ,Proctoscopy ,Endosonography ,Rectal Diseases ,Spinal Nerve Roots ,Fecal Incontinence ,Neoplasm Staging - Abstract
Diagnostics and therapy of anorectal disorders are still questions of surgery. Exact knowledge of functional anatomy and precise clinical examination constitute the basis for the resulting therapeutic strategies. Three-dimensional endosonography and technical advances in flexible endoscopy using high-resolution chromoendoscopy and narrow-band imaging enable exact staging and diagnosis, even of malignancies in earliest stages. Furthermore new in-vivo staining methods combined with high-resolution imaging facilitate the discrimination of inflammatory and neoplastic lesions, which often lead to diagnostic difficulties in chronic inflammatory bowel disease. Developments in neurologic testing, including surface electromyography and sacral nerve stimulation, complement the diagnostic armamentarium.
- Published
- 2008
34. [Acute low back pain--assessment and management]
- Author
-
O P, Gautschi, G, Hildebrandt, and D, Cadosch
- Subjects
Neurologic Examination ,Nerve Compression Syndromes ,Magnetic Resonance Imaging ,Diagnosis, Differential ,Acute Disease ,Humans ,Emergencies ,Polyradiculopathy ,Radiculopathy ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Low Back Pain ,Spinal Cord Compression ,Algorithms - Abstract
Acute low back pain is a very common symptom. Up to 90% of all adults suffer at least once in their life from a low back pain episode, in the majority of cases a nonspecific lumbago. They are, with or without sciatica, usually self-limited and have no serious underlying pathology and subside in 80-90% of the concerned patients within six weeks. Beside a sufficient pain medication and physiotherapy, reassurance about the overall benign character and the favourable prognosis of the medical condition should be in the centre of the therapeutic efforts. A more thorough assessment is required for selected patients with warning signs, so called "red flags" findings, because they are associated with an increased risk of cauda equina syndrome, cancer, infection, or fracture. These patients also require a closer follow-up and, in some cases, an urgent surgical intervention. Among patients with acute nonspecific mechanical low back pain, imaging diagnostic can be delayed for at least four to six weeks, which usually allows the medical condition to improve. From a therapeutic viewpoint, there is enough evidence for the effectiveness of paracetamol, nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, heat therapy, physiotherapy, and the advice to stay "active". A complete relief and protection represent an out-dated concept, because the deconditioning is stimulated and the return to the workplace is needlessly delayed. Spinal manipulative therapy may provide short-term benefits in certain patients. In a multimodal therapeutic concept, the patient education should focus on the natural history of an acute back pain episode, the overall good prognosis, and recommendations for an effective treatment.
- Published
- 2008
35. [How do you clarify acute lumbago?]
- Author
-
T, Weiland and K, Wessel
- Subjects
Diagnosis, Differential ,Male ,Lumbar Vertebrae ,Spinal Injuries ,Nerve Compression Syndromes ,Acute Disease ,Humans ,Middle Aged ,Spinal Nerve Roots ,Low Back Pain ,Magnetic Resonance Imaging ,Spinal Cord Compression ,Gait Disorders, Neurologic - Published
- 2007
36. [Differential diagnosis of neuralgic amyotrophy and vertebral artery dissection]
- Author
-
A, Wöller, K, Plenagl, R, Ilg, H, Stimmer, and M, Mühlau
- Subjects
Diagnosis, Differential ,Neurologic Examination ,Vertebral Artery Dissection ,Shoulder ,Electromyography ,Nerve Compression Syndromes ,Brachial Plexus Neuritis ,Humans ,Female ,Middle Aged ,Spinal Nerve Roots ,Magnetic Resonance Imaging - Abstract
In most cases the definite diagnosis of neuralgic amyotrophy is not possible, so it is based on the typical course of symptoms after other diagnoses have been excluded. We report an otherwise healthy woman who presented with symptoms typical of neuralgic amyotrophy. However we could diagnose a vertebral artery dissection that probably caused the symptoms by compression of the cervical roots. The differential diagnosis of neuralgic amyotrophy and vertebral artery dissection is discussed.
- Published
- 2007
37. [Local vertebral body destruction after migration of a nucleus replacement]
- Author
-
K J, Schnake, F, Weigert, F, Kandziora, and N P, Haas
- Subjects
Adult ,Reoperation ,Lumbar Vertebrae ,Nerve Compression Syndromes ,Magnetic Resonance Imaging ,Prosthesis Failure ,Prosthesis Implantation ,Spinal Osteophytosis ,Postoperative Complications ,Spinal Fusion ,Foreign-Body Migration ,Back Pain ,Recurrence ,Image Processing, Computer-Assisted ,Humans ,Female ,Intervertebral Disc ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Device Removal ,Pain Measurement - Abstract
We present the case report of a 32-year-old female suffering from severe low back pain because of local vertebral body destruction at L3/4 after migration of PDN-SOLO nucleus replacement. Removal of the dislocated implant via a posterior transforaminal approach was not possible. After posterior stabilisation the implant could be salvaged from the anterior direction, but stabilisation with a vertebral body replacement was necessary.
- Published
- 2007
38. [MR-Guided pain therapy: principles and clinical applications]
- Author
-
J, Fritz and P L, Pereira
- Subjects
Adult ,Time Factors ,Injections, Epidural ,Sacroiliac Joint ,Magnetic Resonance Imaging, Interventional ,Amides ,Injections, Intra-Articular ,Adrenal Cortex Hormones ,Back Pain ,Needles ,Fluoroscopy ,Humans ,Anesthesia ,Ropivacaine ,Anesthetics, Local ,Artifacts ,Child ,Spinal Nerve Roots ,Tomography, X-Ray Computed - Abstract
X-ray fluoroscopy and computed tomography are frequently used to perform percutaneous interventions in pain therapy. The development of MR-compatible therapy needles now allows these interventions to be performed under MR imaging guidance. MR-guided interventions may be performed using most clinical MR scanners; however, systems with an open configuration are advantageous. Multiplanar pre- and intra-procedural MR imaging provides the interventionalist with essential information, such as evaluation of anatomy and pathology, as well as the planning of the procedure and monitoring of fluid distribution without the use of contrast agents. With the use of non-ionizing radiation, interventional MR imaging is especially suited for the treatment of children and young adults as well as for serial injection therapy. For spinal MR interventions, passive needle visualization is an easily achievable and reliable method. The resulting needle artifact is influenced by several factors such as the alloy of the needle, the strength of the static magnetic field, the sequence type, the spatial orientation of the therapy needle as well as the echo time and may further be optimized during the intervention by alteration of the last three factors. Fast acquisition techniques and image processing allow for continuous, near real-time MR imaging (so-called MR fluoroscopy) and interactive needle navigations, comparable to X-ray fluoroscopy and CT fluoroscopy. The purpose of this review is to illustrate and discuss general concepts of interventional MR imaging. A spectrum of interventional MR imaging procedures in spinal pain therapy is described and illustrated, including procedures such as lumbar facet joint injections, sacroiliac joint injections, lumbar spinal nerve root infiltrations and drug delivery to the lumbar sympathetic chain.
- Published
- 2007
39. [The facet syndrome: frequent cause of chronic backaches]
- Author
-
M, Ständer, U, März, U, Steude, and J C, Tonn
- Subjects
Neurologic Examination ,Lumbar Vertebrae ,Back Pain ,Cryotherapy ,Nerve Compression Syndromes ,Spondylarthritis ,Humans ,Anesthetics, Local ,Spinal Nerve Roots ,Bupivacaine ,Injections, Spinal - Abstract
The lumbar facet syndrome (LFS) is a frequent cause of chronic backaches. A reliable diagnosis can be made through repeated facet blockades.The diagnosis is considered confirmed if the pain is significantly reduced over several hours. In addition to oral pain medication and physical measures, alternative minimally invasive therapeutic possibilities include surgical stabilization, as well as facet joint denervation. Both can be performed as thermodenervation or cryotherapy.
- Published
- 2007
40. [Adhesive lumbar arachnoiditis. Endoscopic subarachnoepidurostomy as a new treatment]
- Author
-
J-P, Warnke and S, Mourgela
- Subjects
Adult ,Epidural Space ,Male ,Lumbar Vertebrae ,Nerve Compression Syndromes ,Endoscopy ,Tissue Adhesions ,Middle Aged ,Magnetic Resonance Imaging ,Cerebrospinal Fluid Shunts ,Subarachnoid Space ,Catheterization ,Arachnoiditis ,Humans ,Female ,Spinal Nerve Roots ,Aged ,Follow-Up Studies - Abstract
Adhesive lumbar arachnoiditis is essentially an unknown, unreported, and unrecognised disease. It was better known at a time when oil-based dye was used for myelography. The factors causing this pathogenesis remain unknown. In addition, diagnosis is hard to achieve and frequently attained only by an exclusion process. Only in severe cases, using high-resolution MRI, is evidence for the diagnosis obtainable.Modern neuroendoscopic techniques allow diagnosis at a reasonable risk (comparable with lumbar tap) and enable us substantially to treat the pain. Taken together, this means a radical new method of treatment for adhesive arachnoiditis. The treatment of a 23-patient research group suffering from adhesive lumbar arachnoiditis is monitored and described.Various endoscopic manoeuvres were carried out. Endoscopic reduction of adhesions and internal shunting for CSF flow between subarachnoidal and epidural space improved both the biomechanical abilities of rootlets and restoration of blocked CSF pathways. Its main result is the significant reduction of long-term pain registered by a visual analogue pain scale. No bad side effect other than temporary headache was found. No CSF leak syndrome was observed.The success of the method was directly influenced by the interventional procedure on the disturbed CSF circulation and its partial restoration (subarachnoepidurostomy). In cases of severe lumbar adhesive arachnoiditis, it was found very beneficial to implant special gravity-controlled valve systems for subarachnoid-peritoneal shunts.Adhesive lumbar arachnoiditis is no longer a devastating diagnosis. Due to a novel endoscopic treatment of the local CSF disturbances that restores physiologic pathways, the chance exists for long-lasting improvement of the clinical condition.
- Published
- 2007
41. [Clinical and diagnostic characteristics of T1 root syndrome]
- Author
-
A, Ardeshiri, J-C, Tonn, and T N, Witt
- Subjects
Male ,Neurologic Examination ,Spinal Neoplasms ,Nerve Compression Syndromes ,Laminectomy ,Uterine Cervical Neoplasms ,Middle Aged ,Magnetic Resonance Imaging ,Thoracic Vertebrae ,Fingers ,Prosthesis Implantation ,Scapula ,Arm ,Cervical Vertebrae ,Humans ,Female ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Intervertebral Disc Displacement ,Myelography ,Aged ,Follow-Up Studies - Abstract
Among radicular lesions, those affecting the T1 root are rare. Together with the similarity of symptoms to C8 syndrome, which is more common, this makes the diagnosis of T1 radiculopathy complicated. The clinical and diagnostic specifics of T1 syndrome are shown here based on three cases.We report on three patients with T1 syndrome. Clinical diagnostics (clinical investigation, electrophysiology, MRI) showed in two cases lateral intraforaminal disc herniae at the T1-2 level, and the third patient had metastasis of a cervix carcinoma being responsible for the radiculopathy. In all cases surgery was performed. The patients with disc herniae were immediately pain-free after surgery; in the third patient the neurological symptoms and pain clearly improved.These three cases show that by thorough analysis of clinical symptoms and functional (electrophysiology) and morphological (MRI) diagnostics, T1 radiculopathy can be differentiated from C8 lesions. All of the patients benefited from decompressive surgery.
- Published
- 2007
42. [Epidural varicosis as a rare cause of acute radiculopathy with complete foot paresis--case report and literature review]
- Author
-
P H, Pennekamp, M, Gemünd, C N, Kraft, L V, von Engelhardt, C, Lüring, and A, Schmitz
- Subjects
Epidural Space ,Neurologic Examination ,Lumbar Vertebrae ,Foot ,Nerve Compression Syndromes ,Middle Aged ,Magnetic Resonance Imaging ,Diagnosis, Differential ,Varicose Veins ,Sciatica ,Postoperative Complications ,Humans ,Paralysis ,Female ,Spinal Nerve Roots ,Intervertebral Disc Displacement - Abstract
Lumbar epidural varicosis presenting with radiculopathy is a seldom anticipated condition. An uncommon case of symptomatic enlargement of epidural veins mimicking lumbar disc herniation led us to perform a literature review to elucidate aetiopathological and diagnostic considerations as well as treatment options of this intraspinal pathology.The case of a 40-year-old woman with acute sciatia accompanied by a complete paresis of foot elevation and extension caused by enlarged epidural veins is described. A literature survey (Medline 1960-2005) was conducted to uncover further cases of symptomatic epidural varicosis.The literature review revealed only 75 published cases of symptomatic epidural varices which is generally judged as a rare cause of radiculopathy. Different models for the origin of enlarged epidural veins have been proposed. Enlargement may occur primary or secondary to a herniated disc or compressive lesions in the spinal cord. In some cases obstruction or occlusion of the inferior vena cava due to pregnancy or deep vein thrombosis are suspected to increase the pressure of the epidural venous plexi via collateral pathways. MRI has been reported to be of high value in demonstrating the dilated epidural vein, but the findings might be misinterpreted as herniated nucleus pulposus material. Coagulative ablation and/or excision of enlarged epidural veins is recommended and produces good long-term results in cases without extraspinal vessel pathology.Enlargement of epidural veins with compression of lumbar nerve roots can mimic the clinical signs of disc herniation or spinal stenosis, even when accompanied by neurological disorders. Although rare, lumbar epidural varicosis should be appreciated as a possible cause of radiculopathy and diagnosed before surgery. Apart from intraspinal abnormalities causing dilatation of epidural veins, stenosis or occlusion of the extraspinal venous drainage system should be considered.
- Published
- 2007
43. [CT-guided fine-needle aspiration in epidural vacuum phenomenon with lumbar ischialgia]
- Author
-
T, Kau, J, Gasser, and H, Illiasch
- Subjects
Epidural Space ,Male ,Lumbar Vertebrae ,Vacuum ,Nerve Compression Syndromes ,Suction ,Magnetic Resonance Imaging ,Treatment Outcome ,Needles ,Fluoroscopy ,Humans ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Low Back Pain ,Intervertebral Disc Displacement ,Aged - Published
- 2007
44. [Surgical technique of en bloc spondylectomy for solitary metastases of the thoracolumbar spine]
- Author
-
A C, Disch, I, Melcher, A, Luzatti, N P, Haas, and K-D, Schaser
- Subjects
Diagnostic Imaging ,Prosthesis Implantation ,Lumbar Vertebrae ,Spinal Fusion ,Spinal Neoplasms ,Peripheral Nervous System Neoplasms ,Biopsy ,Laminectomy ,Humans ,Spinal Nerve Roots ,Thoracic Vertebrae ,Neoplasm Staging - Published
- 2007
45. [(Modic) signal alterations of vertebral endplates and their correlation to a minimally invasive treatment of lumbar disc herniation using epidural injections]
- Author
-
J P, Liphofer, T, Theodoridis, G T, Becker, O, Koester, and G, Schmid
- Subjects
Adult ,Male ,Sacrum ,Adolescent ,Statistics as Topic ,Anti-Inflammatory Agents ,Injections, Epidural ,Triamcinolone ,Disability Evaluation ,Bone Marrow ,Outcome Assessment, Health Care ,Humans ,Anesthetics, Local ,Intervertebral Disc ,Osteochondritis ,Aged ,Lumbar Vertebrae ,Nerve Compression Syndromes ,Middle Aged ,Magnetic Resonance Imaging ,Hospitalization ,Mepivacaine ,Female ,Spinal Nerve Roots ,Intervertebral Disc Displacement ,Follow-Up Studies - Abstract
To study the influence of (Modic) signal alterations (SA) of the cartilage endplate (CEP) of vertebrae L3-S1 on the outcome of an in-patient minimally invasive treatment (MIT) using epidural injections on patients with lumbar disc herniation (LDH).The MR images of 59 consecutive patients with LDH within segments L3/L4 - L5/S1 undergoing in-patient minimally invasive treatment with epidural injections were evaluated in a clinical study. The (Modic) signal alterations of the CEP were recorded using T1- and T2-weighted sagittal images. On the basis of the T2-weighted sagittal images, the extension and distribution of the SA were measured by dividing each CEP into 9 areas. The outcome of the MIT was recorded using the Oswestry Disability Index (ODI) before and after therapy and in a 3-month follow-up. Within a subgroup of patients (n = 35), the distribution and extension of the signal alterations were correlated with the development of the ODI.Segments with LDH showed significantly more (p0.001) SA of the CEP than segments without LDH. Although the extension of the SA was not dependent on sex, it did increase significantly with age (p = 0.017). The outcome after MIT did not depend on the sex and age of the patients nor on the type of LDH. The SA extension tended to have a negative correlation with the outcome after MIT after 3 months (p = 0.071). A significant negative correlation could be established between the SA extension in the central section of the upper endplate and the outcome after 3 months (p = 0.019).1. Lumbar disc herniation is clearly associated with the prevalence of (Modic) signal alterations. 2. Extensive signal alterations tend to correlate with a negative outcome of an MIT using epidural injections. 3. Such SA in the central portion of the upper CEP correlate significantly with a negative treatment result. 4. The central portion of the upper CEP being extensively affected by (Modic) SA is a negative predictor for the success of a minimally invasive pain therapy.
- Published
- 2006
46. [Intraoperative three-dimensional imaging to monitor selective decompression in lumbar spinal stenosis]
- Author
-
U M, Mauer and U, Kunz
- Subjects
Male ,Lumbar Vertebrae ,Laminectomy ,Middle Aged ,Decompression, Surgical ,Magnetic Resonance Imaging ,Imaging, Three-Dimensional ,Spinal Stenosis ,Surgery, Computer-Assisted ,Fluoroscopy ,Image Processing, Computer-Assisted ,Humans ,Female ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Myelography ,Aged - Abstract
We are looking for a possibility to examine the amount of decompression in operations for spinal stenosis with an Iso-C(3D) fluoroscope (Siemens).In ten patients operated on because of spinal stenosis from one side with undercutting, we performed a scan with the Iso-C(3D) fluoroscope during the operation. In five patients we additionally performed intraoperative myelography.In all cases we were able to make useful scans. Two times we changed our surgical procedure because of the scans. There were no complications because of the investigation with the Iso-C(3D) fluoroscope and none related to the myelography, but the myelography was dispensable.It is possible and useful to investigate the decompression in spinal stenosis intraoperatively with less effort.
- Published
- 2006
47. [Sacral nerve root cysts--a rare cause of bladder dysfunction. Case report and review of the literature]
- Author
-
P, Kümpers, E, Wiesemann, H, Becker, B, Haubitz, R, Dengler, and D-H, Zermann
- Subjects
Microsurgery ,Sacrum ,Nerve Compression Syndromes ,Peripheral Nervous System Diseases ,Middle Aged ,Magnetic Resonance Imaging ,Arachnoid Cysts ,Diagnosis, Differential ,Image Processing, Computer-Assisted ,Humans ,Female ,Urinary Bladder, Neurogenic ,Spinal Nerve Roots ,Tomography, X-Ray Computed ,Myelography - Abstract
Asymptomatic cysts of the sacral nerve roots display a prevalence of 5 % and are occasionally demonstrated by MRI of the spine. Depending on their size and localization, arachnoid cysts may cause sacral or perineal pain, radicular sensomotory symptoms and neurogenic bladder and bowel dysfunction by compression of the nerve roots.We report on a case of a recently developed neurogenic bladder dysfunction. MRI of the spine demonstrated two large, liquor-filled cysts of 2.5 and 3 cm diameter, bilaterally localized at the nerve roots S2/3. Neurological and urological examinations confirmed the diagnosis of symptomatic nerve root cysts at the level S2/3, resulting in detrusor areflexia. A microsurgical excision of the cysts ameliorated the patient's pain symptoms. However, the detrusor areflexia did not improve.Tarlov cysts are predominantly regarded an asymptomatic incidental feature of CT and MRI scans of the spine. The case of our patient, as well as the so far published reports indicate, however, that a Tarlov cyst may cause a variety of neurological and urological symptoms. Nerve root cysts should be seriously considered and not excluded at an early stage, especially when coincident with persistent neurological and urological symptoms.
- Published
- 2006
48. [Chronic inflammatory demyelinating polyradiculoneuropathy with hypertrophy of cervico-thoracal nerve roots in a dog]
- Author
-
I, Kathmann, I Ch, Böttcher, T, von Klopmann, A, Gerdwilker, and A, Tipold
- Subjects
Dogs ,Treatment Outcome ,Polyradiculoneuropathy, Chronic Inflammatory Demyelinating ,Prednisolone ,Forelimb ,Anti-Inflammatory Agents ,Animals ,Female ,Dog Diseases ,Hypertrophy ,Peripheral Nerves ,Spinal Nerve Roots ,Magnetic Resonance Imaging - Abstract
A case of chronic inflammatory demyelinating polyradiculoneuropathy in a Magyar Vizsla dame, 7 months of age, is described. The neurological deficits such as movement disorders, hyporeflexia and muscle atrophy, were limited to the front legs. The hypertrophied cervico-thoracal nerve roots could be shown by magnetic resonance imaging. The diagnosis was additionally based on clinical findings, the relapsing course, the good response to therapy with prednisolone, the results of electrodiagnostic workup and muscle and nerve biopsy.
- Published
- 2006
49. [Risks and complications of epidural neurolysis -- a review with case report]
- Author
-
K J, Wagner, T, Sprenger, C, Pecho, E F, Kochs, T R, Tölle, A, Berthele, and L, Gerdesmeyer
- Subjects
Epidural Space ,Male ,Risk ,Drug-Related Side Effects and Adverse Reactions ,Anti-Inflammatory Agents ,Tissue Adhesions ,Middle Aged ,Magnetic Resonance Imaging ,Spinal Puncture ,Neurosurgical Procedures ,Catheterization ,Pharmaceutical Preparations ,Humans ,Minimally Invasive Surgical Procedures ,Meningitis ,Dura Mater ,Treatment Failure ,Anesthetics, Local ,Spinal Nerve Roots ,Low Back Pain - Abstract
Racz's minimal invasive epidural catheter procedure, also known as "epidural neuroplasty" is not only utilized in patients suffering from failed spine surgery ("failed back surgery syndrome") but also increasingly applied to non-surgical back pain patients to prevent chronification or deterioration. Its hypothesized principle of action is local epidural lysis of adhesions, neurolysis of vertebral nerve roots and local lavage of proinflammatory mediators by repeated injection of local anesthetics, corticosteroids, hyaluronidase and hypertonic saline solution. However adverse events are well known to occur in epidural neuroplasty. Complications of epidural neuroplasty are due to the procedure itself or due to specific drugs-related side effects. Unintended dural puncture, administration of the drugs to the subarachnoid or subdural space, catheter shearing, infection and severe hemodynamic instability during application are most commonly observed adverse events. Complications related to the procedure itself occur immediately, while complications relating to drug administration show later onset. Within this context, we report a case of severe meningitis with neurologic sequelae in a patient who received Racz catheter-treatment for unspecific low-back pain and provide an overview of the literature on other potential severe complications. As a consequence, we recommend that the Racz catheter procedure as yet should be restricted to controlled clinical trials with rigorous inclusion- and exclusion criteria.
- Published
- 2006
50. [Pain patterns of disc lesions of the lumbar spine]
- Author
-
P, Machacek and M, Friedrich
- Subjects
Diagnosis, Differential ,Neurologic Examination ,Nerve Compression Syndromes ,Models, Neurological ,Statistics as Topic ,Humans ,Reproducibility of Results ,Spinal Nerve Roots ,Intervertebral Disc Displacement ,Pain Measurement - Abstract
The aim of this study was to find out the reliability of several dermatomic maps (description of pain pattern within a nerve root lesion) according to the respective segmental area.Different studies which deal with pain pattern caused by disc lesions were searched for with MedLine support and then reviewed.A clear correlation between the pain projections of the lumbar spine does not seem to exist. A contradiction of the most common pain projection (S1) and operated disc (L4/5) is described.Even though there are studies of high scientific design and value (Nitta H, Wolff A) the pain pattern of dermatomic maps is only of limited value for the definition of the affected segment.
- Published
- 2006
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