To share the experience regarding management and follow-up of patients with Pregnancy- and lactation-related osteoporosis (PLRO) who were effectively treated.This case series presented 10 patients diagnosed with PLRO and treated from January 2010 to December 2019. Visual analog scale and laboratory findings were evaluated. Spinal and extremity magnetic resonance imaging was obtained for patients with spinal and extremity pains. Dual energy X-ray absorptiometry was used for the measurement of bone mineral density. Values assessed on dual energy X-ray absorptiometry were L1?L4 T score, L2?L4 T score, and femoral neck T score.In the first-month follow-ups, all patients had meaningful pain relief and symptom resolution. The mean duration of pain control during the treatment period was 2.4 months. Two patients who continued breast-feeding were also the patients whose pain control was achieved at the latest. One patient required vertebroplasty.Patients with PLRO should be promptly treated and followed up. Discontinuation of breast-feeding will provide rapid advantage and should be the first step of the management. Early diagnosis and treatment of calcium and vitamin D with conservative procedures with spinal braces are very important for the treatment of PLRO patients. Additionally, bisphosphonates or teriparatide can improve the bone mineral density in patients with PLRO.
In routine surgical practice, anterior approaches are not often used to treat upper cervical pathologies. Such lesions can be difficult to access surgically. This article describes 2 cases in which the transmandibular approach was used to address anterior upper cervical pathology. One case was a chordoma invading the C2-C3 vertebrae and the other case was atlanto-axial instability. Neurological examination revealed myelopathy in both cases. Each patient had already undergone occipito-cervical fusion at a different center and, thus, had limited neck extension and mouth-opening ability. In the first case, the tumor was totally excised. In the second, the dens was removed. We believe that the transmandibular approach is the best option for patients with limited neck mobility and restricted mouth-opening ability.
Lumbar disc herniation very rarely occurs in adolescence. The aim of this study was to assess the radiological, clinical and surgical features and case outcomes for adolescents with lumbar disc herniation, and to compare with adult cases. The cases of 17 adolescents (7 girls and 10 boys, age range 13-17 years) who were surgically treated for lumbar disc herniation in our clinic between 1998 and 2003 were retrospectively reviewed. The mean follow-up time for these cases was 60 months. The collected histories revealed that 14 (82%) of the 17 cases involved trauma or intense sports activity. Low back pain was the most common complaint (15 cases, 88%). None of the 17 patients had major symptoms during follow-up, and most were engaged in intense sports or heavy work-related activities during this period. The main features of lumbar disc herniation in adolescents are different from those seen in adults. Careful assessment is vital to avoid misdiagnosis and prevent undesirable results from inappropriate surgery. When surgery is indicated and patients are carefully selected, the results of lumbar discectomy in adolescence can be satisfactory.
Pigmented villonodular synovitis is a benign proliferative disease of the synovial structures.This disease is most commonly seen in the extremities, and spinal involvement is extremely rare.In the relevant literature, 53 cases have been reported.We present a 66-year-old female patient with a long history of back pain, which progressed and radiated to the left leg over a period of 2 months.The patient also had a mass in the lumbar region on the grounds of spinal degenerative changes.Following gross total excision, the diagnosis was established by histopathology.In this report, we present our experience and discuss our neuroradiological and clinical findings.
A 32-year-old man presented with gradually increasing bilateral buttock pain. He had intermittent claudication. Multiple, homogenously enhanced intradural extramedullary lesions at L2-L3 and L5-S1 levels were observed on magnetic resonance imaging. The tumors were debulked and were removed in piecemeal pattern until they had completely been resected. Histopathological examination of the surgical specimens confirmed that both tumors were myxopapillary ependymomas (MPE). MPE presenting as concomitant double tumor at conus-cauda-filum level are very rare. This kind of presentation could not be directly considered as dissemination, since both tumors were in the site of classical origin of MPE. Ten cases of double spinal MPEs have been reported to date. Including the present case, analysis of the 11 patients revealed some facts. There is a male predominance, which is opposite to the ependymomas that are commonly observed in females. Median age at presentation is 15 years. Most pronounced symptom is low back pain that sometimes radiates to lower extremities. Surgical approach was aimed in all tumors, which could be succeeded in all tumors except one. Adjuvant radiation therapy was applied in 5 patients. No recurrences have been reported after surgery or surgery + radiotherapy regimens. Keywords: Ependymoma, Surgery, Radiotherapy, Low back pain
In this report the authors present a case of cauda equina syndrome that developed following induction of spinal anesthesia in a patient who had no apparent preexisting bleeding abnormality. An acute subdural hematoma caused the syndrome and was believed to have resulted from direct vascular trauma during administration of spinal anesthesia or from vascular trauma combined with thrombocytopenia in the postoperative period.
The aim of this study was to investigate whether the tumor parameters of spinal intramedullary ependymomas are significant predictors of clinical presentation and postsurgical outcome.The study involved 21 cases of intramedullary ependymoma that were operated on between 1988 and 2001. The patients were 13 males (62%) and 8 females (38%), with an age range of 9-70 years (median 38 years).In most cases (13; 62%), preoperative neurologic examination revealed a sensorimotor deficit in at least one limb. Complete tumor removal was achieved in all cases. The patients with wider tumors had poorer preoperative neurologic condition and poorer neurologic outcome. Tumor length (equivalent to myelotomy length) was not correlated with preoperative neurologic status, but longer length was significantly associated with development of dysesthesia post surgery. In contrast to tumor length, tumor/cord ratio (ratio of the tumor width to the largest cord width at the tumor site) was identified as a significant predictor of preoperative neurologic status and outcome. Ratio values of >0.80 were correlated with poorer preoperative clinical status and poorer neurologic outcome. Neither extent of edema (determined from length [in millimeters] of hyperintensity on T2-weighted images) nor presence of a cyst in the tumor was significant relative to postoperative neurologic recovery in these cases.This study demonstrated that the width of the tumor relative to the cord is the main predictor of neurologic presentation and postoperative status. The length of the tumor affects the postoperative dysesthesia development.
Subarachnoid–pleural fistula is a rare type of cerebrospinal fluid (CSF) fistula, and there are only several cases reported in the literature. The authors describe a 65-year-old male patient in whom a diagnosis of T7–8 disc herniation had been made. He underwent surgery via a right lateral extracavitary approach. Postoperatively he developed progressive respiratory distress and headache. A chest x-ray film revealed a pleural effusion, and computerized tomography (CT) myelography demonstrated a subarachnoidal-pleural fistula at the level at which the herniated disc had been removed. The patient had been managed via a CSF drainage system and a chest tube. He was discharged after relief of symptoms was attained. Subarachnoid–pleural fistulas can be secondary to traumatic injury and surgery, or they can be spontaneous. Patients present with rapidly filling pleural effusion and headache. A diagnosis can be established using CT myelography or myeloscintigraphy. Treatment is conservative, with the placement of a chest tube and insertion of a CSF drainage catheter, and surgical repair should be considered only if the conservative therapy fails.
tumors. A 70-year-old male patient admitted to our clinic with low back and both legs pain of one year's duration. Magnetic resonance imaging revealed a solid mass lesion at T-12 level. The contrast enhancing mass was intradural in location. T-12 laminectomy was performed and a highly vascular mass originated at the T-12 nerve root was totally removed. Histopathological examination revealed diagnosis of haemangioblastoma. He was then screened for von Hippel Lindau disease. No stigmata of this disease were found. The postoperative period was uneventful. He was discharged with no complaints. Spinal root haemangioblastoma should be kept in mind in a patient with highly enhancing spinal intradural mass. Key Wards: Hemangioblastoma, Spinal nerve root, von Hippel Lindau disease
