Zeitschrift für Wirbelsäule

16 year old male was operated upon for trauma induced L1 burst fracture with complete paraplegia. On 7th postoperative day patient started developing rapidly evolving bilaterally symmetrical ascending areflexic motor paralysis involving shoulder accompanied by tingling dysesthesias in the upper extremities. Thereafter, he developed lower cranial nerve palsy with facial diaparesis. All relevant haematological & serological tests were not contributory to definite diagnosis and MRI-Spine did not show any abnormality. However, Electrodiagnostic study & CSF examination supported the diagnosis of Guillain-Barre Syndrome (GBS). Patient was subsequently subjected to plasmapheresis but his condition deteriorated and he succumbed to death on 15th postoperative day.

This rare case reports illustrates the importance of watchful expectancy for a neurodeficit that may or may not be related to spine surgery even after critical postoperative period, so that urgent measures can be initiated at the right time in the form of supportive & curative treatment.

Background: Epidural steroid injections are commonly-performed procedures used to treat several spinal conditions. Traditionally, these procedures have been performed without image guidance. However, a large number of blindly-performed injections are inaccurate with needle placement outside the epidural space. The purpose of the current article was to review the data on inaccuracy rates of non-image guided epidural injections.

Results and Conclusions: 9-52% of non-image guided caudal epidural injections are outside the epidural space. 7-30% on non-image guided lumbar interlaminar epidural injections is outside the epidural space.

Background: Spine height is related to disc hydration and activity. We aimed to establish inter- and intra-tester reliability for spine height measurements using a commercially available stadiometer that can be utilized in clinical settings. Methods: Twenty-nine healthy men and women (mean age = 29 ± 3.2 years) volunteered to participate. Each subject was seated in the stadiometer for 10 minutes with a 4.5 kg weight placed on each shoulder. The load was removed and spine height was measured every minute for five minutes by two different testers. Measurements were repeated twice more by one tester. Results: The means of the standard deviations were smaller than the mean differences, suggesting low variability and good reliability. The intraclass correlation coefficient was 0.99 for both testing sequences. Conclusions: This is the first study to establish the inter-tester and intra-tester reliability of measuring spinal height using a commercially available clinic based stadiometer protoco

Introduction: Neuroenteric cysts are a rare type of spinal tumors that result of anomalies during embryonic development. A case with a rare haemorrhagic presentation is reported.

Case report: 42 years old male that shows an initial clinical picture consisting of cervical pain. Cervical Magnetic  Resonance (MR) reveals a lesion intradural-extramedullar at level C2-C3. Findings are in correlation with hemorrhagic lesion in reabsorption phase. A surgical procedure is performed. Through a bilateral C2-C3 and partial C1 laminectomy the cyst was emptied. The rest of membranes are removed. The patient shows a progressively improvement. The hystopathological analyses find match neuroenteric cyst type A.

Discussion: 58 cases of neuroenteric spinal cysts reported in literature are analyzed. Total excision was performed in about 34%. There was any finding about hemorrhagic presentation in neuroenteric cyst in these cases.

Introduction: The L5-S1 trans-sacral axial rod represents a less invasive approach to spinal fixation. No study to date has biomechanically tested this device to failure to compare it to the more common pedicle screw instrumentation in the human cadaveric spine.

Methods: Seven human lumbar spines (L4-pelvis) with an average t score of -3.5, were randomly divided into a pedicle screw construct [4] and axial trans-sacral rod [3]. The spines were then tested in a custom built platform to determine the effect of a pure flexion moment. Testing was performed with six cycles (10 N/m), and final destructive testing (maximum 50 N/m).

Results:The pedicle screw construct has similar motion at the L5/S1 junction compared to the trans-sacral rod construct in cyclical testing. With destructive testing, no significant motion difference is observed at the L5/S1 segment, and no overt failure was noted. However, there was free motion and displacement at the L4/5 segment and in 3 specimens there was complete failure of the posterior ligamentous complex.

Conclusion: The trans-sacral axial rod was comparable to pedicle screws at the L5/S1 disc space in a pure flexion biomechanical model. No overt failure was observed in the destructive testing at the instrumented levels