Although many patients with infective endocarditis (IE) complain of joint, muscle, and back pain, infections at these sights are rare. The incidence of spinal abscess in cervical spine complicating endocarditis is very rare. Although the surgical management is the mainstay of treatment, conservative treatment can get success in selected patients. We report a patient with cervical epidural abscess due to Streptococcus viridans endocarditis. Both epidural abscess and IE were managed conservatively with intravenous antibiotics for 8 weeks, with recovery. It is important to remind spinal epidural abscess can occur in those patients with bacterial endocarditis.
Abscess ; Anti-Bacterial Agents ; Back Pain ; Endocarditis ; Endocarditis, Bacterial* ; Epidural Abscess* ; Humans ; Incidence ; Joints ; Spine ; Spondylitis ; Viridans Streptococci*

Spontaneous Regression of a Big Subligamentous Extruded Disc Herniation: Case Report And Review of The Literature The most efficient method for the treatment of lumbar disc herniation is still controversial. The most important aspect is the application of the suitable conservative or surgical treatment to the right patient at the right time. In lumbar disc herniation patients, one must not precipitate except for cases that require surgical indications as in cauda equina syndrome, evolutive motor deficit and persistence of pain in spite of the narcotics. However, the spontaneous regression mechanism has not been completely determined yet. The proposed hypotheses are; dehydration, retraction of the disc to the hernia in the annulus fibrosis, enzymatic catabolism and phagocytosis. In this study, the case of a patient with huge lumbar disc hernia regressing by itself has been presented and the potential mechanisms of disc regression have been discussed.
Dehydration ; Fibrosis ; Hernia ; Humans ; Magnetic Resonance Imaging ; Metabolism ; Narcotics ; Phagocytosis ; Polyradiculopathy ; Remission, Spontaneous*

A teratoma is a neoplasm that contains tissues originating from three germ cell layers at ectopic sites. The embryology of teratomas remains unclear. Teratomas are usually composed of cystic and solid components, and they are usually associated with syringomyelia. Cystic lesions of teratomas may rupture in a spontaneous, iatrogenic, or traumatic manner. Lipid droplets in the ventricles and subarachnoid space are rare. We managed a case of a spinal teratoma in the lumbar region in a 67-year-old man. He complained of nocturia, frequent urination, and difficulty in walking for 2 months. Radiographic imaging revealed a lumbar spinal intradural mass. Intracranial lipid droplets dissemination was also existed. The patient underwent surgery, and a diagnosis of mature teratoma was confirmed histopathologically. During the operation, the cystic portion of the intradural mass ruptured. During the hospital stay, the patient's mental status declined. On radiological examination, slightly enlarged ventricle size was observed. Dissemination of lipid droplets within ventricles occurs because of spontaneous, iatrogenic, or traumatic rupture. Additional lipid droplet dissemination to the intracranial space associated with neurologic deterioration after a spinal teratoma surgery should be considered when iatrogenic rupture of the cyst portion occurs.
Aged ; Diagnosis ; Embryology ; Germ Cells ; Humans ; Length of Stay ; Lumbosacral Region ; Nocturia ; Rupture ; Spine ; Subarachnoid Space ; Syringomyelia ; Teratoma* ; Urination ; Walking

Dorsal extradural migration of extruded disc material is clinically uncommon. We report a rare case of posterior epidural migration of an extruded lumbar disc mimicking a facet cyst. A 32-year-old man was admitted to our institute with a 2-week history of severe low back pain and radiating pain in the left leg. The magnetic resonance (MR) images revealed a dorsally located, left-sided extradural cystic mass at the L2-3 level. The initial diagnosis was an epidural facet cyst because of the high signal intensity on MR images and its location adjacent to the facet joint. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was observed and excised. The pathological diagnosis was degenerated disc material. After surgery, the patient experienced complete relief from leg pain.
Adult ; Diagnosis ; Humans ; Leg ; Low Back Pain ; Zygapophyseal Joint

OBJECTIVE: Spinal intramedullary tuberculoma (SIMT) is rare, accounting for 2/100,000 cases of tuberculosis and only 0.2% of all cases of central nervous system(CNS) tuberculosis. We share our experiences of 11 cases of this entity for improving diagnosis and conceptualize the management of this rare disease. METHODS: The clinical profile, radiological data and management of 11 cases of SIMT which were managed either conservatively or by surgical intervention during last 27 years (1987-2014) were analysed. RESULTS: Male:female ratio was 1.75:1. Five cases had associated pulmonary Koch's. Most common site was thoracic cord. Two cases had concurrent multiple intracranial tuberculoma. Most common presentation was paraparesis. X-ray myelography was performed in two patients in the initial period of study suggesting intramedullary pathology. In the subsequent nine cases who had magnetic resonance imaging (MRI), seven showed typical "target sign" and conglomerate ring lesion. Out of 8 surgically managed patients, 6 cases improved rapidly and in 2 patients gradual improvement was seen in follow-up. Most common indication of surgical excision was rapid neurological deterioration followed by diagnosis in doubt. Histopathology confirmed tuberculous etiology of the intramedullary lesion in all. Clinical and radiological improvement was seen in all 3 conservatively managed patients in follow-up. CONCLUSION: MRI findings of SIMT were specific and proven histologically correct. Surgical intervention may be indicated if there is no response to chemotherapy, the diagnosis is in doubt, or there is a rapid deterioration in neurological function because surgical outcome is good in these circumstances.
Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Myelography ; Paraparesis ; Pathology ; Rare Diseases ; Tuberculoma* ; Tuberculoma, Intracranial ; Tuberculosis

OBJECTIVE: To present the clinical benefits of an instrument designed to facilitate removal of polyaxial screws during revision surgery. METHODS: All polyaxial screws can be removed without additional materials or a large amount of debridement using our newly designed instrument. Forty-two screws were removed from five patients without any complications using this instrument. RESULTS: We removed the cap screws and rods from the 42 polyaxial screws in five patients and made them monoaxial using the new screw removal apparatus. The screws and rods were removed quickly in a minimally invasive way with no complications. No damage to the pedicle or surrounding soft tissue occurred during screw removal. No neurogenic changes developed during revision surgery after changing the screws. CONCLUSION: This newly designed screw removal instrument was used safely and effectively to remove all polyaxial and monoaxial pedicle screws.
Debridement ; Equipment Failure ; Humans ; Spinal Fusion ; Spine

We report a rare case that showed aggravation of neurological symptoms due to expansion of the synovial cyst at C7/T1 after several month of trauma and present the consideration of proper prevention and management. A 64-year old male was admitted by right arm weakness(GIV+) after a pedestrian traffic accident. According to computed tomography(CT) scan and electromyography(EMG), a brachial plexus injury was diagnosed and he was treated conservatively. After 7 months, he was re-admitted by the left side weakness(GIV-) with severe pain and magnetic resonance image(MRI) revealed the expanded cystic lesion at C7/T1 level which compressed the cord from left side. After administration of steroid, surgical resection was performed via posterior approach and partial laminectomy. The dural expansion was observed after total removal of cyst which was diagnosed as a pathologist and symptoms were completely recovered. Because of its possibility of expansion of the synovial cyst and critical myelopathic symptoms can be induced in cervical spine, immobilization should be in consideration for acute period of post-trauma, especially, in old-aged patients with degenerative facet joints. And surgical procedure should not be delayed if symptoms developed.
Accidents, Traffic ; Arm ; Brachial Plexus ; Humans ; Immobilization ; Laminectomy ; Magnetic Resonance Spectroscopy ; Male ; Spine ; Synovial Cyst ; Zygapophyseal Joint

The management of thoraco-lumbar fractures remains controversial. Different authors have advocated immobilization, external bracing or internal fixation by either anterior or posterior approaches. To stabilize the fracture and avoid an unne cessary fixation of an uninjured segment, posterior monosegmental fixation was performed in Type B1 fractures according to the classification of Magerl et al, with nearly intact vertebral body for load support. Two patients underwent fixation with 4 titanium pedicle screws, one level above and directly into the fractured vertebra body. Patients had a stable fixation at 6 months following surgery. No patients experienced neurological deficit or had developed a delayed kyphotic deformity. Single level fixation for selected cases of thoracolumbar fracture(Type B1 fractures) may be considered as an effective procedure to obtain fixation and fusion. But it is necessary to get a further follow-up period, further cases and especially biomechanical support.
Braces ; Congenital Abnormalities ; Humans ; Immobilization ; Spine ; Titanium

Merkel cell carcinoma is a skin disease that rarely involves the spine. The common presentation of spinal involvement is quite confusing and may be easily misdiagnosed. However, once it spreads, the disease progresses rapidly, with an extremely poor outcome. We report on the case of a 30-year-old male with cervical spinal metastasis of Merkel cell carcinoma causing quadriparesis.
Adult ; Carcinoma, Merkel Cell ; Humans ; Male ; Neoplasm Metastasis ; Quadriplegia ; Skin Diseases ; Spine

Vertebral hemangioma is relatively common, but rarely extends into the epidural space and causes neurological deficits. This case report describes a 69-year-old woman with vertebral hemangioma extending into the epidural space causing spinal cord compression. The patient presented with low back pain and progressive weakness of the left lower extremity over a period of 1 year. Radiologic findings revealed a dural encasing vertebral hemangioma with spinal cord compression at the T11 level. After T11 vertebroplasty, the lesion was subtotally removed by T10-11 total laminectomy. The patient regained motor power of the left lower extremity postoperatively. And no further tumor growth was observed at last follow-up. This combination of intraoperative vertebroplasty and decompressive laminectomy offers a viable treatment modality for a dural encasing vertebral hemangioma with epidural extension causing cord compression.
Aged ; Epidural Space ; Female ; Hemangioma ; Humans ; Laminectomy ; Low Back Pain ; Lower Extremity ; Spinal Cord ; Spinal Cord Compression ; Vertebroplasty