BACKGROUND: Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain. METHODS: Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis. RESULTS: One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B (p < 0.05). CONCLUSIONS: The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.
Buttocks ; Diagnosis ; Follow-Up Studies ; Humans ; Nerve Block ; Pain, Referred ; Prospective Studies ; Radiculopathy ; Spinal Diseases ; Spinal Stenosis ; Visual Analog Scale ; Zygapophyseal Joint

STUDY DESIGN: Case report. OBJECTIVES: We report a case of Ogilvie's syndrome following posterior decompression surgery in a spinal stenosis patient who presented with acute abdominal distension, nausea, and vomiting. SUMMARY OF LITERATURE REVIEW: Ogilvie's syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus, and is also known as acute colonic pseudo-obstruction. Early recognition and diagnosis enable treatment prior to bowel perforation and requisite abdominal surgery. MATERIALS AND METHODS: An 82-year-old woman presented with 6 months of worsening back pain with walking intolerance due to weakness in both legs. She had hypertension, asthma, and Cushing syndrome without bowel or bladder symptoms. Further workup demonstrated the presence of central spinal stenosis on magnetic resonance imaging. The patient underwent an L2-3 laminectomy and posterior decompression. Surgery was uneventful. RESULTS: The patient presented with acute abdominal distension, nausea, and vomiting on postoperative day 1. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response. CONCLUSION: Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after lumbar spinal surgery. Early diagnosis and initiation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.
Aged, 80 and over ; Asthma ; Back Pain ; Colon ; Colonic Pseudo-Obstruction ; Cushing Syndrome ; Decompression ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Enema ; Female ; Humans ; Hypertension ; Ileus ; Ischemia ; Laminectomy ; Laxatives ; Leg ; Magnetic Resonance Imaging ; Mortality ; Nausea ; Neostigmine ; Spinal Stenosis ; Urinary Bladder ; Vomiting ; Walking

STUDY DESIGN: Case report. OBJECTIVES: We report the case of a long, solitary, rosary-shaped neurofibroma that was misdiagnosed as another disease due to the patient's surgical history involving repetitive procedures and its abnormal appearance. SUMMARY OF LITERATURE REVIEW: Neurofibroma is an intradural-extramedullary spinal tumor. It is generally not difficult to diagnose due to its frequent occurrence and specific magnetic resonance imaging (MRI) findings. However, to date, neurofibromatosis stigmata and long, solitary, rosary-shaped neurofibromas have rarely been reported. MATERIALS AND METHODS: A 60-year-old woman was admitted to our hospital due to persistent pain, despite previous surgery and repetitive procedures. On physical examination, vision loss, hearing loss, skin discoloration, or subcutaneous nodules were not observed. A neurologic examination revealed normal motor and sensory function and voiding sensation. No pathologic reflexes such as the Babinski sign were observed. Previous sequential MRIs revealed intradural lesions that progressed from the thoracic vertebra 11 to the lumbar vertebra 3. She had no signs of neurofibromatosis stigmata, and the neurologic examination was unremarkable. The initial diagnosis was based on serial MRIs, which revealed a parasite infestation, a spinal cord tumor (myxopapillary-type ependymoma with hemorrhage), arachnoiditis, and vascular malformations. Total mass excision was performed, and the final diagnosis was neurofibroma. RESULTS: There were no signs of a tumor remnants or local recurrence in a 1-year follow-up MRI study. CONCLUSIONS: Although intradural spinal tumors are very rare, their clinical features are nonspecific and resemble other degenerative spinal diseases, including spinal stenosis and disc herniation. These diseases may easily be overlooked by physicians.
Arachnoid ; Arachnoiditis ; Christianity ; Diagnosis ; Diagnostic Errors ; Ependymoma ; Female ; Follow-Up Studies ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurofibroma* ; Neurofibromatoses ; Neurologic Examination ; Parasites ; Physical Examination ; Recurrence ; Reflex ; Reflex, Babinski ; Sensation ; Skin ; Spinal Cord Neoplasms ; Spinal Diseases ; Spinal Stenosis ; Spine ; Vascular Malformations

STUDY DESIGN: A retrospective study. PURPOSE: To assess postoperative bone regrowth at surgical sites after lumbar decompression with >5 years of follow-up. Postoperative preservation of facet joints and segmental spinal instability following surgery were also evaluated. OVERVIEW OF LITERATURE: Previous reports have documented bone regrowth after conventional laminectomy or laminotomy and several factors associated with new bone formation. METHODS: Forty-nine patients who underwent microscopic bilateral decompression via a unilateral approach at L4–5 were reviewed. Primary outcomes included correlations among postoperative bone regrowth, preservation of facet joints, radiographic parameters, and clinical outcomes. Secondary outcomes included comparative analyses of radiographic parameters and clinical outcomes among preoperative diagnoses (lumbar spinal stenosis, degenerative spondylolisthesis, and degenerative lumbar scoliosis). RESULTS: The average value of bone regrowth at the latest follow-up was significantly higher on the dorsal side of the facet joint (3.4 mm) than on the ventral side (1.3 mm). Percent facet joint preservation was significantly smaller on the approach side (79.2%) than on the contralateral side (95.2%). Bone regrowth showed a significant inverse correlation with age, but no significant correlation was observed with facet joint preservation, gender, postoperative segmental spinal motion, or clinical outcomes. Subanalysis of these data revealed that bone regrowth at the latest follow-up was significantly greater in patients with degenerative lumbar scoliosis than in those with lumbar spinal stenosis. Postoperative segmental spinal motion at L4–L5 did not progress significantly in patients with degenerative spondylolisthesis or degenerative lumbar scoliosis compared with those with lumbar spinal stenosis. CONCLUSIONS: Microscopic bilateral decompression via a unilateral approach prevents postoperative spinal instability because of satisfactory preservation of facet joints, which may be the primary reason for inadequate bone regrowth. Postoperative bone regrowth was not related to clinical outcomes and postoperative segmental spinal instability.
Bone Development ; Decompression* ; Diagnosis ; Follow-Up Studies* ; Humans ; Laminectomy ; Minimally Invasive Surgical Procedures ; Osteoarthritis, Spine ; Osteogenesis ; Retrospective Studies ; Scoliosis ; Spinal Stenosis ; Spondylolisthesis ; Treatment Outcome ; Zygapophyseal Joint

STUDY DESIGN: This is a prospective study that was undertaken at a single centre and involved 80 consecutive patients diagnosed with lumbar spinal stenosis (LSS). PURPOSE: The aim of the study was to assess the efficacy of a qualitative grading system as seen on magnetic resonance imaging (MRI) as a tool in the management of multilevel LSS. OVERVIEW OF LITERATURE: LSS diagnosis is clinical but is usually radiologically supplemented. However, there are often multilevel radiological findings with non-specific or atypical clinical features. We used a qualitative grading system to help in the decision-making process of the management of patients with multilevel LSS. METHODS: 80 patients with LSS were treated with decompression and prospectively followed-up for a minimum of 12 months. All had failed conservative treatment. Qualitative grading of LSS severity was based on the dural sac in T2 weighted axial MRI images at all disc levels and was done from L1–2 to L5–S1 (n=400). Functional outcome was assessed using the Oswestry disability index (ODI). RESULTS: The mean patient age was 56.6 years, with a gender ratio of 0.6:1. Forty patients had degenerative LSS and 40 had degenerative spondylolysthesis. A total of 178 levels were decompressed, the majority of which were L4–L5 (43.82%), followed by L5–S1 (41.57%). According to our qualitative grading system, grade D stenosis (53.93%) was decompressed most frequently, followed by grade C stenosis (41.57%). The average preoperative ODI score was 58.55%, which later reduced to 19.15%. Seventy percent of patients achieved excellent results, whereas 30% achieved good results. CONCLUSIONS: Morphological grading is a useful tool in decision making in surgery for multilevel LSS. Grade C and D stenosis should be decompressed, whereas A and B should not be, unless clinically justified.
Constriction, Pathologic* ; Decision Making ; Decompression ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Prospective Studies ; Spinal Stenosis ; Spine*

STUDY DESIGN: Cross-sectional retrospective study designed to assess interobserver agreement. PURPOSE: To investigate if interobserver agreement using magnetic resonance imaging (MRI) in the evaluation of lumbar spinal canal stenosis and root compression can be improved upon combination with magnetic resonance myelography (MRM). OVERVIEW OF LITERATURE: The interpretation of lumbar spinal MRI, which is the imaging modality of choice, often has a significant influence on the diagnosis and treatment of low back pain. However, using MRI alone, substantial interobserver variability has been reported in the evaluation of lumbar spinal canal stenosis and nerve root compression. METHODS: Hardcopies of 30 lumbar spinal MRI (containing a total of 150 disk levels) as well as MRM films were separately reviewed by two radiologists and a neurosurgeon. At each intervertebral disk, the observers were asked to evaluate the thecal sac for the presence and degree of spinal stenoses (mild, moderate, or severe) and presence of root canal compression. Interobserver agreement was measured using weighted kappa statistics. RESULTS: Regarding lumbar spinal canal stenosis, interobserver agreement between the two radiologists was moderate (kappa, 0.4) for MRI and good (kappa, 0.6) for combination with MRM. However, the agreement between the radiologist and neurosurgeon remained fair for MRI alone or in combination with MRM (kappa, 0.38 and 033, respectively). In the evaluation of nerve root compression, interobserver agreement between the radiologists improved from moderate (kappa, 0.57) for MRI to good (kappa, 0.73) after combination with MRM; moderate agreement between the radiologist and neurosurgeon was noted for both MRI alone and after combination with MRM (kappa, 0.58 and 0.56, respectively). CONCLUSIONS: Interobserver agreement in the evaluation of lumbar spinal canal stenosis and root compression between the radiologists improved when MRM was combined with MRI, relative to MRI alone.
Constriction, Pathologic* ; Dental Pulp Cavity ; Diagnosis ; Intervertebral Disc ; Low Back Pain ; Lumbosacral Region ; Magnetic Resonance Imaging ; Myelography* ; Neurosurgeons ; Observer Variation ; Radiculopathy ; Retrospective Studies ; Spinal Canal* ; Spinal Stenosis

STUDY DESIGN: Case report OBJECTIVES: This study introduces an interesting case of adolescent cervical myelopathy with atypical cervical magnetic resonance imaging (MRI) findings. A differential diagnosis was made, followed by successful surgical treatment. SUMMARY OF LITERATURE REVIEW: A careful differential diagnosis of high signal intensity on T2-weighted cervical MRI is necessary if there is no evidence of cervical stenosis. Recent reports have suggested that the differential diagnosis should be based on a comprehensive analysis of data, including brain MRI, a cerebrospinal fluid examination, and empirical steroid treatment. MATERIALS AND METHODS: A 17-year-old male patient complained of upper extremity weakness, gait disturbance, and decreased sensation in the upper extremity. Cervical spine MRI findings suggested C3/4 disc herniation, moderate cervical stenosis, and high signal intensity in the spinal cord. A differential diagnosis was made between cervical myelopathy and myelitis. RESULTS: Decompression and posterolateral fusion of C3/4 were performed in a 17-year-old patient with cervical myelopathy without significant cervical stenosis. Postoperatively, upper extremity sensation and weakness and gait disturbance showed improvement, and the Japanese Orthopedic Association score improved to 17 points at 6 months after surgery. CONCLUSIONS: In patients with cervical myelopathy showing high signal intensity on T2-weighted imaging without evident spinal stenosis, a differential diagnosis should be made between cervical myelopathy and myelitis; surgical decompression can be an effective treatment choice upon the diagnosis of cervical myelopathy.
Adolescent* ; Asian Continental Ancestry Group ; Brain ; Cerebrospinal Fluid ; Constriction, Pathologic ; Decompression ; Decompression, Surgical ; Diagnosis ; Diagnosis, Differential* ; Gait ; Humans ; Magnetic Resonance Imaging ; Male ; Myelitis* ; Orthopedics ; Sensation ; Spinal Cord ; Spinal Cord Diseases* ; Spinal Stenosis ; Spine ; Upper Extremity

Calcium pyrophosphate dihydrate deposition disease most commonly presents with acute arthritis of the peripheral joints. Infrequently, a mass effect of this disease can cause axial symptoms, such as spinal stenosis, radiculopathy, or myelopathy. Herein, we report on the first Korean case of acute arthritis in the lumbar facet joint due to calcium pyrophosphate dihydrate crystal deposition disease. A 73-year-old female presented with acute fever, severe lumbago, and knee arthralgia, 11 days after partial parathyroidectomy. Plain radiographs showed multiple chondrocalcinosis, while a bone scan, computed tomography, and magnetic resonance imaging showed right L5-S1 facet arthritis. In synovial fluid from the facet and knee joints, positively birefringent calcium pyrophosphate dihydrate crystals were observed under polarized light microscopy. Under the diagnosis of acute calcium pyrophosphate dihydrate crystal arthritis (formerly known as 'pseudogout') in the facet joint, an intra-articular triamcinolone injection was administered, which resulted in dramatic improvement of the symptoms within 24 hours.
Aged ; Arthralgia ; Arthritis* ; Calcium Pyrophosphate* ; Calcium* ; Chondrocalcinosis ; Diagnosis ; Female ; Fever ; Humans ; Joints ; Knee ; Knee Joint ; Low Back Pain ; Magnetic Resonance Imaging ; Microscopy, Polarization ; Parathyroidectomy ; Radiculopathy ; Spinal Cord Diseases ; Spinal Stenosis ; Synovial Fluid ; Triamcinolone ; Zygapophyseal Joint*

BACKGROUND: The study investigated in detail the current status of the consultations requested in a pain clinic. We evaluated the characteristics of the consultations to determine the kind of contents requested, referring departments and factors including demographics, co-morbidities, previous medical problems, and the descriptions of the reasons for the consultation to the pain clinic. METHODS: Clinical data were collected in the authors' institution between 1 January 2009 and 31 December 2013. The medical records were reviewed and compared. Characteristics of both outpatients and inpatients were analysed. RESULTS: Data from 1,140 patients was available for this study. Seven hundred thirteen individuals belonged to the outpatient group and 427 individuals belonged to the inpatient group. Orthopedic surgery, neurosurgery, and otolaryngology were the main departments that requested consultations to the pain clinic. The most frequent requested lesion and diagnostic term were low back and lumbar spinal stenosis, respectively, and the most common reason for consulting was for "control of pain not controlled by medications." Factors that were significantly different between the two groups were gender, questions about other illnesses apart from the main diagnoses, history of specific diseases, acute onset, cancer, operation within 3 months, and physical system abnormalities. CONCLUSIONS: The medical problems addressed by a pain clinic consultation service were diverse. It is rational to develop standardized guidelines for pain consultations, and treatment strategies aimed at alleviating pain per se as well as caring for comorbid conditions.
Acute Disease ; Demography ; Diagnosis ; Humans ; Inpatients ; Medical Records ; Neurosurgery ; Orthopedics ; Otolaryngology ; Outpatients ; Pain Clinics* ; Referral and Consultation* ; Spinal Stenosis

STUDY DESIGN: Descriptions of technical strategies to overcome pitfalls associated with early learning periods in biportal endoscopic spinal surgery (BESS). PURPOSE: To introduce BESS for lumbar spinal diseases (LSDs) and to inform certain challenges to be overcome in mastering the technique. OVERVIEW OF LITERATURE: BESS has shown superior benefits including excellent magnification, a wider range of view by dynamic handling of an endoscope and instruments. Clinical reports, however, have not yet been very revealing for its new introduction into minimally invasive spine surgery. METHODS: To evaluate the learning curve for BESS, the procedures for various LSDs by one surgeon were analyzed in the view of shortening of the operating times and reduction of complications. Reviewing of recorded procedures helped in finding the reasons and the implemented solutions. RESULTS: The 68 cases included 25 for lumbar disc herniation (LDH), 3 for revision for recurred LDH, 39 for lumbar spinal stenosis (LSS) and 1 for synovial cyst. The operation time for the total cases averaged 83.7±33.6 minutes. According to diagnosis, it was 68.2±23.7 minutes for LDH. After the 14th case of LDH, it was nearly constant and close to the average time. One level of LSS needed 110.4±34.4 minutes. Prolonged operation times even in some later cases of LSS were mainly from struggling against blurred vision due to epidural bleeding. There were 7 cases of complications (10.3%) including 2 cases of dural tear, 1 case of root injury, and 4 cases of incomplete decompression on postoperative magnetic resonance imaging. There was no case of symptomatic hematoma or wound infection. CONCLUSIONS: BESS seemed to have a relatively short learning curve period. The overall complication rate in early learning period was 10.3%. These could be avoided by magnified regional views on an endoscope and a clear surgical field by controlling epidural bleeding.
Decompression ; Diagnosis ; Endoscopes ; Hematoma ; Hemorrhage ; Learning Curve* ; Learning* ; Lysergic Acid Diethylamide ; Magnetic Resonance Imaging ; Spinal Diseases ; Spinal Stenosis ; Spine ; Synovial Cyst ; Tears ; Wound Infection