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   2014| October-December  | Volume 5 | Issue 4  
    Online since December 16, 2014

 
 
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ORIGINAL ARTICLES
Describing a new syndrome in L5-S1 disc herniation: Sexual and sphincter dysfunction without pain and muscle weakness
Nezih Akca, Bulent Ozdemir, Ayhan Kanat, Osman Ersagun Batcik, Ugur Yazar, Orhan Unal Zorba
October-December 2014, 5(4):146-150
DOI:10.4103/0974-8237.147076  PMID:25558144
Context: Little seems to be known about the sexual dysfunction (SD) in lumbar intervertebral disc herniation. Aims: Investigation of sexual and sphincter dysfunction in patient with lumbar disc hernitions. Settings and Design: A retrospective analysis. Materials and Methods: Sexual and sphincter dysfunction in patients admitted with lumbar disc herniations between September 2012-March 2014. Statistical Analysis Used: Statistical analysis was performed using the Predictive Analytics SoftWare (PASW) Statistics 18.0 for Windows (Statistical Package for the Social Sciences, SPSS Inc., Chicago, Illinois). The statistical significance was set at P < 0.05. The Wilcoxon signed ranks test was used to evaluate the difference between patients. Results: Four patients with sexual and sphincter dysfunction were found, including two women and two men, aged between 20 and 52 years. All of them admitted without low back pain. In addition, on neurological examination, reflex and motor deficit were not found. However, almost all patients had perianal sensory deficit and sexual and sphincter dysfunction. Magnetic resonance imaging (MRI) of three patients displayed a large extruded disc fragment at L5-S1 level on the left side. In fourth patient, there were not prominent disc herniations. There was not statistically significant difference between pre-operative and post-operative sexual function, anal-urethral sphincter function, and perianal sensation score. A syndrome in L5-S1 disc herniation with sexual and sphincter dysfunction without pain and muscle weakness was noted. We think that it is crucial for neurosurgeons to early realise that paralysis of the sphincter and sexual dysfunction are possible in patients with lumbar L5-S1 disc disease. Conclusion: A syndrome with perianal sensory deficit, paralysis of the sphincter, and sexual dysfunction may occur in patients with lumbar L5-S1 disc disease. The improvement of perianal sensory deficit after surgery was counteracted by a trend toward disturbed sexual function. Further researches are needed to explore the extent of this problem.
  12,240 79 4
Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison
Savni R Satoskar, Aimee A Goel, Pooja H Mehta, Atul Goel
October-December 2014, 5(4):157-162
DOI:10.4103/0974-8237.147079  PMID:25558146
Objective : The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of 'Goel facet spacer' in the treatment of degenerative spinal canal stenosis. Materials and Methods : Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint. Results : The spacers achieved distraction of facets that was more pronounced in the vertical perspective. Introduction of spacers on both sides resulted in an increase in the intervertebral foraminal height and a circumferential increase in the spinal canal dimensions. Additionally, there was an increase in the disc space or intervertebral body height. The lumbar facets are more vertically and anteroposteriorly oriented when compared to cervical facets that are obliquely and transversely oriented. Conclusions : Understanding the anatomical peculiarities of the lumbar and cervical facets can lead to an optimum utilization of the potential of Goel facet distraction arthrodesis technique in the treatment of spinal degenerative canal stenosis.
  5,255 42 4
CASE REPORTS
Traumatic atlantoaxial rotatory fixation associated with C2 articular facet fracture in adult patient: Case report
Mehdi Bellil, Khaled Hadhri, Maamoun Sridi, Mondher Kooli
October-December 2014, 5(4):163-166
DOI:10.4103/0974-8237.147083  PMID:25558147
Traumatic atlantoaxial rotatory fixation is a very rare injury in adults which is often misdiagnosed initially. Its combination with C2 fractures is predominated by dens lesions. Therapeutic management is challenging because of the difficulty to achieve optimal reduction and permanent stability. We report a rare case of traumatic atlantoaxial rotatory fixation in a 56-year-old women associated with C2 articular facet fracture successfully treated by conservative means after patient-awake manual reduction with optimal functional and radiographic outcome.
  3,237 30 1
Complete absence of the posterior arch of C1: Case report
R Khanna, ZA Smith, BJ Dlouhy, NS Dahdaleh
October-December 2014, 5(4):176-178
DOI:10.4103/0974-8237.147090  PMID:25558151
Posterior atlas arch anomalies are relatively common, but have a variety of presentations ranging from partial clefts to complete agenesis of the posterior arch. Partial clefts are prevalent in 4% of patients and are generally asymptomatic. However, complete agenesis of the posterior arch is extremely rare. We report the case of a 46-year-old man who presented with upper cervical spine and occipital pain as well as left sided headaches. Imaging revealed congenital complete absence of the posterior arch of C1 (Type E) without any radiographic evidence of instability. We discuss our case in light of other reported cases and detail its management.
  2,798 67 1
Occipitalized os odontoideum: A case report
Junich Ohya, Kota Miyoshi, Tomoaki Kitagawa, Shogo Nakagawa
October-December 2014, 5(4):170-172
DOI:10.4103/0974-8237.147087  PMID:25558149
We report on a 36-year-old man presenting with a sudden onset of motor weakness and numbness in the upper extremities following a fall from a truck bed. Radiological findings demonstrated an os odontoideum and osseous continuity between the occiput and an ossicle, termed an "occipitalized os odontoideum." The occipitalized ossicle and atlas moved as a functional unit from the body of the axis. He underwent atlantoasxial stabilization with an atlas lateral mass screw and axis pedicle screw. Eighteen months later, he remained free of symptoms and showed solid bone fusion. Atlantoaxial stabilization resulted in an excellent clinical outcome for this condition. Our report provides useful knowledge regarding treatment of extremely rare osseous anomalies in the craniovertebral junction.
  2,825 21 -
ORIGINAL ARTICLES
Optimal measurement for "posterolateral protrusion" of the vertebral artery at the craniovertebral junction using computed tomography angiography
Junichi Ohya, Kota Miyoshi, Hiroyuki Oka, KO Matsudaira, Masayoshi Fukushima, Kosei Nagata
October-December 2014, 5(4):151-156
DOI:10.4103/0974-8237.147077  PMID:25558145
Purpose: Among extraosseous abnormalities of the vertebral artery (VA) at the craniovertebral junction (CVJ), available evidence regarding "posterolateral protrusion," the VA running distant from the groove over the superior surface of the posterior arch of the atlas, is limited. The purpose of this study was to determine the optimal measurement to indicate posterolateral protrusion of the VA. Materials and Methods: Computed tomography angiography (CTA) images of 40 consecutive patients with cervical disease were reviewed. Ultimately, 66 arteries were included in this study. Five parameters predicted to indicate posterolateral protrusion of the VA were defined (A-E) and measured by two surgeons twice over a 2-week interval. Intraclass correlation coefficients (ICC) were used to examine intra-observer reproducibility and inter-observer reliability. Receiver operating characteristic (ROC) curve analysis was performed to determine the most optimal parameter to predict posterolateral protrusion of the VA. Results: Excellent inter-observer reliability and intra-observer reproducibility were obtained for all parameters (ICC = 0.87-0.99). Among them, parameter A, defined as the maximal length from the outer surface of the VA to the outer surface of the posterior arch of the atlas, was most accurately described posterolateral protrusion of the VA. The optimal cut-off value of parameter A obtained with ROC curves was 8.3 mm (sensitivity 97.5%, specificity 100%). Conclusions: The measurement in this study can quantitatively evaluate the posterolateral protrusion of the VA. Before posterior surgery at the CVJ, pre-operative CTA can help surgeons detect anomalous VA and reduce the risk of intra-operative VA injury.
  2,804 28 2
CASE REPORTS
Lumbosacral actinomycosis in an immunocompetent individual: An extremely rare case
VR Patil, AR Joshi, SS Joshi, D Patel
October-December 2014, 5(4):173-175
DOI:10.4103/0974-8237.147088  PMID:25558150
Actinomycosis is a gram positive commensal bacteria. In predisposed individuals like immunocompromised patients, it can cause myriad lesions involving virtually any organ of the body. Involvement of spinal cord with its compression is rare though. We are reporting here a case of 30-year-old immunocompetent male who presented with weakness of left lower limb. Radiologically differential diagnosis was tuberculosis or lymphoma of spinal cord. Histopathology showed actinomycotic colonies that were periodic Schiff (PAS) positive and revealed gram positive filamentous bacteria.
  2,608 23 4
EDITORIALS
The music of movement - in health - n - disease
Manu Kothari, Atul Goel
October-December 2014, 5(4):143-145
DOI:10.4103/0974-8237.147073  PMID:25558143
  2,557 49 -
Not neural deformation or compression but instability is the cause of symptoms in degenerative spinal disease
Atul Goel
October-December 2014, 5(4):141-142
DOI:10.4103/0974-8237.147070  PMID:25558142
  2,433 72 10
CASE REPORTS
Radiculopathy due to spontaneous facetal cyst hemorrhage
Prasad Krishnan, Sugat Sanyal, Sayan Das
October-December 2014, 5(4):167-169
DOI:10.4103/0974-8237.147085  PMID:25558148
Facetal cysts are usually encountered as incidental radiological findings in spinal imaging studies. Only rarely can neurological symptoms be attributed to them. These cysts are lined by vascularized synovial tissue. There are few reports in literature of hemorrhagic transformation in these cysts with sudden increase in size precipitating symptoms acutely. We report one such case where the existence of a hitherto undiagnosed cyst was unmasked by the haemorrhage. There is a need to be aware of this complication in patients with untreated or incidentally diagnosed cysts so that any sudden neurological deterioration can be dealt with promptly.
  2,192 31 -
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