scholarly journals Progressive foot drop caused by below-knee compression stocking after spinal surgery

2016 ◽  
Vol 2016 (9) ◽  
pp. omw075
Author(s):  
Karan Malhotra ◽  
Joseph S. Butler ◽  
Adam Benton ◽  
Sean Molloy
Keyword(s):  
Spinal Surgery ◽  
Foot Drop ◽  
Compression Stocking

Incidence and Characteristics of Spinal Decompression Surgery after the Onset of Symptoms of Amyotrophic Lateral Sclerosis

Neurosurgery ◽  
2005 ◽  
Vol 57 (5) ◽  
pp. 984-989 ◽  
Author(s):  
Daniel Yoshor ◽  
Arnett Klugh ◽  
Stanley H. Appel ◽  
Lanny J. Haverkamp
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Symptom Onset ◽  
Spinal Surgery ◽  
Foot Drop ◽  
Spinal Decompression ◽  
Sporadic Als ◽  
Number Of Patients ◽  
Als Patients ◽  
The Impact ◽  
Lateral Sclerosis

Abstract OBJECTIVE: The high incidence of spondylosis in patients at the mean age of onset (55.7 yr) of amyotrophic lateral sclerosis (ALS) can make recognition of ALS as a cause of weakness difficult. METHODS: To assess the impact of this diagnostic dilemma on neurosurgical practice, we performed a retrospective analysis of a database of more than 1500 patients with motor neuron disease. RESULTS: Of 1131 patients with typical, sporadic ALS, 47 (4.2%) underwent decompressive spinal surgery after the onset of retrospectively recognized symptoms of ALS. Among 55 operations in 47 ALS patients, 86% yielded no improvement, 9% produced minor improvement, and only 5% provided significant benefit. Cervical decompression was performed in 56%, lumbar in 42%, and thoracic in 2%. Foot drop was a symptom prompting surgery in 11 patients, and in 10, this finding was subsequently attributed solely to ALS. No differences between ALS patients who underwent spinal decompression and other ALS patients were noted regarding age at symptom onset, severity of impairment at time of diagnosis, or rate of disease progression. Not surprisingly, patients who had spinal surgery tended to have a longer interval between retrospectively recognized symptom onset and diagnosis of ALS. CONCLUSION: A small but significant number of patients with unrecognized ALS undergo spinal surgery that in retrospect may be inappropriate. The possibility of ALS must be considered in the evaluation of patients with weakness even in the presence of radiographic evidence of spondylosis and nerve root or spinal cord impingement.

Cotton Balls and Socks—A Dangerous Combination: Foot Drop Related to Compression Stocking Use

2021 ◽  
Vol 22 (3) ◽  
pp. B4-B5
Author(s):  
Lara Magnabosco ◽  
L. Magnabosco ◽  
W. Godfrey ◽  
L. Xu ◽  
A. Chandra
Keyword(s):  
Foot Drop ◽  
Compression Stocking

048 Large pseudo-meningocele causing severe papilledema, retinal haemorrhages and recurrent positional syncope

2018 ◽  
Vol 89 (6) ◽  
pp. A20.2-A20
Author(s):  
Wai Foong Hooi ◽  
John Waterston
Keyword(s):  
Spinal Cord ◽  
Intracranial Pressure ◽  
Spinal Surgery ◽  
Foot Drop ◽  
Fundus Photography ◽  
List Type ◽  
Raised Intracranial Pressure ◽  
Lumbar Spinal ◽  
The Brain ◽  
Retinal Haemorrhages

IntroductionPseudo-meningocele is an abnormal collection of cerebrospinal fluid in the extradural space that occurs due to leakage from the CSF-filled spaces surrounding the brain and spinal cord. Pseudo-meningocele may result after spinal surgery. We report a case of a young woman with pseudo-meningocele post lumbar spinal surgery. She subsequently developed recurrent syncope, headaches and clinical signs of raised intracranial pressure (severe papilledema and retinal haemorrhages).CaseA 34 year old woman with spina bifida occulta and a large lipoma at the lumbar spinal level of L5 presented with urinary retention, worsening right leg pain, numbness and foot drop. She subsequently underwent L4-S1 laminectomy, debulking of lipoma and detethering of the cord. Her neurological deficits resolved post-surgery. One month later, the patient re-presented with recurrent syncope and intermittent headaches. She was admitted to the hospital for further investigations. Detailed neurological examination revealed grade IV papilledema and retinal haemorrhages. MRI of the brain showed distended optic nerve sheaths and narrowed distal transverse sinuses, in keeping with intracranial hypertension. MRI spine showed a large CSF collection posterior to the spinal canal at the L4-L5 level, measuring 77×53 mm in trans axial plane and 98 mm in craniocaudal dimension. Her symptoms improved with insertion of external ventricular drain. The symptoms resolved completely after a ventriculo-peritoneal shunt was inserted. She was commenced on acetazolamide. She remained well and asymptomatic. Repeat fundus photography a month later showed complete resolution of papilledema.ConclusionPostoperative pseudo-meningocele is uncommon and the exact incidence is unknown as most of these patients are asymptomatic. This case illustrates that pseudo-meningocele can cause raised intracranial pressure leading to recurrent syncope. It is important for clinician to recognise the varied clinical presentations of meningocele and pseudo-meningocele.References. Marlin A, Epstein F, Rovid R. Positional headache and syncope associated with a pseudomeningocele. Arch Neurol1980;37(11):736–737.. Bekavac I, Hollaran J. Meningocele-induced positional syncope and retinal haemorrhages. AJNR Am J NeuroradiolMay 2003;24:838–839.. Arseni C, Maretsis M. Tumours of the lower spinal cord associated with increased intracranial pressure and papilloedema. J Neurosurg1967;27:105–110.

Rating Post-Operative Backs (Part I)

1997 ◽  
Vol 2 (4) ◽  
pp. 1-3
Author(s):  
James B. Talmage
Keyword(s):  
Spinal Stenosis ◽  
Foot Drop ◽  
Neurogenic Claudication ◽  
Root Damage ◽  
Fourth Edition ◽  
Minor Strain ◽  
Injury Model ◽  
Strain Type ◽  
A Minor ◽  
Anterior Tibialis

Abstract The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, uses the Injury Model to rate impairment in people who have experienced back injuries. Injured individuals who have not required surgery can be rated using differentiators. Challenges arise when assessing patients whose injuries have been treated surgically before the patient is rated for impairment. This article discusses five of the most common situations: 1) What is the impairment rating for an individual who has had an injury resulting in sciatica and who has been treated surgically, either with chemonucleolysis or with discectomy? 2) What is the impairment rating for an individual who has a back strain and is operated on without reasonable indications? 3) What is the impairment rating of an individual with sciatica and a foot drop (major anterior tibialis weakness) from L5 root damage? 4) What is the rating for an individual who is injured, has true radiculopathy, undergoes a discectomy, and is rated as Category III but later has another injury and, ultimately, a second disc operation? 5) What is the impairment rating for an older individual who was asymptomatic until a minor strain-type injury but subsequently has neurogenic claudication with severe surgical spinal stenosis on MRI/myelography? [Continued in the September/October 1997 The Guides Newsletter]

Lymphedema and lipedema - an overview of conservative treatment

VASA ◽  
2011 ◽  
Vol 40 (4) ◽  
pp. 271-279 ◽  
Author(s):  
Wagner
Keyword(s):  
Conservative Treatment ◽  
General Practitioners ◽  
Subcutaneous Tissue ◽  
Compression Therapy ◽  
Compression Stocking ◽  
Lymph Drainage ◽  
Intensive Phase ◽  
Manual Lymph Drainage ◽  
Causal Therapy

Lymphedema and lipedema are chronic progressive disorders for which no causal therapy exists so far. Many general practitioners will rarely see these disorders with the consequence that diagnosis is often delayed. The pathophysiological basis is edematization of the tissues. Lymphedema involves an impairment of lymph drainage with resultant fluid build-up. Lipedema arises from an orthostatic predisposition to edema in pathologically increased subcutaneous tissue. Treatment includes complex physical decongestion by manual lymph drainage and absolutely uncompromising compression therapy whether it is by bandage in the intensive phase to reduce edema or with a flat knit compression stocking to maintain volume.

The treatment of venous leg ulcers with a specifically designed compression stocking kit

Phlebologie ◽  
2008 ◽  
Vol 37 (04) ◽  
pp. 191-197 ◽  
Author(s):  
V. Mattaliano ◽  
G. Mosti ◽  
V. Gasbarro ◽  
M. Bucalossi ◽  
W. Blättler ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Compression Stocking ◽  
Leg Ulcers ◽  
Compression Stockings ◽  
Venous Leg Ulcers ◽  
Venous Ulcers ◽  
Time To Completion ◽  
Validated Questionnaire ◽  
First Choice ◽  
Ankle Movement

SummaryTraditionally, venous leg ulcers are treated with firm nonelastic bandages. Medical compression stockings are not the first choice although comparative studies found them equally effective or superior to bandages. Patients, methods: We report on a multi-center randomized trial with 60 patients treated with either short stretch multi-layer bandages or a two-stocking system (Sigvaris® Ulcer X® kit). Three patients have been excluded because their ankle movement was restricted to the extent that they could not put on the stockings and 1 patient withdrew consent. Patient characteristics and ulcer features were evenly distributed. The proportion of ulcers healed within 4 months and the time to completion of healing were recorded. Subjective appraisal was assessed with a validated questionnaire. Results: Complete wound closure was achieved in 70.0% (21 of 30) with bandages and in 96.2% (25 of 26) with the ulcer X kit (p = 0.011). Ulcers with a diameter of up to about 4cm healed twice as rapidly, the larger ones as fast with the stocking kit as with bandages. The sum of problems encountered with bandages was significantly greater than that observed with the stocking kit (p < 0.0001). Pain at night and in the morning was absent with stockings but reported by 40% and 20% in the bandage group, respectively. The cardinal features associated with delayed or absent healing were ulcer size and pain. Conclusions: Common venous ulcers can readily be treated with the ulcer X compression kit provided the ankle movement allow its painless donning. Bandages, even when applied by the most experienced staff are less effective and cause more problems.

Stellenwert der Navigation

2017 ◽  
Vol 01 (04) ◽  
pp. 317-334
Author(s):  
Jan-Sven Jarvers ◽  
Ulrich Spiegl ◽  
Stefan Glasmacher ◽  
Christoph Heyde ◽  
Christoph Josten
Keyword(s):  
Patient Safety ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Spinal Surgery ◽  
Intraoperative Imaging ◽  
Intraoperative Navigation ◽  
Advantages And Disadvantages ◽  
Tumor Diseases ◽  
Intraoperative Control ◽  
Improved Technology

Abstract Importance of Navigation Navigation and intraoperative imaging have undergone an enormous development in recent years. By using intraoperative navigation, the precision of pedicle screw implantation can be increased in the sense of patient safety. Especially in the case of complex defects or tumor diseases, navigation is a decisive aid. As a result of the constantly improved technology, the requirements for reduced radiation exposure and intraoperative control can also be met. The high costs of the devices can be amortized, for example by a reduced number of revisions. This overview presents the principles of navigation in spinal surgery and the advantages and disadvantages of the different navigation procedures.

Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now?

2018 ◽  
Vol 1 (2) ◽  
pp. 2
Author(s):  
Chiung Chyi Shen
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Surgical Navigation ◽  
Improve Patient Safety ◽  
Intraoperative Imaging ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Image Guided

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system. 

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