scholarly journals Gout in the thoracic spine causing acute paraplegia: illustrative case

2021 ◽  
Vol 2 (9) ◽  
Author(s):  
Lacin Koro ◽  
Ryan Khanna ◽  
Dominick Richards ◽  
Dean G. Karahalios
Keyword(s):  
Spinal Cord ◽  
Thoracic Spine ◽  
Clinical Manifestations ◽  
Cord Compression ◽  
Pathological Examination ◽  
Rapid Progression ◽  
Illustrative Case ◽  
Tophaceous Gout ◽  
Thoracic Spinal ◽  
Acute Paraplegia

BACKGROUND Although spinal involvement by gout is not uncommon, spinal gout leading to symptomatic spinal cord compression in the thoracic spine is very rare and poses a diagnostic challenge by mimicking symptoms of more common diagnoses such as epidural abscess and malignancy. An even more unique presentation is spinal gout causing thoracic cord compression leading to acute paraplegia. OBSERVATIONS The authors present an illustrative case of a 35-year-old man with thoracic spinal compression by tophaceous gout who developed rapid progression to complete paraplegia over a 5-day period. Magnetic resonance imaging of the thoracic spine revealed a cystic-appearing lesion within the dorsal extradural space of the lower thoracic spine extending from T8 to T10 accompanied by compression of the spinal cord. An emergent T9–10 laminectomy was performed, and the occupying lesion in the thoracic spine was resected. The diagnosis of spinal tophaceous gout was made by pathological examination. LESSONS Although varying clinical manifestations of spinal gout have been reported in the literature, the patient’s age and the rapid progression to complete paraplegia over a 5-day period reveals a unique presentation that broadens understanding of the manner in which this condition can present and allow more rapid diagnosis and treatment.

scholarly journals An update on hemilaminectomy of the cranial thoracic spine: Review of six cases

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Kathryn Y. Bray ◽  
Peter J. Early ◽  
Natasha J. Olby ◽  
Melissa J. Lewis
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Thoracic Spine ◽  
Surgical Approach ◽  
Cord Compression ◽  
Thoracic Vertebrae ◽  
Disc Disease ◽  
Thoracic Spinal Cord ◽  
Neurologic Status ◽  
Thoracic Spinal

Background: The optimal surgical approach to relieve spinal cord compression in the cranial thoracic spine is not well described, and the anatomy of the cranial thoracic vertebrae creates added surgical difficulty.Aim: This study describes the surgical approach, treatment, and outcome of three dogs and three cats that underwent a cranial thoracic hemilaminectomy for the treatment of extradural spinal cord compression. Surgical positioning was tailored to avoid extensive dissection and provide for a restricted, careful approach.Methods: Three dogs and three cats presenting for cranial thoracic spinal cord compression requiring surgical intervention were included.Results: All patients were discharged within 5 days. No patients experienced postoperative deterioration in neurologic status, and four animals had improved neurologic status at discharge.Conclusion: In cases with cranial thoracic spinal cord compression, the spinous processes can be spared, extensive muscle dissection minimized, and successful outcomes achieved with the appropriate positioning and limited approach. Keywords: Hemilaminectomy, Intervertebral Disc Disease, Myelopathy, Thoracic.

scholarly journals Spinal Cord Compression by Ligamentum Flavum Hematoma in the Thoracic Spine

Spine ◽  
2009 ◽  
Vol 34 (25) ◽  
pp. E942-E944 ◽  
Author(s):  
Hideki Sudo ◽  
Kuniyoshi Abumi ◽  
Manabu Ito ◽  
Yoshihisa Kotani ◽  
Masahiko Takahata ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Thoracic Spine ◽  
Ligamentum Flavum ◽  
Cord Compression

Thoracic spinal cord compression masquerading as cauda equina syndrome

2016 ◽  
Vol 34 (4) ◽  
pp. 756.e3-756.e5 ◽  
Author(s):  
Katherine Stolper ◽  
Erin R. Hanlin ◽  
Michael D. April ◽  
John L. Ritter ◽  
Curtis J. Hunter ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Cord Compression ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal

scholarly journals Symptomatic thoracic ossification of the ligamentum flavum in a patient with ankylosing spondylitis: Report of a case and review

2021 ◽  
Vol 12 ◽  
pp. 596
Author(s):  
Abolfazl Rahimizadeh ◽  
Parviz Habibollahzadeh ◽  
Walter L. Williamson ◽  
Housain Soufiani ◽  
Mahan Amirzadeh ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Ankylosing Spondylitis ◽  
Spinal Cord Compression ◽  
Marked Improvement ◽  
Ligamentum Flavum ◽  
Cord Compression ◽  
Case Description ◽  
Thoracic Spinal Cord ◽  
Decompressive Laminectomy ◽  
Thoracic Spinal

Background: Thoracic spinal cord compression due to both ankylosing spondylitis (AS) and ossification of the ligamentum flavum (OLF) is rare. Case Description: A 33-year-old male with AS presented with a paraparesis attributed to MR documented T9-T10 OLF/stenosis. He was successfully managed with a decompressive laminectomy; this resulted in marked improvement of his deficit. Conclusion: Thoracic OLF and AS rarely contribute T9-T10 spinal cord compression that may be readily relieved with a decompressive laminectomy.

scholarly journals Surgery for Metastatic Epidural Spinal Cord Compression in Thoracic Spine, Anterior or Posterior Approach?

2019 ◽  
Author(s):  
Jen Chung Liao
Keyword(s):  
Spinal Cord ◽  
Blood Loss ◽  
Spinal Cord Compression ◽  
Thoracic Spine ◽  
Posterior Approach ◽  
Cord Compression ◽  
Thoracic Vertebrae ◽  
Neurologic Status ◽  
Significant Difference ◽  
Group A

Abstract Background: The most commonly encounter tumor of the spine is metastasis, and thoracic spine is the most commonly metastatic spine. Controversy exists regarding the optimal surgical approach for this kind of patient. The author conducted a study to assess the differences between anterior thoracotomy and posterior approach in patients with malignant epidural cord compression in the thoracic spine. Methods: Between January 2003 and December 2015, patients with metastatic thoracic lesion underwent surgery at our department were stratified into two groups according to different approach method to the lesion site. Group A mean anterior thoracotomy, decompression and fixation. Group P represented posterior decompression and fixation. Survival was defined as months since surgery to last tractable times. American Spinal Injury Association grade was used to assess preoperative and postoperative neurologic status. Days at intensive care unit (ICU) were compared. Every complication by surgery or during admission was documented. Results: Group A had 25 patients and Group P had 67 patients. Lung cancer was ther most commonly origin cancer in both groups. The most commonly surgical level was the 9th thoracic vertebrae in Group A and the 10th thoracic vertbrae in Group P. Both gropus had a similar preoperative neurologic (p=0.959). One patients in Group A and two in the Group P sustained neurologic deterioation immediately after surgery. Group A took more operation time (213.0 vs 199.2 minutes, p=0.380) and had more blood loss (912.5 vs 834.4 ml, p=0.571). 6 patients in Group A (24%) and 10 patients in Group P (13.9%) developed complications immediately or postoperatively. Patients in Group A need more days of care at ICU (2.36 vs 0.19 days, p<0.001). The longer survival was seen in the goup P (15.4 vs 11.2 months) but without significant differnce. Conclusion: Patients in Group P required significantly less days of care at ICU. Besides, posterior approach also took a shorter surgical time, and had a less blood loss during surgery, although without statistically significant difference. According to the results, the author would prefer posterior approach by decompression and fixation for those with thoracic metastatic tumor with epidural compression. Keywords: Thoracic spine; metastatic epidural spinal cord compression; anterior thoracotomy; posterior approach; survivorship; neurologic status; complications.

scholarly journals Acute thoracic disc heralded by change in spinal cord stimulation pattern: illustrative case

2021 ◽  
Vol 2 (20) ◽  
Author(s):  
Faraz Behzadi ◽  
Edvin Telemi ◽  
Tarek R. Mansour ◽  
Thomas M. Zervos ◽  
Muwaffak M. Abdulhak ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
Chronic Back Pain ◽  
Cord Compression ◽  
Illustrative Case ◽  
Disc Protrusion ◽  
Stimulation Parameters ◽  
Spine Pathology ◽  
Thoracic Disc

BACKGROUND Spinal cord stimulation (SCS) uses unique electric stimulation parameters to selectively treat specific regions of chronic or refractory back pain. Changing these parameters can lead to spreading paresthesia and/or pain beyond the desired region. OBSERVATIONS A patient with a history of stable, successful SCS treatment presented with acute development of paresthesias that were relieved by reduction of stimulation parameters. The patient required paradoxically lower SCS settings for control of chronic back pain. This presentation prompted further investigation, which revealed a new disc protrusion and cord compression at the level of the paddle lead. LESSONS In patients with SCS, a new onset of back pain accompanied by acute paresthesia that is reversible by reducing the SCS amplitude warrants investigation for new spine pathology.

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