Ehud Shalmon

Intradiscal cement leak following percutaneous vertebroplasty.

Study Design. A retrospective study to detect patients with cement leakage into the disc space following vertebroplasty. Objective. To determine the frequency, causes, and clinical significance of cement leakage into the disc space. Summary of Background Data. Much has been written about cement leakage into the epidural space following vertebroplasty but only little about intradiscal leakage. Methods. A total of 66 patients with 1 cemented osteoporotic, fractured vertebra between T5 and L5 were followed for at least 2 years. Two of the senior authors (Y.M. and A.P.) evaluated independently cement leakage into the disc space, possible causes were investigated, and the clinical results were evaluated according to patient self-assessment. Results. Detected in 27 patients, cement leakage into the disc space did not negatively affect patient satisfaction with the procedure. In 7 of these patients, leakage occurred through an intravertebral vacuum cleft and, in 8, through a perforation of the endplate created by the needle tip. In only 2 patients was cement found to cross the height of the vertebral body and leak into the contralateral disc. Conclusions. Apart from iatrogenic endplate perforation, cement extravasation into the disc space was always found to occur through the fractured endplate or a vacuum cleft. Placing the needle tip far from the fractured endplate and using more solid cement appear to decrease the risk of leakage.

Lumbar Stenosis and Systemic Diseases: Is There any Relevance?

Study Design A retrospective study of spinal stenosis patients admitted to Assaf Harofeh Medical Center Orthopedic Departments. Objective To assess any correlation between systemic disease and spinal stenosis. Summary of Background Data Lumbar stenosis is a common spinal disease with various etiologies. No findings have been reported correlating spinal stenosis incidence with background diseases, although diabetes mellitus (DM) has been found to play a role in intervertebral disc degeneration and spondylolisthesis. Methods Hospitalization records of patients with spinal stenosis admitted to Assaf Harofeh Medical Center Orthopedic Departments between 1984 and 1993 were checked for background diseases, age, and sex. The data collected were statistically evaluated for any correlation between spinal stenosis and chronic diseases and compared with the data published by the “Israeli Bureau of Statistics” and Israels largest Health Maintenance Organizations chronic disease survey. Results Of 537 patients with spinal stenosis 57% (308) were males and (229) 43% females with an average age of 60±14 years. Diseases occurring with a high incidence were hypertension (HTN)—23.2% (compared with 7.8% in the general population), DM—13.6% (5.9%), ischemic heart disease (IHD)—11.9%, and hyperlipidemia—4.4%. Patients with spinal stenosis had no significant age and sex distribution difference compared with the general population and no such difference was found for patients suffering from HTN, IHD, or DM. Isolating the effect of DM on HTN and IHD revealed that HTN was a primary disease whereas IHD was secondary to DM with significant statistical validation (P=0.003). Conclusions To the best of our knowledge this is the first study linking spinal stenosis and DM or HTN. It was found that chronic diseases do not alter the natural age and sex distribution of spinal stenosis. The major question remaining concerns the biologic mechanism linking spinal stenosis and DM or HTN.

Superior mesenteric artery syndrome after scoliosis repair surgery: a case study and reassessment of the syndromeʼs pathogenesis

We carried out a retrospective analysis to investigate the prevalence of superior mesentery artery syndrome (SMAS) in children who underwent scoliosis surgical repair at our hospital between 1998 and 2006 and to reassess the syndromes pathogenesis. Among 133 consecutive pediatric patients, two cases were identified, both 13-year-old girls with idiopathic scoliosis, undergoing surgery using third-generation instrumentation systems. Conservative management achieved resolution of the symptoms without recurrence. SMAS prevalence in our series was 1.6%. SMAS might occur after derotation and translation forces application, and even with nonextreme corrections. Low BMI and significant weight loss at presentation are not mandatory.

The use of dynamic CT surview for cervical spine clearance in comatose trauma patients : A pilot prospective study

BACKGROUND Bedside flexion and extension fluoroscopy was proposed for detecting occult ligamentous instability in comatose trauma patients. Nevertheless, a recent study showed that the C7-T1 motion segment is rarely visualised by this technique. We propose a new method for clearing the cervical spine in comatose patients. METHODS We conducted a prospective clinical pilot study on 31 consecutive comatose trauma patients to evaluate a new dynamic imaging technique for cervical spine clearance in comatose trauma patients. All patients were examined by a fine-cut helical CT scan of the entire cervical spine (C-spine) and by four-stage flexion-extension examination using the surview function of the CT scanner. The mean range of motion between extension and full flexion, the lowest visualised vertebrae, complications, positive findings, and the time from arrival to clearance was recorded. RESULTS The mean range of motion of the subaxial cervical spine was 39 degrees . The C7-T1 segment was fully visualised at the CT surview in 15 patients. The C6-C7 segment was visualised in all patients. No complication directly related to the study protocol was observed. C-spine clearance was completed in less than 6h from arrival in 26 patients. CONCLUSION The CT surview allows better visualisation of the C6-C7 and cervicothoracic junctions during flexion and extension. A short series of CT cuts can be used when visualisation is inadequate. Further studies are needed to assess the risks and benefits of the suggested protocol.

Lumbar Disk Replacement With the ProDisc Prosthesis

Twenty-two ProDisc II prostheses (Spine Solutions, New York, New York) were implanted in 21 patients with degenerative disk disease at L5-S1 (19 disks) and L4-L5 (3 disks). After mean follow-up of 3.1 years (range, 17-49 months), pain intensity in all but 3 patients had improved from an average of 7.7 preoperatively to 4.6 postoperatively (P< .001) on a visual analog scale. Average Oswestry Disability Index score improved from 61 to 35 (P< .001). Radiographic reconstruction of the disk space height was achieved in all cases. Previous diskectomy at the implanted level and disk degeneration adjacent to previous fusion negatively influenced the results.

Cortical Calcification of the Temporal Lobe Presenting as Recurrent Paroxysmal Room Tilt Illusion

During the paroxysmal tilt illusion (PRTI) the patient experiences that the room is turned upside down or tilted to one side in the frontal plane. This rare symptom is assumed to reflect otolith dysfunction and has been reported in association with peripheral vestibular, brainstem and cortical lesions. In the cortex, PRTI has usually been described as a part of complex partial seizures, mainly of parieto-occipital origin. However, only a few of the cortical lesions responsible for seizures have been documented by neuroimaging. We report a patient with a posterior temporal cortical calcification who presented with recurrent monosymptomatic PRTIs that were assumed to be partial seizures. Isolated PRTI should thus be recognized as an organic complaint and prompt the search for a structural brain abnormality.

An unusual combination of a lumbar seat belt injury and hemorrhagic contusion of the lower thoracic cord in a 2-year-old child: a case report.

We describe a previously unreported combination of lumbar flexion–distraction ligamentous disruption and incomplete thoracic spinal cord injury in a 2-year-old boy. Magnetic resonance imaging of the thoracolumbar spine showed hemorrhagic cord contusion at the T11–T12 level. Plain radiographs showed mild kyphosis of the L3–L4 segment. Fluoroscopy showed pathological motion at L3–L4 in flexion indicating a ligamentous injury. The lumbar spine was surgically stabilized and at 1-year follow-up, a remarkable neurological recovery was noted. We believe that physicians managing children with multiple trauma injuries should be aware of this rare type of injury that might be underdiagnosed.