P. Lisai

Cauda Equina Syndrome Secondary to Idiopathic Spinal Epidural Lipomatosis

Study Design. Three cases of idiopathic epidural lipomatosis are reported. Objectives. Description of the relationship between spinal pathologic overgrowth of fat tissue and neurologic symptoms. Summary of Background Data. Idiopathic epidural lipomatosis is a very rare condition; it is usually secondary to chronic steroid therapy or endocrinopathic diseases. Methods. Three men with a mean age of 58.5 years, who experienced intermittent claudication, bilateral radicular pain in both legs, and urinary dysfunction with hypoesthesia in the perineal region, were evaluated by plain radiography and magnetic resonance imaging, the results of which demonstrated a pathologic overgrowth of fat tissue in the spinal canal with a marked impingement of the dural sac. Obesity, endocrinopathic diseases, and chronic steroid therapy were excluded for all patients. Surgical treatment was performed by wide multilevel laminectomies, fat debulking, and instrumented posterolateral fusion. Results. After surgery there was a gradual improvement in symptoms and signs so that 2 years later the patients returned to daily activities and were neurologically normal. Conclusions. Spinal epidural lipomatosis can be a cause of back pain but rarely radicular impingement. Magnetic resonance imaging is the procedure of choice. The treatment must be performed early by wide surgical decompression.

Posterior epidural migration of an extruded free fragment from a lumbar disc herniation

Abstract The majority of symptomatic lumbar disc herniations are located in a posterolateral position with resultant nerve root compression. Although caudal, rostral and lateral migrations of disc fragments are common, posterior epidural migration of an extruded free fragment from a lumbar disc herniation is a rare occurrence and sometimes may cause a dural sac compression with cauda equina syndrome. This retrospective case report describes a 63-year-old man with intractable lower back pain and cauda equina syndrome. Emergency magnetic resonance imaging (MRI) revealed a posterior epidural soft tissue compressing the dural sac. The lesion was hypointense on T1-weighted images, hyperintense on T2-weighted images and showed rim enhancement after intravenous injection of gadolinium. A laminectomy at L3 was performed and the extruded disc fragment was removed with dural sac decompression. Postoperatively the patients radicular symptoms completely resolved. At the 2-year follow-up visit, the patient had recovered full motor, sensory and urinary functions.MRI is the modality of choice in the evaluation of an extruded free disc fragment and a cauda equina compression. In such cases a wide decompressive laminectomy is recommended.

Instrumented posterior interbody fusion in degenerative and multioperated lumbar spine

Lumbar interbody fusion is a valid technique for the treatment of disc diseases. We report a series of 37 patients who underwent posterior lumbar interbody fusion with titanium cylindric screwing-expansion cages. Clinical outcomes and radiological results were evaluated 3 years after surgery. After surgery, the majority of patients returned to their normal activities. Follow-up plain roentgenograms showed no loss of disc height and no signs of implant looseness. Computed tomography (CT) showed the presence of mineralized autologous bone grafts inside the interbody cages. Expandable interbody cages allow the restoration of disc space height, giving support to the anterior column, opening the neuroforaminal area and providing increased stability. The interpretation of fusion on the basis of roentgenograms is difficult; CT offers more information than radiography about the fusion process, but a bony arthrodesis cannot be demonstrated with certainty.

Far lateral lumbar disc herniations: 3- to 14-year results

Abstract A retrospective review of 38 patients who underwent surgical treatment for far lateral lumbar disc herniation (FLLDH) using two different techniques is reported.Between October 1986 and October 1997, we operated on 38 patients with FLLDH: 12 had extraforaminal disc herniation and 26 had foraminal disc herniation. Plain roentgenograms, computed tomography (CT) scans and magnetic resonance (MR) images were obtained before surgery. Postoperative outcomes showed a relief of clinical symptoms with recovery of neurological signs. There was no difference among the results encountered in the two surgical groups. A diagnosis of level based on physical examination alone is difficult. The combined use of CT and MR imaging helps to confirm the exact localization of disc herniation.

Therapeutical approach to unifocal lumbar vertebral metastasis of unknown origin

Abstract Low back pain often represents the first sign of a lumbar metastasis from a primary unknown tumor. In 13 cases who came to our observation, a unifocal metastasis was detected. All the patients underwent biopsy directed by computed tomography. The 8 patients who showed vertebral instability and radicular involvement underwent surgical treatment. The prognosis in cases of unifocal lumbar metastasis is related to the kind of primary tumor. Surgical treatment plays an important role in achieving pain relief and in improving life quality. Conservative care must be reserved for metastatic localizations from primary cancers that are sensitive to chemiotherapy or radiation therapy in patients without vertebral instability and neurological signs.

Free gas in the spinal canal as cause of low back pain and sciatica

Abstract We describe two patients suffering from sciatica for the presence of epidural gas compressing the nerve root. Previously, only one patient had undergone spinal surgery. The aim of this report is to describe the origin and the treatment of radiculopathies caused by epidural gas.