Journal of Spine Practice (JSP)

Neurological Recovery Following Surgical Intervention in Patients with Traumatic Spinal Cord Injury at the University Teaching Hospital in Zambia

Munosiya Mulemwa — 2024-12-06

Introduction

Traumatic spinal cord injuries cause long-term disability and functional impairment. Timely and proper surgical treatment improves neurological recovery and functional outcomes. However, in low-resource setting countries, surgical intervention is usually delayed raising concerns about the recovery of patients. Hence, this study investigated the neurological improvement of patients undergoing surgery for traumatic spinal cord injuries at the University Teaching Hospital in Lusaka, Zambia.

Methods

This was a retrospective study that included all eligible patients with traumatic spinal cord injury managed surgically at the University Teaching Hospital between 2018 and 2022. The study assessed neurological improvement by comparing the American Spinal Injury Association’s neurological grading before surgery to that at discharge. Data was analysed using Stata 17, and the level of significance was set at 5%.

Results

Out of the 96 patients in the study, 45.8% showed neurological improvement of at least one grade after surgery. Patients with thoracic injuries showed lower improvement rates (25.0%) than those with cervical (55.0%) or lumbar injuries (65.0%), while those with incomplete injuries showed higher improvement rates (78.7%) (p <0.05). Thoracic injuries were associated with reduced neurological improvement (AOR 0.21; 95% CI: 0.04 – 0.95, p = 0.043), while incomplete injuries were associated with higher neurological improvement (AOR 18.58; 95% CI: 6.11 – 56.51, p < 0.001).

Conclusion

Neurological improvement was poor for thoracic injuries and complete injuries, highlighting the necessity for further investigation into the specific structural features and mechanisms of injury that contribute to poor neurological improvement in thoracic injuries and the identification of effective recovery approaches for these patients.

A Solitary Osteochondroma Originating from the Spinous Process of the Third Cervical Vertebra: A Case Report and Comprehensive Literature Review

Jinan Mohammed Aljasem — 2024-12-06

Background

Osteochondroma is one of the most common solitary bone lesions. Multiple lesions are possible only in some genetic abnormalities, such as hereditary multiple exostoses (HME). Half of spinal osteochondroma is documented at the cervical level, although there are some levels and locations where it is rare to find an osteochondroma.

Methods

An advanced search of the PubMed database was performed for case reports and case series of spinal cervical osteochondroma. After data extraction, information was organized in one table and many figures to facilitate data comprehension.

Result

Osteochondroma was common in younger patients, with 26% of all cases in the literature being in those aged 18 to 35 years, and 24% of patients were aged 36 to 50. Over half (55%) of cases were in males. The most common presentation among all patients was neck pain and swelling or lump sensation. Moreover, 38% of cases were osteochondroma at the C1 level, and 33% were noted to affect the posterior arch. The majority of the cases had a favorable prognosis as most of them underwent total surgical resection of the tumor and decompression of the neural compartment.

Conclusion

Solitary cervical osteochondroma is a bony, benign lesion that can have devastating sequelae such as severe painful radiculopathy and quadriplegia if it is not approached correctly. History, examination, and radiological investigation are all crucial to making the best clinical judgment for the patients.

Acute Pancreatitis after Lumbar Spine Surgery: A Case Report

Abdulaziz Ahmed Munshi — 2024-12-06

Acute pancreatitis is a rare but potentially life-threatening complication that typically occurs after various abdominal procedures, but it is extremely uncommon following spinal surgery. This case study describes a 38-year-old male martial arts champion who developed acute pancreatitis after undergoing lumbar laminectomy and Transforaminal Lumbar Interbody Fusion (TLIF) surgery for chronic lower back pain and bilateral radiculopathy in both legs. Despite the absence of typical risk factors, such as alcohol consumption or a history of pancreatitis, the patient developed abdominal pain, nausea, and vomiting on the second postoperative day, along with elevated serum amylase levels. These clinical findings raised suspicion for acute pancreatitis, which was subsequently confirmed through diagnostic imaging. Prompt treatment led to the resolution of symptoms and normalization of pancreatic enzyme levels. This case underscores the importance of recognizing and managing uncommon complications following spinal surgery, highlighting the necessity for a comprehensive, multidisciplinary approach to ensure optimal patient care.

Thoracic Radiculopathy Unveiling Giant Bilateral Thoracic Tarlov Cysts

Maroua Slouma — 2024-12-06

Background

Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that typically arise between the covering layers of the perineurium and endoneurium at the junction of the dorsal root ganglion. They are usually asymptomatic and typically located at the lumbosacral spine. Thoracic localization is rarely reported and is a challenging condition both clinically due to its misleading wide range of symptoms and therapeutically, given the lack of management guidelines.

Case

We report a case of a man in his seventies complaining of chronic back pain with worsening bilateral thoracic radiculopathy with tingling and burning sensations following T11-T12 dermatomes. The neurological examination was without abnormalities. Magnetic resonance imaging revealed bilateral, extradural, and large cystic formations. The diagnosis of thoracic bilateral giant cysts was established. The patient denied surgical treatment. Topical non-steroidal anti-inflammatory drugs and acetaminophen led to partial improvement of symptoms.

Conclusion

This case highlights clinical and imaging features of thoracic Tarlov cysts. The MRI is considered the gold standard for diagnosing Tarlov cysts and effectively ruling out differential diagnoses. The initial therapeutic approach for Tarlov cysts typically involves conservative management.