Iranian Journal of Neurosurgery
Volume:6 Issue: 1, Winter 2020

Acute lower lumbar spinal fractures (L4 and L5) can cause major neurologic damage and mechanical instability. The ultimate surgical method for management of unstable lower lumbar spine fractures remains questionable.

Online search databases including Google Scholar, PubMed and Ovid were searched using these keywords: low lumbar, fractures, spine trauma, biomechanics, classification, anatomy, spinopelvic alignment, non-operative and surgical treatment options. Finally, about 47 related studies were identified and reviewed.

The L4 and L5 vertebra and related discs contribute to 50% of the lordosis in lumbar area. Fracture of the trapezoidal body of fifth vertebra can considerably decrease this and change the L4/5 and L5/S1 biomechanics. Lower lumbar spine, in contrast to the thoracolumbar junction is secure by the pelvis and the robust musculature. There is great controversy about the treatment of lumbar burst fractures without neurologic deficit. The surgical indication and optimal procedure can be influenced by numerous aspects such as the severity of signs and symptoms, the amount of vertebral body height loss and spinal canal involvement, and finally, the continuity of the posterior spinal components.

 There has been great controversy concerning what establishes the paramount treatment for low lumbar burst fractures. Conservative care has been related with respectable outcomes for patient with a burst fracture and neurologic intact. In more severe injuries, decisions contain spinal decompression and stabilization via a posterior or anterior approach based on the surgeon’s preference. For lower lumbar burst fractures or fracture-dislocations of the lumbo–sacral junction with neurologic injury, posterior decompression and stabilization and a period of rest and bracing for preservation lumbar lordosis are appropriate

Surgical management of lumbar spinal stenosis (LSS) is a common practice. The aim of this study to was to report morbidity and mortality observed during surgical treatment of LSS and the outcome of these patients after management over an 8-year study period.

It was a retrospective, descriptive and transversal study performed at Departmental Teaching Hospital of Borgou in Republic of Benin (West Africa) from January 2010 to December 2018. This study concerned patients who underwent surgical management for LSS. Each type of complication, its management and the patient’s outcome was registered.

During the study period, 270 patients underwent laminectomy for lumbar spinal stenosis; 239 (88.5%) were selected. These patients were divided into 135 men (56.5%) and 104 women (43.5%). The mean age of the patients was 52.36 ± 10.94 years. Laminectomy was performed on one, two and three lumbar spinal segments in 42(17.6%), 133(55.6%) and 64 (26.8%) cases respectively. Laminectomy was associated with dissectomy in 15 patients (6.3%). No arthrodesis with spinal fixation was performed. The postoperative evolution was simple and uncomplicated for 215 (90%) patients. Functional postoperative results were considered excellent, good, acceptable and poor in 32.1%, 52.1%, 10.9% and 4.9% of cases respectively. Five types of complications were observed in 22 patients (9.2%). A reoperation was performed in 4 (1.6%) patients. These different complications was : dural tear (4.6%), Wound infection (3.3%), Stroke (0.8%), Pseudomeningocele (0.4%) and Cauda equina syndrom (0.4%). Mortality was 0.8% (n=2).

Lumbar canal stenosis surgery is not without complications. Careful selection of patients, consideration of risk factors, and selection of an appropriate surgical strategy can reduce or avoid these complications.

approaches have been proposed for the treatment of carpal tunnel syndrome (CTS) based on its severity. The aim of this study is to determine the optimal management for severe CTS.

 This cross-sectional study was conducted for 22 months from August 2017 to June 2019 in a referral rehabilitation clinic in southern Iran. A total of 117 hands diagnosed with severe CTS were included in 78 patients according to electrodiagnostic study (EDX) reports (considering Sensory Proximal Latency (SPL)>3.6 msec, Sensory Distal Latency (SDL)>5.3 msec, Sensory Nerve Conduction Velocity (SNCV) <30 m/sec, Distal Motor Latency (DML)>6.5 msec as being severe) who refused to undergo surgery. Boston questionnaire was filled out and conventional EDX was carried out at the first and the 1-year follow-up visits.

In patients with a detectable sensory nerve action potential (SNAP), motor amplitude (P<0.002) and latency (p<0.01), SPL (p<0.003) and SNCV (p<0.006), and Boston parameters improved significantly in the 1-year follow-up visit compared with the results at the first visit. However, improvement in patients with absent or low amplitude SNAP at first visit was only observed in proximal sensory latency (p<0.005) and amplitude (p<0.003).

There is a considerable chance for non-surgical improvement of patients with severe CTS in terms of symptom relief, hand function, and EDX parameters in those with detectable SNAP at first visit; however, patients with undetectable SNAP have little, if any, the chance for improvement with conservative measures.

Of utmost importance for the success of neurosurgical operations is proper patient positioning. This is particularly the case for operations conducted in the prone position, which is associated with several potential complications.

Here we report the case of a 52 year-old male patient who underwent endoscopic discectomy for an L5-S1 herniated disc. Following placement in the prone position, motor evoked potentials (MEP) were significantly asymmetric, with those from the left side being disproportionately low considering his clinical presentation. MEP recordings were ameliorated when the patient was placed in the supine position. Considering the nervous and vascular anatomy of the area, a peripheral insult is highly unlikely to be the cause of the neurophysiological profile of this patient. Instead, compression of the dural sac due to biomechanical alterations of the contents of the spinal canal, is the most possible pathogenetic mechanism.

Proper patient positioning is of paramount importance for the success of a neurosurgical operation. Still, even if all precautions have been taken, it is possible that insults to neuronal structures can cause from biomechanical alterations of the contents of the spinal canal, secondary to prone positioning

Plasmacytoma is more likely to involve the spine, with up to 50%, most commonly in the thoracic spine.

We present the case of a solitary C2 plasmocytoma with neck pain and abnormal C1-C2 range of motion, which happened to have an osteolytic C2 lesion on CT scanning. The patient underwent a fluoroscopically guided anterior percutaneous C2 vertebroplasty without posterior fusion, which resulted in long-standing pain control, maintenance of normal motions and restoration of cervical alignment.

This case represents fluoroscopically guided anterior percutaneous C2 vertebroplasty as an effective treatment for C2 osteolytic lesions with abnormal range of motion, which can be considered in selected cases as an alternative approach for demanding open surgical approaches to this challenging region.

Hydatid cyst is endemic in India, with different clinical presentations according to the site of involvement in the body. However, its occurrence in the brain without the involvement of other body parts is rare.

An eight-year-old female child presented with right-sided limb weakness and slurring of speech. The diagnosis of primary brain hydatid cyst was made with Magnetic Resonance Imaging (MRI) of the brain. The cyst was removed in toto, resulting in improved post-operative slurring of speech and limb weakness.

In countries with endemic hydatid disease, it should be kept as one of the possible differential diagnoses and managed as per hydatid protocol until another definitive diagnosis of brain cystic mass can be made, in order to prevent rupture and dissemination.