In the authors' experience, early detection and surgical removal in cases of symptomatic spinal OC is a key element for the best outcome. Posterior approaches are generally sufficient. The chronicity of symptoms may limit functional recovery postoperatively, especially with cervical and thoracic lesions.

Primary intradural extramedullary hydatid cyst is a rare form of parasitic infection, causing focal neurological signs, commonly observed in sheep-raising areas of the world. We report a rare case of intradural, extramedullary spinal cyst, which we had misdiagnosis in the first surgery, because of rarity of the case. A 55-year-old man presented to our hospital in August 2008. He was admitted to our clinic because of lumbar pain of increasing severity and progressive difficulty with walking and stiffness of both lower limbs, which had lasted for 1 month. On the basis of imaging results, arachnoid cyst of the lumbar spine was diagnosed. Due to rapid progression of the patient’s symptoms toward spastic paraplegia, he underwent an emergency surgical decompression procedure. The patient underwent exploratory surgery using a posterior approach. A L1–L2 laminectomy was performed. After opening the dura, an intradural extramedullary cystic mass was determined. The surgical specimen measured 6 × 2 cm and was described as a whitish, pearl-like, semitranslucent, cystic material, which was thought to be parasitic. Surgery has to be followed by albendazole therapy.

BACKGROUNDMany patients with lumbar disc surgery experience postoperative back and radicular pain, delaying hospital discharge and resumption of normal activity. Some surgeons have used intraoperative epidural corticosteroids and local anesthetics to decrease pain following surgery for a herniated lumbar disc. Controversies still exist regarding the benefits of these drugs. The present study was meant to compare the effects of the intraoperative administration of epidural methylprednisolone and bupivacaine with that of normal saline (placebo) in lumbar disc surgery for postoperative pain control.PATIENTS AND METHODSOne hundred fifty patients with single level herniated nucleus pulposus (L4–L5 or L5–S1), which was refractory to 6 weeks of conservative management, were divided randomly in three groups. A standard hemipartial lamimectomy and discectomy was performed on all patients. At the end of the surgery, before the closure of fascia, 40 mg methylprednisolone with 3 mL normal saline for group 1, 2 mL bupivacaine 5% with 2 mL normal saline for group 2 and 4 mL normal saline for group 3 were instilled onto the epidural and exposed nerve root. Postoperative back and radicular pain intensity was assessed by a visual analogue scale (VAS) before and at 24, 48, 72, and 96 hours after surgery.RESULTSThere was no significant difference in back and radicular pain intensity between the three groups.CONCLUSIONIntraoperative administration of epidural methylprednisolone or bupivacaine does not relieve postoperative back and radicular pain.

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AIM:Pedicle screw instrumentation is widely used in the lumbar spine as a means of stabilization to enhance arthrodesis and has gained acceptance in the thoracic spine in recent years. The purposes of this study were to determine the incidence of screw misplacement, complications, the accuracy and usefulness of CT scan in evaluation of pedicle screw placement. MATeRIAL and MeTHodS: Postoperative CT was performed in all 53 cases to evaluate implant position within first month after surgery. The CT scans were obtained with 2-mm axial slices of the instrumented levels. These images were then inspected for evidence of pedicle violation. ReSULTS: In assessing 247 pedicle screws inserted in 53 patients, lateral screw misplacement was observed in 59 screws (67.82%) and medial pedicle wall violation in 28 screws (32.18%). Of the 87 misplaced screws, 41 cases were classified as minor (cortical perforation ≤ 2 mm), 41 cases as moderate (2.1-4 mm), and 5 cases as severe penetration (> 4 mm).Nerve root injury with radicular pain and neurological deficits was observed in 8 patients with malpositioned screws (15.09% of all patients). CoNCLUSIoN: Pedicle screw placement is a technically demanding procedure with a high complication rate. Fortunately, most complications are not severe.

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Aim: Pedicular screws have known, well-recognized complications; however, the surgeon should be aware of the morphometry of the pedicles, as well as the anatomy of the surrounding neural structures to minimize these risks. This study examined the physical characteristics of lumbar pedicles and this study is unique for this purpose.Materials and Methods: Twenty-five vertebrae were selected in either sex, 18 years or older, and E-film computer software was used to measure the different diameters of pedicle.Results: The L 5 pedicle was the widest (16.8 mm), whereas L 1 was the narrowest (8.25 mm). This figure was 8.82, 10.48, and 12.86 for L 2 , L 3 , and L 4 , respectively. The longitudinal depth of the pedicle was 47. 98, 48.68, 50.42, 48.32, and 47.8 for L 1 , L 2 , L 3 , L 4 , and L 5 , respectively. Statistically significant differences were found between some dimensions detected in our study and similar studies. Conclusions:The shape and diameter of the pedicles are different in different races. Some differences were found in our study with regard to pedicle dimensions.