INTRODUCTION:Posterior epidural sequestrated disc is a fairly uncommon condition. We report a case of an unusual presentation of posterior epidural migration with contralateral symptoms. We emphasize a high index of suspicion for early recognition and treatment to promote a good neurological recovery. CASE PRESENTATION: A 58-year-old man with a history of severe back pain for 1 week developed sudden right leg weakness while walking. Neurological examination revealed motor and sensory impairments of the right lower extremities (positive right straight leg raising test, right tibialis anterior grade 2/5, right extensor hallucis longus grade 1/5, decreased pinprick sensation of L4-5 dermatome right side) according to the Standards for Neurological Classification of Spinal Cord Injury as Asia Impairment Scale D. Magnetic resonance images showed an acute disc herniation at L4-5 on the left side, cranially migrated and sequestrated to the posterior epidural area, causing severe compression to the cauda equina in the thecal sac. The patient was successfully treated with surgery (transforaminal lumbar interbody fusion) on an urgent basis. We saw significant neurological recovery on the first day after surgery. Motor power recovery was achieved with a minor deficit at 4 weeks. At the follow-up examination at 3 months, the patient had no residual neurological deficits as Asia Impairment Scale E. DISCUSSION: Posterior epidural sequestrated disc with contralateral radiculopathy is very rare. This case brings a new presentation of posterior epidural sequestrated disc. To our knowledge, this is the first report of a case with an unusual presentation of contralateral radiculopathy.
Both treatments led to significant improvements in patient outcomes that were sustained for at least 24 months. Costs were lower with IDET, and for appropriate patients IDET is an effective and cost-effective treatment alternative.
Purpose To share long-term clinical outcomes and our experience with full-endoscopic interlaminar decompression (FEI) for lateral recess stenosis (LRS). Methods We included all patients who underwent FEI for LRS from 2009 to 2013. VAS for leg pain, ODI, neurological findings, radiographic findings, and complications were analyzed at one week, one month, three months, and one year postoperation. The telephone interview for local patients with simple questions was done approximately ten years after the operation. International patients receive an email with the same questionnaire as local patients during the same follow-up period. Results One hundred and twenty-nine patients underwent FEI for LRS with complete data during 2009–2013. Most of the patients (70.54%) had LRS radiculopathy for less than one year, mainly L4-5 (89.92%), followed by L5-S1 (17.83%). Early outcomes three months after surgery showed that most patients (93.02%) reported significant pain relief, and 70.54% reported no pain at their ODI scores were significantly reduced from 34.35 to 20.32% (p = 0.0052). In contrast, the mean VAS for leg pain decreased substantially by 3.77 points (p < 0.0001). There were no severe complications. At ten years of follow-up, 62 patients responded to the phone call or email. 69.35% of the patients reported having little or no back or leg pain, did not receive any further lumbar surgery, and were still satisfied with the result of the surgery. There were six patients (8.06%) who underwent reoperation. Conclusion FEI for LRS was satisfactory at 93.02%, with a low complication rate during the early follow-up period. Its effect seems to decline slightly in the long term at a 10-year follow-up. 8.06% of the patients subsequently underwent reoperation.
Purpose To evaluate the accuracy of screw placement and fusion rate after the minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique under O-arm navigation. Methods In 475 consecutive patients at a single-center, the accuracy of screw placement was evaluated on intraoperative O-arm imaging. Misplaced screws were investigated to identify the direction of deviation and associated clinical outcomes. The fusion rate was evaluated on postoperative computed tomography scan at 1 and 2 year(s). The assessment of screw placement and fusion level was analyzed for inter-rater reliability and reported as a kappa value. Accuracy of screw placement (Gertzbein-Robbins Classification), extent of fusion (Bridwell Interbody Fusion Grading System), and complications were considered as outcome measures. Results A retrospective data analysis from 2,098 pedicle screws in 475 patients. The mean age of participants was 56.61 ± 12.30 years, and 45.26% were female. Their ethnicities were as follows: Asian (58.74%), Caucasian (20.21%), Middle-eastern (14.32%), and African (6.74%). The final fusion levels were single (80.63%), two (18.11%), three (1.05%), and four (0.21%). There were L4/L5 as the most prevalent placement (55.35%), followed by L5/S1 (36.29%), L3/L4 (5.22%), L2/L3 (2.35%), L1/L2 (0.52%), and S1/S2 (0.26%). Seven out of 2,098 screws were breaches. None of screw needed immediate revision. In total, 99.66% of the screws were grade A (no breach), 0.19% were grade B (breach < 2 mm) and 0.14% were grade C (breach < 4mm). Conclusion The accuracy of pedicle screw insertion was 99.66%, with a fusion rate of 95.45% after MIS-TLIF under O-arm navigation. Breaches were not associated with poor clinical outcomes or fusion rates.
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