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Transvenous embolization of conus spinal arteriovenous malformation: illustrative case

Mohammad Anadani and Jonathan Lena

Conus medullaris spinal arteriovenous malformations (AVMs) are a rare spinal vascular malformation that can lead to significant morbidity. 1 , 2 Conus AVMs can present with acute neurological deterioration due to subarachnoid/intramedullary hemorrhage or with stepwise gradual progression due to venous congestion, mechanical compression, or ischemia due to vascular steal. 1 , 3 Treatment options include endovascular embolization alone, microsurgery, or a combined approach. Endovascular treatment of conus spinal AVMs is challenging due to involvement of

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Incomplete myelographic block with hypertrophic spinal pachymeningitis

Case report

Fremont P. Wirth Jr. and Mokhtar Gado

H ypertrophic spinal pachymeningitis, first described by Charcot in 1869, is characterized by radicular pain in the neck and arms progressing to weakness and atrophy of the arms and finally spastic paralysis of the legs with loss of sensation and sphincter control. 4 The myelographic characteristics of this condition were first described by Moniz as a complete block except in rare cases. 7 Subsequently several authors have reported a complete block on Pantopaque myelography. 1, 6, 9 The symmetrical encroachment on the cervical subarachnoid space, as seen in

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An orphan disease: IgG4-related spinal pachymeningitis: report of 2 cases

Bishan D. Radotra, Ashish Aggarwal, Ankur Kapoor, Navneet Singla, and Debajyoti Chatterjee

the last decade or so as the disease had been diagnosed with increased frequency clinically, it has been described in virtually every organ system: the biliary tree, salivary glands, periorbital tissues, kidneys, lungs, lymph nodes, meninges, aorta, breast, prostate, thyroid, pericardium, and skin. 3 , 4 , 6–8 The treatment guidelines are being continually modified. We report 2 cases of spinal pachymeningitis due to IgG-related disease. The presentation was like any other intradural spinal lesion. Although the intraoperative features were not typical of a spinal

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Radiofrequency ablation of spinal osteoid osteoma: a prospective study

Joe Faddoul, Yara Faddoul, Sandra Kobaiter-Maarrawi, Ronald Moussa, Tony Rizk, Georges Nohra, Nabil Okais, Elie Samaha, and Joseph Maarrawi

(NSAIDs) and salicylic acid. 7 Spinal osteoid osteomas may be complicated by painful scoliosis and rarely by neurological deficit. 3 Diagnosis of osteoid osteomas is based mainly on CT scanning findings, which characteristically show a hypodense region surrounded by a sclerosis of varying intensity. 14 On nonenhanced MRI, the nidus is optimally visualized on T2-weighted sequences, when it appears as a hypointense lesion surrounded by marrow edema. Perinidal enhancement is observed after gadolinium administration. 6 Conservative treatment using NSAIDs and salicylic

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Hypofractionated spinal stereotactic body radiation therapy for high-grade epidural disease

Robert J. Rothrock, Yi Li, Eric Lis, Stephanie Lobaugh, Zhigang Zhang, Patrick McCann, Patricia Mae G. Santos, T. Jonathan Yang, Ilya Laufer, Mark H. Bilsky, Adam Schmitt, Yoshiya Yamada, and Daniel S. Higginson

W hen patients with metastatic solid tumor malignancies present with lower-extremity weakness due to high-grade epidural spinal cord compression (ESCC), the recognized standard of care consists of surgical decompression first, followed by radiotherapy. This standard is largely based on the sentinel study published in 2005 by Patchell et al., which found that ambulation outcomes were superior in the surgery plus radiation arm compared with the radiation-alone arm. 1 However, for patients with high-grade ESCC but no symptoms or physical examination findings

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Exploratory meta-analysis on dose-related efficacy and morbidity of bone morphogenetic protein in spinal arthrodesis surgery

Christoph P. Hofstetter, Anna S. Hofer, and Allan D. Levi

M ore than 400,000 spinal fusion procedures are performed annually in the US. 68 Autologous iliac crest bone graft is considered the gold standard for bone grafting material due to its superior osteoconductive, osteoinductive, and osteogenic properties. 18 However, donor site morbidity, 1 , 3 , 32 , 91 as well as high demands of the quality of bone grafting material commanded by minimal access surgery and by long-segment instrumented fusions in deformity surgery, has fueled the quest for alternatives to existing bone graft substitutes. Bone

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Utility of topical tranexamic acid for adult patients with spinal deformity and contraindications to systemic tranexamic acid: initial experience and report of 2 cases

Bhargav D. Desai, Davis G. Taylor, Ching-Jen Chen, Thomas J. Buell, Jeffrey P. Mullin, Bhiken I. Naik, Justin S. Smith, and Christopher I. Shaffrey

S urgical treatments for adult spinal deformity (ASD) are typically complex procedures associated with significant blood loss and the potential risk for perioperative coagulopathy, as well as requisite blood product administration, volume resuscitation, and their associated risks. 28 , 29 Acute intraoperative blood loss can be managed with allogeneic transfusions; however, the risks include transfusion-related acute lung injury, hemolytic transfusion reactions, and transfusion-associated sepsis. 31 Reducing perioperative blood loss in complex spine surgery is

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Spinal epidural lipomatosis: a review of its causes and recommendations for treatment

Daniel R. Fassett and Meic H. Schmidt

Spinal epidural lipomatosis is most commonly observed in patients receiving long-term exogenous steroid therapy, but can also be seen in patients with endogenous steroid overproduction, obesity, or idiopathic disease. With this condition, there is hypertrophy of the epidural adipose tissue, causing a narrowing of the spinal canal and compression of neural structures. A majority of patients will present with progressive myelopathy, but radicular symptoms are also common. Conservative treatment—weaning from steroids or weight loss—can reverse the hypertrophy of the adipose tissue and relieve the neural compression. If conservative management fails, surgery with decompressive laminectomy is also very successful at improving the patient's neurological symptoms.

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Immediate effects of spinal cord stimulation in spinal spasticity

Giancarlo Barolat-Romana, Joel B. Myklebust, David C. Hemmy, Barbara Myklebust, and William Wenninger

reported on the effectiveness of SCS in spasticity. 3, 4, 13, 14, 17 At our institution we have implanted epidural SCS systems for the management of spasms in six patients with spinal cord injuries. The goal of this paper is to present objective evidence of some of the immediate effects that SCS has on spasms in patients with spinal spasticity. We define as “immediate” those effects occurring within seconds or minutes after the onset or cessation of SCS. Only three of our patients experienced immediate effects related to SCS. Clinical Material and Methods Six

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Microsurgical obliteration of a thoracic spinal perimedullary arteriovenous fistula

Justin M. Caplan, Mari Groves, Ignacio Jusue-Torres, Jennifer E. Kim, Jason Liauw, Ali Bydon, and Rafael J. Tamargo

Spinal vascular lesions are rare and may be classified as a) dural arteriovenous fistulas (AVFs), b) arteriovenous malformations, or c) perimedullary AVFs. In this narrated video illustration, we present the case of a 71-year-old woman who presented with progressive bilateral lower extremity weakness and urinary retention who was diagnosed with a thoracic spinal perimedullary arteriovenous fistula. The diagnostic studies included a thoracic MRI and spinal angiogram. A multilevel thoracic laminoplasty was performed for microsurgical obliteration of the AVF. The techniques of intraoperative angiography, thoracic laminoplasty and microsurgical obliteration and resection of the AVF are reviewed.

The video can be found here: