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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From June, 1989 to March, 1991, 24 cases with various spinal disorders were treated in our department using the Dick technique. The results were as follows: In the fresh fracture group (7 cases), all the spine fractures were reduced anatomically: the 2 cases without neurological defects returned to work 3 months after operation; the 3 cases with incomplete paraplegia had rapid neurological recovery; and the 2 cases with complete paraplegia showed no recovery after operation. In the late fracture group (10 cases), traumatic kyphotic curves were partially reduced and back pain was decreased markedly in all: Muscle power was increased significantly in 3 cases; spasticity was remarkably improved in 2 cases; 3 cases obtained complete cure of incontinence; and 4 cases had no significant improvement. In 3 cases with ankylosing spondylitis, the initial average kyphotic curve was 73.3 degrees, while the postoperative average curve was 28.3 degrees. The result of treatment of spinal stenosis due to degenerative spondylolisthesis (1 case) was good; slipping vertebrae were stabilized and fused with the Dick system after thorough decompression. In 1 tumor and 2 Tb-spine cases, the patients recovered and were ambulatory soon after operation.
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PMID:The application of Dick instrumentation in spine surgery. 142 57

A case of spinal dumbbell shaped melanotic schwannoma was reported. A 58-year-old housewife had a 3-months history of progressive gait disturbance. She also complained of mild backache and numbness in both legs. Her family history was not remarkable. When examined on admission, October 10, 1982, mild weakness of both legs with spasticity and sensory impairment below the level of T10 dermatome without sacral sparing were evident. Her deep tendon reflexes were hyperactive on both sides and plantar responses were extensor bilaterally. Sphincteric disturbance was not significant. The function of her cranial nerves was intact. She had neither cutaneous lesions, abdominal mass nor organomegaly. Thoracic plain X-rays revealed erosion of the right side vertebral body and pedicle of the 10th thoracic vertebra. Myelography disclosed a complete block at the same level by an epidural mass. On CT-myelogram, soft tissue density mass compressing the thoracic cord was apparent in the right epidural space of the spinal canal which extended to the paravertebral region through the right intervertebral foramen. Partial destruction of the body and the right side pedicle was easily recognized. Laminectomy from T9 to T11 exposed a large extradural mass which was encapsulated, elastic soft and pigmented in nature. The tumor was dumbbell shaped and extended to the right paravertebral region through the intervertebral foramen. Costotransversectomy was performed to excise the mass entirely. Following the total removal of the tumor, internal fixation was carried out by means of Harrington instrumentation with methylmethacrylate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spinal melanotic schwannoma: report of a case]. 306 Jul 51

Two types of operations can be proposed today in the neurosurgical treatment of spasticity; the destruction of a brain target, a medullary pathway or a nerve root, and electrical stimulation of nervous structures. Striking improvements in voluntary motor control and sensory appreciation were first reported by Cook and Weinstein (1) in 1973, after implantation of a dorsal cord stimulator for intractable back pain in a case of muiltiple scleroris. The favourable effect on spasticity was confirmed later by other groups. Our own experience, with 26 cases tested for a few days with floating electrodes and 11 cases operated on and followed up for more than 3 years, shows that the best results are obtained in cases of medullary spasticity, without complete section of the cord, occurring mainly in multiple sclerosis. Cerebral spasticity did not respond as well. The objective data, measurement of stretch and H-reflexes, support the clinical results. The physiological mechanisms of dorsal cord stimulation on spasticity have not yet been elucidated.
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PMID:Treatment of spasticity by dorsal cord stimulation. 696 38

In this report we present the case of a 16-year-old patient, born in Macedonia, who complained of abdominal and back pain and developed paraparesis. On admission to hospital, he showed a paraplegic syndrome, the level of sensation being T7, together with high-grade paraparesis of the lower extremities and spasticity and urinary incontinence. The protein content of the CSF was raised to 183 mg/dl. CT and MRI of the thoracic spine showed cystic lesions at the level of the 6th and 7th thoracic vertebrae, in the paravertebral area and in the 7th rib on both sides. The antibody titer of Echinococcus in the serum was positive. To treat this problem, corporectomy of the 6th to 8th thoracic vertebrae was performed, the area being bridged by a corticospongoid pelvic bone graft and with instrumental support of the 5th to 9th thoracic vertebrae. Histological examination revealed multilocular Echinococcus lesions. Under long-term treatment with mebendazole, the neurological deficits decreased in the postoperative phase.
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PMID:[High-grade transverse syndrome caused by echinococcus cysts]. 771 54

From June, 1989 to March, 1991, 24 cases were treated in our department with the Dick technique. The study population included 7 patients with fresh horacolumber spine fracture, 10 with late spinal fracture (15 of the above 17 cases had incomplete paraplegia), 3 with ankylosing spondylitis, 2 with tuberculosis, and one each with spondylolisthesis and spine tumor. The results of these 24 cases were as follows. In the fresh fracture group, all the spine fractures were reduced completely. The 2 patients without neurological defects returned to work 3 months after operation. The 3 with incomplete paraplegia had rapid neurological recovery and could walk with a brace 3 months after surgical treatment. The 2 with complete paraplegia did not recover after toperation. In the late fracture group, traumatic kyphotic curve were reduced partially and back pain was decreased markedly in all 10 cases. Muscular power was increased significantly in 3 cases; they are all able to walk with a cane. Spasticity was remarkably improved in 2 patients after operation; they can now walk with crutches. Three patients obtained complete cure of incontinence. Four patients had no significant improvement. In the 3 patients with ankylosing spondylitis, the initial average kyphotic curve was 73.3 degrees, while the postoperative average curve was 28.3 degrees. The result in treating spinal stenosis due to degenerative spondylolisthesis was good: the slipping vertebrae were stabilized and fused with the Dick system after thorough decompression. In the tumor and Tb-spine cases, the patients recovered and were ambulatory soon after operation, thanks to rigid internal fixation.
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PMID:[The application of Dick instrumentation in the field of spine surgery]. 832 36

Spinal angiolipomas are distinct, benign lesions composed of mature lipocytes admixed with abnormal blood vessels. Three new cases of spinal angiolipoma are presented and 34 previously reported cases are analyzed. The 37 total cases (23 females and 14 males) ranged in age from 17 to 73 years (mean 43 years; median 45 years). The mean age of the female patients was older than that for the males (45.0 vs. 41.6 years; p < 0.001, Student's t-test) and most were peri- or postmenopausal. Prior to diagnosis, 97% of the patients had weakness of the lower extremities, 94% had sensory dysfunction, 84% had hyperreflexia and spasticity, 51% had sphincter dysfunction, and 41% had back pain lasting from 1 to 180 months (mean 28 months). Five (22%) of the 23 female patients were pregnant and two had exhibited significant weight gain coincident with the onset of symptoms. The angiolipomas were extradural in 35 patients and intramedullary in two; seven of the extradural lesions infiltrated the surrounding bone. The tumors extended from C-6 to L-4 and had a predilection for the midthoracic region (53% of cases). Plain radiographs were abnormal in 11 (39%) of 28 patients and in all patients with bone infiltration. Myelograms were abnormal in 97% of 32 patients and showed a complete block in 63% of patients. Computerized tomography (CT) and magnetic resonance (MR) imaging revealed the fat-density lesions in all cases studied. There was vascular enhancement in three of five cases with contrast-infused CT and in the one case with gadolinium-infused MR imaging. All patients improved following resection of the epidural lesions and internal decompression of the intramedullary lesions. It is concluded that spinal angiolipomas predominantly affect women. They involve the thoracic (especially the midthoracic) region, and produce symptoms and signs of spinal compression and, in some cases, bone erosion and pathological fractures. Their symptomatology can be exacerbated by pregnancy and weight gain, suggesting that vascular engorgement and the presence of obesity influence their evolution. Their preponderance in older, peri-, or postmenopausal women, and their clinical exacerbation in pregnant women support a role for hormonal influence. Magnetic resonance imaging is the investigation of choice for the diagnosis of these lesions. Surgery is universally successful in relieving symptoms.
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PMID:Spinal angiolipomas. Report of three cases. 842 Dec 11

Charcot spine, also known as neuropathic spinal arthropathy, is a late complication of traumatic spinal cord injury that can produce pain and further disability. We report five cases of Charcot spine occurring in patients with previous traumatic spinal cord injury that we have identified at our institution from 1985 to 1994. All patients had complete paraplegia with levels of neurologic injury ranging from T7 to T12. Common presenting symptoms included back pain, loss of spasticity, change in bladder function, and audible noises with motion. The diagnosis of Charcot spine was made from 6 to 31 years after original spinal cord injury. In four cases where a surgical fusion had been performed, the Charcot joint developed within two spinal segments below the caudal end of the fusion. Radiological studies, especially plain films and computed tomography, were helpful in making the diagnoses. Immobilization of the affected joint is an essential element of treatment. Surgical repair and stabilization were performed in four patients and has been recommended to the other patient. Early diagnosis and proper treatment is important in preventing the progression of this disorder.
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PMID:Charcot spine as a late complication of traumatic spinal cord injury. 904 6

The clinical presentation of tethered spinal cord and the results of tethered cord release were examined in a group of 30 low motor level (L3 and below) children with a history of myelomeningocele without concomitant CNS complications. Changes in orthopedic and/or neurologic status formed the basis of consideration for tethered cord release. Clinically, these patients presented with a new onset or recently progressing scoliosis, spasticity with or without contractures, decrease in motor function and low back pain at the site of closure. One or more of these findings was present in all cases and led to the suspicion of tethered spinal cord. The diagnosis of tethered cord was confirmed in all cases by MRI or CT myeolography. In order to isolate tethering as the etiology for the patients' clinical deterioration, patients with concomitant CNS complications, e.g. shunt dysfunction or hydromyelia were excluded from the study. Twenty-nine such patients, of an initial 59, who would have otherwise been considered, were excluded on the basis of this criteria of concomitant CNS complications. The results of release 1 year after the procedure were as follows: regarding scoliosis, in 75% of cases the curve either remained stable or decreased by more than 10 degrees, with 25% experiencing curve progression of > 10 degrees. The most recent follow-up in this group revealed that 11.8% experienced a decrease in curvature of >10 degrees; 47.1% remained stable, and 41.2% ultimately progressed 10 degrees. In the group with spasticity, 43.8% improved; 56.3% remained stable, and none worsened. Most (78.6%) of the children who had experienced a decline in motor function improved postoperatively, and all those with back pain experienced complete resolution. In conclusion, tethered cord release in symptomatic low lumbar and sacral level children with myelomeningocele appears to be of benefit, especially with respect to stabilization of scoliosis in selected patients, back pain at the site of closure, and prior decline in motor function. Results in the cases with spasticity were more equivocal.
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PMID:Tethered cord syndrome in low motor level children with myelomeningocele. 934 49

Selective dorsal rhizotomy (SDR) has been shown to be an effective treatment for the spasticity of cerebral palsy, but few studies have addressed specifically the side effects of the procedure. A retrospective study was performed to determine the frequency and nature of complications in 158 children who had undergone SDR at British Columbia's Children's Hospital from 1987 to 1996. Intraoperative, preoperative (immediate postoperative until discharge at approximately 7 days) and postdischarge complications occurred in 3.8, 43.6 and 30% of patients, respectively. The most common intraoperative complication was aspiration pneumonia, which was experienced by 2 patients (1.3%). Perioperatively, sensory changes were found in 8.9% of the children, and transient urinary retention in 4.4%. Complications after discharge included back pain starting more than 6 months after surgery in 10.8%, sensory changes in 13.9%, and neurogenic bladder or bowel problems in 12.7%. Persistent sensory changes occurred in 3.8%, were not important functionally, and tended to occur in patients with the largest amount of dorsal root tissue cut. In 8 patients (5.1%), bladder and/or bowel dysfunction attributed to the SDR was present at the latest follow-up, although in only 2 patients (1.3%) this dysfunction was a definite complication of the rhizotomy. The use of pudendal monitoring and/or cutting less than 50% of the S2 roots may have been associated with a lower incidence of long-term sphincter dysfunction. Data about the nature and frequency of complications may result in further modifications to the SDR procedure, and is critical for counseling about SDR and alternative options available for treatment of the child with spastic cerebral palsy.
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PMID:Complications after selective posterior rhizotomy for spasticity in children with cerebral palsy. 978 7

Factors determining change in ambulatory status were studied over a 12-year observation time in 60 ambulating patients with myelomeningocele. There were 26 female and 34 male subjects with a median age of 22 years (range, 12-54). We used the method of Lindseth to define the neurologic level of the lesion and classified walking ability according to the criteria of Hoffer. The prevalence of spasticity and spine and lower-limb deformities was assessed. Orthopedic and neurosurgical interventions and other medical events were registered, as well as occurrence of pressure sores, musculoskeletal pain, and use of orthoses. There were 19 patients with downward transitions in ambulatory level during the follow-up time. Factors explaining deterioration in these 19 patients included deterioration of the neurologic level of lesion, spasticity, knee and hip flexion contractures, low-back pain, lack of motivation, as well as those of major medical events like stroke, recurrent septicemia, lower limb edema, and invasive surgical interventions.
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PMID:Ambulation in patients with myelomeningocele: a 12-year follow-up. 1008 89


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