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Policy Horses Still Running Around Healthcare Courses: A Response to Recent Commentaries.

BACKGROUND: Durotomy during endoscopic spine surgery can cause a patient's neurological or cardiovascular status to deteriorate unexpectedly … urgeons thought that they had patients with neurological deficits ranging from nerve root injury to cauda equina syndrome related to irrigation fluid. Autonomic dysreflexia associated with hypertension was attributed by 19 of the 244 responding surgeons to the noxious stimulus of escaped irrigation fluid that migrated from the decompression site in the spinal canal. Tw …

[Vertebral body replacement with a Synex implant].

AIM: The authors assessed options for vertebral body replacements with the Synex telescopic expansion cage. Autologic or homologic bone graf … ad has been reported. In one subject, the left-sided L4 root injury was recorded postoperatively, a cauda equina syndrome, diagnosed after the injury, persits in one subject. No signs of deep infection have been recorded. There are no records of the Synex release or displacement. Correction loss (kyphotisation) of up to 2 degrees was recorded in patients with transpedi …

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis).

BACKGROUND & IMPORTANCE: This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare "iatrogenic chronic meningitis" causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. METHODS: The prospective PRISMA protocol is pu

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… Reports range from transient paralysis and acute DLM to permanent cauda equina syndrome. A 2021 systematic review of transforaminal injections, not included in our data, discusses but does not quantify resultant LMF [ 939 ]. … Is chronic cauda equina syndrome (CES) from DLMs ± flare considered a surgical emergency? There are still multiple patient and physician resources that state all CES is a surgical emergency. Acute or sub-acute compressive CES is a surgical emergency. …

Challenges in the Diagnosis and Management of the Miller Fisher Variant of Guillain-Barré Syndrome: A Case Report.

Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS), characterized by the triad of ophthalmoplegia, ataxia, and areflexia, often following a bacterial or viral illness. This case report presents a 58-year-old Hispanic female patient with a preceding streptococcal pharyngitis who developed symptoms of bilateral facial nerve palsy and lower limb ataxia. Cerebrospinal fluid (CSF) analysis revealed albuminocytologic dissociation and, combined with her presentation of ophthalmoplegia, ataxia, and areflexia, supported the diagnosis of MFS. Magnetic resonance imaging (MRI)

Current role of radiation therapy for multiple myeloma.

BackgroundRadiation therapy (RT) is a treatment modality traditionally used in patients with multiple myeloma (MM), but little is known regarding the role and effectiveness of RT in the era of novel agents, i.e., immunomodulatory drugs and proteasome inhibitors.MethodsWe retrospectively reviewed data from 449 consecutive MM patients seen at our institute in 2010-2012 to assess indications for RT as well as its effectiveness. Pain response was scored similarly to RTOG 0631 and used the Numerical Rating Pain Scale.ResultsAmong 442 evaluable patients, 149 (34%) patients and 262 sites received RT.

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… Another frequent reason for RT were neurological complications (16%), such as spinal cord compression (10%), or impingement of cranial nerves, spinal neural foramina, or cauda equina syndrome (6%). … In our series, other indications for RT included neurologic complications (such as spinal cord compression, cauda equina syndrome, and involvement of cranial nerves), extramedullary disease, and esthetical reasons, for example painless disfiguring bony prominences in the skull. …

Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series.

BackgroundBecause patients with advanced cancer live longer, the number of patients with the sequelae of metastatic spine disease has increased. Pathologic instability of the mobile spine has been classified, and minimally invasive surgery has been well described. However, pathologic sacral instability is uncommon and often underdiagnosed. Although most sacral fractures are stable, patients with unstable U- or H-type fractures have spinopelvic dissociation and can experience progressive pain, sacral kyphosis, and neurological injury. Open lumbopelvic fusion carries a high perioperative risk fo

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… equina syndrome, intractable neuropathic pain, fracture, mechanical instability, and decreased ambulatory capacity. … This latter patient, who had presented with an acutely kyphotic fracture and cauda equina syndrome ( Fig. 3 ), had ongoing difficulty with an upright stance but did not wish to undergo revision surgery. FIG. 3. …

Diagnostic imaging for spinal disorders in the elderly: a narrative review.

The high prevalence of neck and low back pain in the rapidly aging population is associated with significant increases in health care expenditure. While spinal imaging can be useful to identify less common causes of neck and back pain, overuse and misuse of imaging services has been widely reported. This narrative review aims to provide primary care providers with an overview of available imaging studies with associated potential benefits, adverse effects, and costs for the evaluation of neck and back pain disorders in the elderly population. While the prevalence of arthritis and degenerative

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… Be alert to red flags of cancer, infection, cauda equina syndrome, and presence of severe or progressive neurologic deficits (multiple levels). Immediate imaging and/or referral are indicated if major red flags are present. … Cauda Equina Syndrome: A Literature Review of Its Definition and Clinical Presentation. Arch Phys Med Rehabil. 2009;90:1964–1968. doi: 10.1016/j.apmr.2009.03.021. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK. …

Clinical Presentation and Causes of Non-traumatic Spinal Cord Injury: An Observational Study in Emergency Patients.

Introduction: Diagnosing non-traumatic spinal cord injury (NTSCI) is often challenging. However, clear discrimination from non-spinal pathologies, e.g., "myelopathy-mimics" (MMs), is critical in preventing long-term disability and death. In this retrospective study we (1) investigated causes of NTSCI, (2) identified clinical markers associated with NTSCI and (3) discuss implications for NTSCI management. Methods: Our sample consisted of 5.913 consecutive neurological and neurosurgical patients who were treated in our emergency department during a one-year period. Patients with a new or worsene

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… Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review. Spinal Cord. (2017) 55:886–90. 10.1038/sc.2017.54 24. Compston A. Aids to the investigation of peripheral nerve injuries. Medical research council: nerve injuries research committee. …

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy against foot processes of aquaporin-4 (AQP4) water channels. … ong-standing bony pathology (ankylosis) related to compressive myelopathy, myelo-radiculopathy, and cauda equina syndromes.12,13 The authors present a case of a young Indian man with an undiagnosed progressive AS (misdiagnosed and mismanaged by an indigenous medical practitioner) presenting with acute-onset LETM variant of AQP4-positive NMOSD. A 35-year-old healthy, no …

Adverse events among older adults receiving chiropractic spinal manipulation and related treatments: an updated systematic review.

BACKGROUND: This systematic review updated adverse events (AEs) reporting in persons aged > 55 years who received chiropractic treatment, including spinal manipulation. METHODS: Protocol was registered prospectively with the Prospective Register of Systematic Reviews (PROSPERO)(CRD42024629286). Search strategy was audited with Peer Review of Electronic Search Strategies (PRESS) methodology. We searched PubMed, Cochrane Central Register of Controlled Trials, CINAHL, AMED, and Index to Chiropractic Literature on December 12, 2025. We included AEs attributed to treatment provided by chiropractors

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… Equina Syndrome, n = 0; Fracture in SMT region, n = 0; surgical hardware failure, n = 0 There were no incidents of any of the patients receiving SMT experiencing vertebrobasilar/ cervical artery injury, cauda equina syndrome, fracture, or surgical hardware failure within 10 days following SMT Pohlman … Equina Syndrome, n = 0; Fracture in SMT region, n = 0; surgical hardware failure, n = 0 | There were no incidents of any of the patients receiving SMT experiencing vertebrobasilar/ cervical artery injury, cauda equina syndrome, fracture, or surgical hardware failure within 10 days following SMT Pohlman …

Sciatica как нетипичное первоначальное представление множественной миеломы: отчет о деле.

ВЕРТЕБРАЛЬНОЕ участие в множественной миеломе является частой причиной заболеваемости и связано с сильной болью, деформацией позвоночника и неврологическим компромиссом. Несмотря на то, что боль в спине является широко распространенной особенностью, сицика в качестве первоначального проявления множественной миеломы является крайне редким явлением, особенно у пациентов, не имеющих истории травм или остеопоротических факторов риска. Признание таких нетипичных презентаций имеет решающее значение для своевременной диагностики и управления. ОПИСАНИЕ СЛУЧАИ: Мужчина среднего возраста без какой-либо

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… Southerst et al. described a case of MM initially misdiagnosed as sacroiliac joint pain ( 7 ), while Pisklakova et al. and Chakraborti et al. reported cauda equina syndrome and spinal cord compression as presenting features of MM ( 8 , 9 ). … Cauda Equina Syndrome as the Initial Presentation of Concurrent Plasmacytoma and Multiple Myeloma. Cureus 2021;13:e12888. 10.7759/cureus.12888 9. Chakraborti C, Miller KL. Multiple myeloma presenting as spinal cord compression: a case report. J Med Case Rep 2010;4:251. 10.1186/1752-1947-4-251 10. …

Better pain control with 8-gray single fraction palliative radiotherapy for skeletal metastases: a Bayesian network meta-analysis.

External Beam Radiotherapy (EBRT) allows remarkable pain control in patients with skeletal metastases. We performed a Bayesian network meta-analysis comparing the most commonly used radiotherapy regimens for palliative management in patients with skeletal metastases. The main online databases were accessed in October 2020. All randomized clinical trials evaluating the irradiation of painful bone metastases were considered. The following irradiation patterns were analysed and included in the present network meta-analysis: 8 Gy- and 10 Gy/single fraction, 20 Gy/5 fractions, 30 Gy/10 fractions. T

The Use of Imaging in Management of Patients with Low Back Pain.

Lower back pain (LBP) is one of the most common chief complaints encountered in primary care. Advanced imaging studies, including computerized tomography (CT) and magnetic resonance imaging (MRI), are frequently ordered in the setting of LBP. Structural abnormalities are commonly identified by CT and MRI in patients complaining of low back pain, however, these findings are also found in asymptomatic patients. In the past decade, multiple guidelines have been published to help providers identify patients in whom the use of advanced imaging is appropriate. In this article, we review common condi

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… Lumbar spinal stenosis N Engl J Med 2008 358 818 25 18287604 10.1056/NEJMcp0708097 30 Fairbank J Hashimoto R Dailey A Patel AA Dettori JR Does patient history and physical examination predict MRI proven cauda equina syndrome? … Evid Based Spine Care J 2011 2 27 33 23230403 10.1055/s-0031-1274754 PMC3506147 31 Bell D Collie D Statham PF Cauda equina syndrome: What is the correlation between clinical assessment and MRI scanning? …

Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network.

BACKGROUND: Drop foot resulting from degenerative lumbar diseases can impair activities of daily living. Therefore, predictors of recovery o … injury (duration), preoperative tibialis anterior muscle strength (pretibialis anterior), leg pain, cauda equina syndrome, and number of involved levels. Manual muscle testing was used to assess the tibialis anterior muscle strength. Drop foot was defined as a tibialis anterior muscle strength score of less than 3 of 5 (5 = movement against gravity and full resistance, …

Whole brain radiotherapy combined with intrathecal liposomal cytarabine for leptomeningeal metastasis-a safety analysis and validation of the EANO-ESMO classification.

BackgroundAlthough there is no proven standard therapy for leptomeningeal metastases (LM), treatment often includes intrathecal chemotherapy combined with whole brain radiation therapy (WBRT). Little is known about the toxicity of such combination therapies. We performed a retrospective safety analysis for the combination of intrathecal liposomal cytarabine with WBRT in patients with LM and validated the EANO-ESMO (European Association of Neuro-oncology-European Society for Medical Oncology) classification in this unique cohort.MethodsTreatment toxicities in patients diagnosed with LM between

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… The most common toxicities included chemical meningitis (17.5% in ventricular administration versus 15% lumbar), conus medullaris/cauda equina syndrome (5%), decreased visual acuity (5% versus 2.5%), encephalopathy (5%), leukoencephalopathy (7.5% versus 2.5%), myelopathy (2.5%), radiculopathy (1.3% versus …

Spinal Cord Compression As the Initial Manifestation of Relapsed Acute Myeloid Leukemia: A Case Report and Literature Review of a Rare Presentation.

Myeloid sarcoma (MS) is a solid mass of myeloid blasts outside the bone marrow (BM). Most cases occur in the setting of intramedullary acute myeloid leukemia (AML), but it can also present in the absence of overt BM disease, as a presentation of newly diagnosed or relapsed AML, or as a progression of myeloproliferative neoplasms or myelodysplastic syndromes. There are a few reports of spinal cord compression due to MS, and there is no consensus regarding its management. Here, we present a case of relapsed AML in the form of MS resulting in spinal cord compression and provide a comprehensive li

CNS Вовлечение нескольких серий дел Myeloma-A и наррутический литературный обзор.

Фон: участие центральной нервной системы (ЦНС) в множественной миеломе (ММ) представляет собой экстрамуллярное проявление заболевания, которое часто является весьма сложным для врачей, поскольку неврологические симптомы могут легко перекликаться с симптомами, связанными с гиперкалкемией, уремией, высокой вязкостью крови или связанной с лечением нейропатией. Цели: Это ретроспективное исследование было проведено в Клиническом институте Фундэни в Бухаресте с целью выявления и систематического анализа ряда клинических случаев, диагностированных внематочным заболеванием. Методы: В период с 2019 по

Secondary Hyperparathyroidism Presenting as a Brown Tumor: A Case Report and Review of the Literature.

Severe secondary hyperparathyroidism in advanced stages of chronic kidney disease (CKD) is associated with CKD-related mineral and bone disease (CKD-MBD). A 70-year-old woman was admitted at the Hospital for generalized bone pain and peripheral edema. Initial laboratory tests revealed normocytic anemia and severe renal dysfunction, and further tests evidenced severe secondary hyperparathyroidism. Full-body computerized tomography showed an osteolytic lesion in the right iliac wing. The iliac bone lesion was biopsied and histological examination was consistent with the diagnosis of a brown tumo

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… NS – not specified; Reference | Age | Sex | Location | Renal primary disease | PTH [mmol/L] | Calcium | Phosphate | Alkaline phosphatase | Symptoms | Treatment Tarrass et al., 2006 [ 18 ] | 42 | M | Lumbosacral region | Chronic glomerulonephritis | 154.4 | Normal | Normal | High | Cauda equina syndrome …

Comprehensive Insights into Metastasis-Associated Spinal Cord Compression: Pathophysiology, Diagnosis, Treatment, and Prognosis: A State-of-the-Art Systematic Review

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Giant Cell Tumor of the Sacrum: A Narrative Review of Management Challenges and Modalities.

Background/Objectives: Sacral giant cell tumor of bone (GCTB) is a rare, mostly benign but locally aggressive neoplasm that carries significant diagnostic and treatment challenges due to its anatomic complexity, proximity to sacral nerve roots as well as the blood vessels, and potential impact on bowel, bladder, sexual, and lumbopelvic function and stability. This narrative review aimed to synthesize current evidence on the epidemiology, clinical presentation, diagnostic evaluation, classification, management strategies, outcomes, and surveillance of sacral GCTB. Methods: A focused literature

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… Reported neurological symptom rates were 70% (7/10) in one series and 56% (5/9) in another, with manifestations including sensory disturbance, weakness, bowel and bladder dysfunction, and sexual symptoms; cauda equina syndrome was uncommon but documented [ 2 , 8 ]. … Sacral Giant Cell Tumor-Induced Cauda Equina Syndrome: Case Report with Successful Management. J. Neurosci. Rural. Pract. 2021;12:398–401. doi: 10.1055/s-0040-1718856. 10. Zoccali C., Skoch J., Patel A.S., Walter C.M., Maykowski P., Baaj A.A. …