China 
Africa 
Explore chapters and articles related to this topic
Central nervous system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Urgent referral for lumbar spine MRI is indicated for osteomyelitis, spondylo-discitis or cauda equina syndrome, which is the acute onset of low back pain with serious features such as sphincter and gait disturbance or saddle anaesthesia. The role of MRI in non-specific low back pain is controversial since there is no evidence of improved patient outcome and the high incidence of abnormal findings in individuals without low back pain [110]. NICE guidelines state that referral for MRI in this patient group should be limited to patients referred for surgical intervention (111). MRI is performed for suspected spinal metastasis, lumbar radiculopathy and for recurrence of symptoms post-operatively. MRI in osteoporotic collapse is described under MRI of the thoracic spine (opposite).
Spine
Published in David A Lisle, Imaging for Students, 2012
Sciatica refers to pain confined to a nerve root distribution, with leg pain being more severe than back pain. Sciatica may be accompanied by other neurological symptoms such as paraesthesia, and by signs of nerve root irritation such as positive straight leg raise test. Sciatica or leg pain syndromes are classified based on whether the pain is acute or chronic, unilateral or bilateral:Unilateral acute nerve root compression: ‘classical’ sciaticaUsually caused by focal disc herniationBilateral acute nerve root compression: cauda equina syndromeCauda equina syndrome refers to the sudden onset of bilateral leg pain accompanied by bladder and/or bowel dysfunctionUsually caused by a massive disc herniation or sequestrationUnilateral chronic nerve root compression: sciatica lasting for monthsUnilateral chronic sciatica may be caused by disc herniation or spinal stenosisBilateral chronic nerve root compressionBilateral chronic nerve root compression refers to vague bilateral leg pain aggravated by walking and slowly relieved by restUsually caused by spinal canal stenosisA common clinical difficulty is differentiating neural compression from vascular claudication– Clinical pointers that indicate a vascular cause include absent peripheral pulses, pain is in the exercised muscles, and rapid pain relief with rest.
A contemporary systematic review of the complications associated with SURGICEL
Published in Expert Review of Medical Devices, 2023
Matthew Masoudi, Jacob Wiseman, Sam M. Wiseman
In the product insert information provided with SURGICEL, the manufacturer states that ‘it must always be removed from the site of its application when used in, around, or in the proximity to foramina in bone, areas of bony confinement, the spinal cord, and/or the optic nerve and chiasm regardless of the type of surgical procedure because SURGICEL hemostat, by swelling, may exert pressure resulting in paralysis and/or nerve damage’ [69]. However, a common practice among neurosurgeons and others is to leave the material in situ, as removing it may reinitiate bleeding [70]. Bessette and Mesfin reported a case of a patient who underwent a lumbar microdiscectomy, with preexisting motor deficits, and the postoperative course was complicated by an acute decline in neurological function [10]. The findings at the time of reoperation confirmed compression in the spinal canal due to SURGICEL, and symptoms partially improved after reoperation. The first report of a ‘Surgiceloma’ manifesting as cauda equina syndrome was in 1998 by Banerjee and Goldschmidt. Their patient was a 28-year-old man who needed urgent decompression because of development of cauda equina syndrome 36 hours after an operation performed for treatment of disk degeneration and spinal stenosis. At re-exploration, swollen blood-soaked SURGICEL was found to be the only cause of compression [9]. Additionally, the product insert information from the manufacturer describes unconfirmed reports of migration of SURGICEL into the spinal canal after laminectomy or decompressive thoracotomy [21]. An example of this rare but devastating complication was reported by Henry and colleagues where they described the case of paraplegia in a child after the resection of a mediastinal neuroblastoma. In this case, the paraplegia was caused by spinal cord compression after migration of oxidized cellulose into the spinal canal [21]. Therefore, although SURGICEL is advertised as being absorbable and safe for internal use, groups studying this product often advise surgeons to minimize the amount of SURGICEL used, and once bleeding is controlled to remove the hemostat whenever possible. The manufacturer instructions that accompany the product do not specify a recommended threshold for the volume of SURGICEL that can be safely left inside a patient [69].