Spinal Cord Disease
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Intramedullary: Inflammatory.Infectious.Metabolic/toxic.Vascular.Genetic/hereditary.Structural.Neoplastic.Heredodegenerative.
Pediatric Spinal Tumors
David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack in Brain and Spinal Tumors of Childhood, 2020
Spinal tumors can be classified based on anatomic location and are grouped into lesions that are extradural, intradural extramedullary, and intramedullary (Table 20.1). While particular pathologies have a propensity to develop in specific anatomic compartments, they may in some cases span multiple compartments or lie in atypical areas—for example, chordomas with intradural extension and intramedullary metastases, or nerve sheath tumors extending from an intradural to extradural location. Extradural lesions can arise from the osseous spinal column, or the epidural space, which is a common location for metastatic disease. Intradural extramedullary lesions, such as meningiomas and nerve sheath tumors, lie within the thecal sac and outside the spinal cord, but can cause spinal cord compression due to progressive growth. Finally, intramedullary lesions arise from cells within the spinal cord itself, which can lead to progressive neurological decline due to their expansile nature.
Atrophy of the Small Muscles of the Hand
K. Gupta, P. Carmichael, A. Zumla in 100 Short Cases for the MRCP, 2020
There are several causes of wasting of the small muscles of the hand. These are: Rheumatoid arthritis.Peripheral nerve lesions, e.g. median and ulnar nerve lesions.Spinal cord or nerve root lesions. Intramedullary (inside the spinal cord) e.g. motor neurone disease; syringomyelia; tumours.Extramedullary (outside the spinal cord) e.g. cervical spondylosis; cervical rib; tumours; apical lung tumours affecting Ta root.
Lower extremity fractures in patients with spinal cord injury characteristics, outcome and risk factors for non-unions
Published in The Journal of Spinal Cord Medicine, 2018
Lukas Grassner, Barbara Klein, Doris Maier, Volker Bühren, Matthias Vogel
The management of fractures in patients with SCI requires special consideration due to the mentioned sublesional osteoporosis and dysfunction of the spinal cord with all related consequences. The development of intramedullary-nailing systems, however, improved surgical treatment options. This study provides demographic characteristics, distribution patterns, outcome analysis and complication rates of lower extremity fractures in patients with SCI managed in our institution, with a special emphasis on bone healing. In general non-unions are thought to be multifactorial and several risk factors have been identified for this complication in patients without SCI.11 However, in the SCI population, pseudarthrosis probably has been underestimated, since the clinical significance of this complication has been questioned. However, we believe that also in patients with SCI the compromised mechanical stability and increased risk for infections and other complications caused by pseudarthrosis must not be neglected especially ambulatory patients but also in non-walkers. Therefore, non-unions in patients with SCI deserve special attention among physicians.
Technical considerations for the management of segmental osseous defects with an internal bone transport nail
Published in Expert Review of Medical Devices, 2022
Lee M Zuckerman, John A Scolaro, Matthew P Gardner, Thomas Kern, Philipp Lanz, Stephen M. Quinnan, J. Tracy Watson, Jan Duedal Rölfing
The Precice BTN is a novel technology that allows for in-line distraction osteogenesis without external rings, pins, wires or cables. It similarly obliviates the need for supplemental internal plate fixation. The device provides the stability and benefits of an intramedullary implant positioned along the anatomic axis of the limb. In addition, the nail also ensures the transport segment moves directly between its origin and destination. Finally, without external components, the nail allows for bone transport beneath compromised soft tissue envelopes and flaps without any concern for complication. Similar to other techniques utilized for distraction osteogenesis, patient selection and pre-operative planning are critical to the success of this technique.
Retrospective analysis of high-dose chemotherapy followed by autologous stem cell transplantation for high-risk pediatric osteosarcoma
Published in Pediatric Hematology and Oncology, 2020
Suguru Uemura, Takeshi Mori, Shinya Ishiko, Satoru Takafuji, Nanako Nino, Nobuyuki Yamamoto, Akira Hayakawa, Noriyuki Nishimura, Hitomi Hara, Teruya Kawamoto, Toshihiro Akisue, Kazumoto Iijima
All patients were slated to undergo biopsy, sequential therapy with neoadjuvant chemotherapy, surgical resection of the primary tumor, adjuvant chemotherapy, and high-dose chemotherapy followed by ASCT (in that order). Neoadjuvant chemotherapy treatment consisted of methotrexate (MTX), cisplatin (CDDP), and anthracycline agents. the evaluation of responses to chemotherapy using imaging findings was performed after the induction chemotherapy of neoadjuvant chemotherapy. If progressive disease, increase in the diameter of extramedullary and/or intramedullary lesions or appearance of a new lesion. occurred at this point, subsequent chemotherapy was switched to ifosfamide (IFO) ± etoposide (ETP) as a second-line neoadjuvant chemotherapy.
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