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Wang Q, Wen M, Hou G, Zhao S, Yao Z, Tu Z, Huang P, Ye B, Xie F, Luo Z, Hu X. Chronic cauda equina syndrome decompression surgery recovery is very "bad"? Based on patient self-assessment. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:932-940. [PMID: 37947889 DOI: 10.1007/s00586-023-07984-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Symptoms of cauda equina syndrome (CES) secondary to degenerative lumbar spine diseases are sometimes mild and tend to be ignored by patients, resulting in delayed treatment. In addition, the long-term efficacy of surgery is unclear. OBJECTIVE To determine the predictive factors of CES and post-operative recovery in patients with symptoms lasting > 3 months. METHODS From January 2011 to December 2020, data of 45 patients with CES secondary to lumbar disk herniation/lumbar spinal stenosis were collected from a single center. The patients had bladder, bowel or sexual dysfunction and decreased perineal sensation that lasted for > 3 months. A 2-year post-operative follow-up was conducted to evaluate recovery outcomes, which were measured by validated self-assessment questionnaires conducted by telephone and online. RESULTS Overall, 45 CES patients (57.8% female; mean age, 56 years) were included. The duration of pre-operative CES symptoms was 79.6 weeks (range, 13-730 weeks). The incidence of saddle anesthesia before decompression was 71.1% (n = 32), bladder dysfunction 84.4% (n = 38), bowel dysfunction 62.2% (n = 28) and sexual dysfunction 64.4% (n = 29). The overall recovery rate of CES after a 2-year follow-up was 64.4%. The rates of the residual symptoms at the last follow-up were as follows: saddle anesthesia 22.2%, bladder dysfunction 33.3%, bowel dysfunction 24.4% and sexual dysfunction 48.9%. Pre-operative saddle anesthesia, overactive bladder and sexual dysfunction were risk factors for poor prognosis after decompression. CONCLUSION CES patients with symptoms lasting > 3 months may recover after surgery. Sexual dysfunction has a high residual rate and should not be ignored during diagnosis and treatment.
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Affiliation(s)
- Qiushi Wang
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Mengyuan Wen
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Shixian Zhao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhou Yao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhipeng Tu
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Peipei Huang
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Bin Ye
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Fang Xie
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhuojing Luo
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China.
| | - Xueyu Hu
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China.
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Kim SG, Jung JY. Role of MR Neurography for Evaluation of the Lumbosacral Plexus: A Scoping Review. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1273-1285. [PMID: 36545407 PMCID: PMC9748467 DOI: 10.3348/jksr.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/06/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022]
Abstract
Purpose MR neurography (MRN) is an imaging technique optimized to visualize the peripheral nerves. This review aimed to discover an optimized protocol for MRN of the lumbosacral plexus (LSP) and identify evidence for the clinical benefit of lumbosacral plexopathies. Materials and Methods We performed a systematic search of the two medical databases until September 2021. 'Magnetic resonance imaging', 'lumbosacral plexus', 'neurologic disease', or equivalent terms were used to search the literature. We extracted information on indications, MRN protocols for LSP, and clinical efficacy from 55 studies among those searched. Results MRN of the LSP is useful for displaying the distribution of peripheral nerve disease, guiding perineural injections, and assessing extraspinal causes of sciatica. Three-dimensional short-tau inversion recovery turbo spin-echo combined with vascular suppression is the mainstay of MRN. Conclusion Future work on the MRN of LSP should be directed to technical maturation and clinical validation of efficacy.
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Palackdkharry CS, Wottrich S, Dienes E, Bydon M, Steinmetz MP, Traynelis VC. The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis). PLoS One 2022; 17:e0274634. [PMID: 36178925 PMCID: PMC9524710 DOI: 10.1371/journal.pone.0274634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
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 published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. RESULTS Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. DISCUSSION & CONCLUSION DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.
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Affiliation(s)
| | - Stephanie Wottrich
- Case Western Reserve School of Medicine, Cleveland, Ohio, United States of America
| | - Erin Dienes
- Arcsology®, Mead, Colorado, United States of America
| | - Mohamad Bydon
- Department of Neurologic Surgery, Orthopedic Surgery, and Health Services Research, Mayo Clinic School of Medicine, Rochester, Minnesota, United States of America
| | - Michael P. Steinmetz
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine Neurologic Institute, Cleveland, Ohio, United States of America
| | - Vincent C. Traynelis
- Department of Neurosurgery, Rush University School of Medicine, Chicago, Illinois, United States of America
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Boulter DJ, Job J, Shah LM, Wessell DE, Lenchik L, Parsons MS, Agarwal V, Appel M, Burns J, Hutchins TA, Kendi AT, Khan MA, Liebeskind DS, Moritani T, Ortiz AO, Shah VN, Singh S, Than KD, Timpone VM, Beaman FD, Corey AS. ACR Appropriateness Criteria® Plexopathy: 2021 Update. J Am Coll Radiol 2021; 18:S423-S441. [PMID: 34794598 DOI: 10.1016/j.jacr.2021.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 10/19/2022]
Abstract
Plexopathy may be caused by diverse pathologies, including trauma, nerve entrapment, neoplasm, inflammation, infection, autoimmune disease, hereditary disease, and idiopathic etiologies. For patients presenting with brachial or lumbosacral plexopathy, dedicated plexus MRI is the most appropriate initial imaging modality for all clinical scenarios and can identify processes both intrinsic and extrinsic to the nerves. Other imaging tests may be appropriate for initial imaging depending on the clinical scenario. This document addresses initial imaging strategies for brachial and lumbosacral plexopathy in the following clinical situations: nontraumatic plexopathy with no known malignancy, traumatic plexopathy (not perinatal), and plexopathy occurring in the context of a known malignancy or posttreatment syndrome. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Daniel J Boulter
- Clinical Director of MRI, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Joici Job
- Research Author, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Vikas Agarwal
- Vice Chair of Education, Chief, Neuroradiology, and Director, Spine Intervention, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | - Judah Burns
- Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - Troy A Hutchins
- Chief Value Officer for Radiology, University of Utah Health, Salt Lake City, Utah
| | | | - Majid A Khan
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California; President, SVIN; and American Academy of Neurology
| | | | - A Orlando Ortiz
- Chairman, Department of Radiology, Jacobi Medical Center, Bronx, New York
| | - Vinil N Shah
- University of California San Francisco, San Francisco, California; and Executive Committee, American Society of Spine Radiology
| | - Simranjit Singh
- Indiana University School of Medicine, Indianapolis, Indiana; Secretary, SHM, Indiana Chapter; Secretary, SGIM, Midwest Region; and American College of Physicians
| | - Khoi D Than
- Duke University, Durham, North Carolina; Neurosurgery expert
| | - Vincent M Timpone
- Co-Director, Neuroradiology Spine Intervention Service, Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | | | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Klepinowski T, Orbik W, Sagan L. Global incidence of spinal perineural Tarlov's cysts and their morphological characteristics: a meta-analysis of 13,266 subjects. Surg Radiol Anat 2021; 43:855-863. [PMID: 33452905 PMCID: PMC8164596 DOI: 10.1007/s00276-020-02644-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Spinal perineural Tarlov's cysts (TCs) are considered incidental findings that occasionally might exert pressure upon nerve roots and correspond with patients' signs and symptoms. Purpose of this meta-analysis is to deliver global incidence and characteristics (location, size, and shape) of TCs. METHODS Following PRISMA checklist, all major databases were searched by two authors for radiologic studies reporting incidence and morphologic features (location, size, and shape) of TCs. Anatomical Quality Assessment tool was applied for risk of bias evaluation. Meta-analysis of random-effects model was employed. Subgroup analysis for regional distribution, gender, sacral levels, age, correspondence with symptoms, and persistent genital arousal disorder (PGAD) were planned ahead. RESULTS 22 radiologic studies of level 3 evidence involving 13,266 subjects were included. Global pooled prevalence of TCs was 4.18% (95% CI 2.47-6.30). Mean pooled sagittal diameter was 11.86 mm (95% CI 10.78-12.93). Sacral cysts strongly prevailed over the other segments. Of the sacral, S2 level was the most common (46.7% [95% CI 29.4-60.5]). Geographically, the highest incidence was found in Europe (6.07% [95% CI 1.49-13.00]), followed by North America (3.82% [95% CI 0.49-9.44]), and Asia (3.33% [95% CI 1.52-5.75]). TCs were more common in women than in men (5.84% vs 3.03%, p < 0.001, test of homogeneity, χ2). Subjects with PGAD had incidence of 37.87% (95% CI 2.45-81.75). TCs in pediatric population are rare-0.53% (95% CI 0.02-1.51). 15.59% of TCs corresponded with symptoms. CONCLUSIONS Spinal perineural (Tarlov) cysts are found in a minority of population. S2 level of the sacral bone is affected most frequently. There is female predominance. Correspondence with symptoms is seen in less than one-fifth of TCs. Studies with stronger evidence level are needed to corroborate the results. The purported high incidence in PGAD requires confirmation in case-control studies for the risk-ratio calculation.
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Affiliation(s)
- Tomasz Klepinowski
- Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland.
| | - Wojciech Orbik
- Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland
| | - Leszek Sagan
- Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland
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Yan K, Xi Y, Hlis R, Chhabra A. Piriformis syndrome: pain response outcomes following CT-guided injection and incremental value of botulinum toxin injection. Diagn Interv Radiol 2021; 27:126-133. [PMID: 33252337 PMCID: PMC7837716 DOI: 10.5152/dir.2020.19444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE Piriformis syndrome is a common pain condition affecting the buttock and posterior hip with or without radiation to the leg, and management of the condition involves many treatments. In this study, we hypothesize that a CT-guided injection with botulinum toxin is more effective in providing pain relief than a CT-guided injection without Botox. METHODS Overall, 97 consecutive patients with piriformis syndrome presented for a CT-guided injection of the piriformis muscle and perineural injection of the sciatic nerve. After the injection, the patients received a visual analog scale pain log to record their pain level until the follow-up appointment. P values of less than 0.2 were considered as confounder and adjusted by inverse probability of treatment weighting (IPTW) via propensity score. The effect of botulinum toxin on 48-hour response and duration of response was tested using weighted chi-square test and weighted Kaplan-Meier analysis. RESULTS There was a total of 97 patients in the study, and 111 injections, as some patients had bilateral injections. Patients in the Botox group had more 48-hour response than patients in the non-botulinum toxin group (P < 0.001 with IPTW, P = 0.005 without IPTW). Median pain-free survival was 30 days for Botox group and 1 day for non-Botox group (P = 0.059 with IPTW, P = 0.10 without IPTW). CONCLUSION CT-guided injections with botulinum toxin for patients with piriformis syndrome are more likely to lead to a positive response and a longer duration of response than patients who receive a CT-guided injection without botulinum toxin. We hope that this study facilitates future prospective randomized blind trials for patients with suspected piriformis syndrome.
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Affiliation(s)
- Kevin Yan
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Rocco Hlis
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA; Department of Orthopedics, UT Southwestern Medical Center, Dallas, Texas, USA
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Adamian L, Urits I, Orhurhu V, Hoyt D, Driessen R, Freeman JA, Kaye AD, Kaye RJ, Garcia AJ, Cornett EM, Viswanath O. A Comprehensive Review of the Diagnosis, Treatment, and Management of Urologic Chronic Pelvic Pain Syndrome. Curr Pain Headache Rep 2020; 24:27. [PMID: 32378039 DOI: 10.1007/s11916-020-00857-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Urologic chronic pelvic pain syndrome (UCPPS) is a chronic, noncyclic pain condition which can lead to significant patient morbidity and disability. It is defined by pain in the pelvic region, lasting for greater than 3 to 6 months, with no readily identifiable disease process. The aim of this review is to provide a comprehensive update of diagnosis and treatment of UCPPS. RECENT FINDINGS UCPPS encompasses chronic pelvic pain syndrome or chronic prostatitis (CP/CPPS) in men and interstitial cystitis or painful bladder syndrome (IC/PBS) in women. Underlying inflammatory, immunologic, and neuropathic components have been implicated in the pathogenesis of UCPPS. For optimal patient management, an individualized and multimodal approach is recommended. Medical management and physical therapy are the mainstays of treatment. Injection therapy may offer additional relief in medically refractory patients. Further minimally invasive management may include spinal cord and peripheral nerve stimulation, though evidence supporting efficacy is limited.
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Affiliation(s)
- Leena Adamian
- Creighton University School of Medicine, Omaha, NE, USA
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Vwaire Orhurhu
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Dylan Hoyt
- Creighton University School of Medicine, Omaha, NE, USA
| | | | - John A Freeman
- Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA
| | - Alan D Kaye
- Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA
| | - Rachel J Kaye
- Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA
| | - Andrew J Garcia
- Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.,Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Chhabra A, Bajaj G, Wadhwa V, Quadri RS, White J, Myers LL, Amirlak B, Zuniga JR. MR Neurographic Evaluation of Facial and Neck Pain: Normal and Abnormal Craniospinal Nerves below the Skull Base. Radiographics 2018; 38:1498-1513. [DOI: 10.1148/rg.2018170194] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Dessouky R, Xi Y, Scott KM, Khaleel M, Gill K, Jones S, Khalifa DN, Tantawy HI, Aidaros MA, Chhabra A. Magnetic Resonance Neurography in Chronic Lumbosacral and Pelvic Pain: Diagnostic and Management Impact-Institutional Audit. World Neurosurg 2018; 114:e77-e113. [PMID: 29581014 DOI: 10.1016/j.wneu.2018.02.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE Low back and pelvic pain are among the most prevalent conditions worldwide, with major social and economic costs. The aim of this study was to evaluate the role of magnetic resonance neurography (MRN) of lumbosacral plexus in the management and outcomes of these patients with chronic pain. METHODS Consecutive patients with chronic lumbosacral and pelvic pain referred for MRN over a year were included. Preimaging and postimaging clinical diagnosis and treatment, pain levels, and location were recorded. Pain-free survival was compared between treatments using a Cox proportional hazards model. RESULTS A total of 202 patients with mean age 53.7 ± 14.8 years and a male/female ratio of 1:1.53 were included. Of these patients, 115 presented with radiculopathy (57%), 56 with pelvic pain (28%), and 31 with groin pain (15%). Mean initial pain level was 6.9 ± 1.9. Mean symptom duration was 4.21 ± 5.86 years. Of these patients, 143 (71%) had a change in management because of MRN. After MRN, reduction in pain levels was observed in 21 of 32 patients receiving conservative treatment (66%), 42 of 67 receiving injections (63%), and 27 of 33 receiving surgery (82%). Follow-ups were available in 131 patients. Median pain-free survival was 12 months. Patients treated with surgery had significantly lower pain recurrence than patients receiving other treatments in the same time frame (hazard ratio, 3.6; 95% confidence interval, 1.4-9.2; P = 0.0061). CONCLUSIONS MRN use in chronic lumbosacral and pelvic pain led to a meaningful change in diagnosis and treatment. After MRN, conservative treatment and injections provided pain relief; however, patients benefited more from surgery than from any other treatment.
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Affiliation(s)
- Riham Dessouky
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kelly M Scott
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mohammed Khaleel
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Gill
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephanie Jones
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dalia N Khalifa
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hazim I Tantawy
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Magdy A Aidaros
- Department of Neurology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Persistent Genital Arousal Disorder: Current Conceptualizations and Etiologic Mechanisms. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0122-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Iwamuro H, Yanagawa T, Takamizawa S, Taniguchi M. Atypical findings of perineural cysts on postmyelographic computed tomography: a case report of intermittent intercostal neuralgia caused by thoracic perineural cysts. BMC Med Imaging 2017; 17:37. [PMID: 28610610 PMCID: PMC5470231 DOI: 10.1186/s12880-017-0210-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022] Open
Abstract
Background Perineural cysts are sometimes found incidentally with magnetic resonance imaging, and clinical symptoms requiring treatment are rare. Perineural cysts typically exhibit delayed filling with contrast medium on myelography, which is one of the criteria used by Tarlov to distinguish perineural cysts from meningeal diverticula. We present a case of multiple thoracolumbar perineural cysts, one of which was considered the cause of intermittent intercostal neuralgia with atypical findings on postmyelographic computed tomography seen as selective filling of contrast medium. Case presentation A 61-year-old woman presented with intermittent pain on her left chest wall with distribution of the pain corresponding to the T10 dermatome. Magnetic resonance imaging showed multiple thoracolumbar perineural cysts with the largest located at the left T10 nerve root. On postmyelographic computed tomography immediately after contrast medium injection, the largest cyst and another at left T9 showed selective filling of contrast medium, suggesting that inflow of cerebrospinal fluid to the cyst exceeded outflow. Three hours after the injection, the intensity of the cysts was similar to the intensity of the thecal sac, and by the next day, contrast enhancement was undetectable. The patient was treated with an intercostal nerve block at T10, and the pain subsided. However, after 9 months of observation, the neuralgia recurred, and the nerve block was repeated with good effect. There was no recurrence 22 months after the last nerve block. Conclusions We concluded that intermittent elevation of cerebrospinal fluid pressure in the cyst caused the neuralgia because of an imbalance between cerebrospinal fluid inflow and outflow, and repeated intercostal nerve blocks resolved the neuralgia. Our case demonstrates the mechanism of cyst expansion.
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Affiliation(s)
- Hirokazu Iwamuro
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, 1830042, Japan. .,Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 1138421, Japan.
| | - Taro Yanagawa
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, 1830042, Japan
| | - Sachiko Takamizawa
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, 1830042, Japan
| | - Makoto Taniguchi
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, 1830042, Japan
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