[Neurological complication after a vertical infraclavicular brachial plexus block : Case report of possible differential diagnoses of a neurological deficit.]

Anaesthesist. 2009 Jun 24; Ehrenberg R, Bucher M, Graf BA 72-year-old man with an obliteration of the brachial artery received a vertical infraclavicular block (VIP) for vascular surgery but 20 h after the operation a complete paresis of the affected extremity occurred. A new vascular obliteration could be excluded. During the diagnostic examination the patient noticed a snapping noise in the cervical column when moving his head and an abrupt recovery of the neurological deficits occurred. The radiological diagnostic provided no indication of cerebral ischemia or lesions of the brachial plexus. An additional diagnostic finding was a profound herniated vertebral disc with compression of the myelon. Fortunately, the neurological deficits completely returned to normal.

When is the appropriate time for surgical intervention of the herniated lumbar disc in the adolescent?

J Clin Neurosci. 2009 Jun 20; Fakouri B, Nnadi C, Boszczyk B, Kunsky A, Cacciola FSymptomatic lumbar disc herniation in the adolescent is uncommon. The appropriate treatment in this particular age group is not clear. We conducted a retrospective review of the medical, surgical, and radiological records of six adolescents with symptomatic lumbar disc herniation who underwent microdiscectomy after failed conservative therapy. The mean follow-up was 13months. All patients improved quickly and returned to their normal activity levels. We suggest that severe pain resulting from a herniated lumbar disc, even without any neurological deficit, is an indication for microdiscectomy in adolescents so that these patients return to full-time education and normal activities as soon as possible.

The use of flexion-extension magnetic resonance imaging for evaluating signal intensity changes of the cervical spinal cord.

J Neurosurg Spine. 2009 Apr; 10(4): 366-73Guppy KH, Hawk M, Chakrabarti I, Banerjee AThe authors present 2 cases involving patients who presented with myelopathy. Magnetic resonance imaging of the cervical spine showed spinal cord signal changes on T2-weighted images without any spinal cord compression. Flexion-extension plain radiographs of the spine showed no instability. Dynamic MR imaging of the cervical spine, however, showed spinal cord compression on extension. Compression of the spinal cord was caused by dynamic anulus bulging and ligamentum flavum buckling. This report emphasizes the need for dynamic MR imaging of the cervical spine for evaluating spinal cord changes on neutral position MR imaging before further workup for other causes such as demyelinating disease.

Senescence mechanisms of nucleus pulposus chondrocytes in human intervertebral discs.

Spine J. 2009 Jun 18; Kim KW, Chung HN, Ha KY, Lee JS, Kim YYBACKGROUND CONTEXT: The population of senescent disc cells has been shown to increase in degenerated or herniated discs. However, the mechanism and signaling pathway involved in the senescence of nucleus pulposus (NP) chondrocytes are unknown. PURPOSE: To demonstrate the mechanisms involved in the senescence of NP chondrocytes. STUDY DESIGN/SETTING: Senescence-related markers were assessed in the surgically obtained human NP specimens. PATIENT SAMPLE: NP specimens remaining in the central region of the intervertebral disc were obtained from 25 patients (mean: 49 years, range: 20-75 years) undergoing discectomy. Based on the preoperative magnetic resonance images, there were 3 patients with Grade II degeneration, 17 patients with Grade III degeneration, and 5 patients with Grade IV degeneration. OUTCOME MEASURES: We examined cell senescence markers (senescence-associated beta-galactosidase [SA-beta-gal], telomere length, telomerase activity, p53, p21, pRB, and p16) and the hydrogen peroxide (H(2)O(2)) content as a marker for an oxidative stress in the human NP specimens. METHODS: SA-beta-gal expression, telomere length, telomerase activity, and H(2)O(2) content as well as their relationships with age and degeneration grades were analyzed. For the mechanism involved in the senescence of NP chondrocytes, expressions of p53, p21, pRB, and p16 in these cells were assessed with immunohistochemistry and Western blotting. RESULTS: The percentages of SA-beta-gal-positive NP chondrocytes increased with age (r=.82, p