Clinical Neuroscience

[Hungarian Society of Neuroradiology]

VÁRALLYAY György

JANUARY 20, 1993

Clinical Neuroscience - 1993;46(01-02)

[The Hungarian Neurological Society held its III Congress in Győr on 15-16 October 1992. Report of the General Assembly of the Neurological Society. Bulletin of the Hungarian Society of Neuroradiology.]

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Clinical Neuroscience

[Acute neurosurgical management of severe thoraco-lumbar spinal injuries]

ZSOLCZAI Sándor, PENTELÉNYI Tamás, TÚRÓCZY László, VERES Róbert

[Authors show their experiences with up-to-date segmental stabilization methods in the acute neurosurgical management of severe thoraco-lumbar spinal injuries. Among the 134 acute operations during 5 years with at least 1 year follow-up 81 were performed by Fixateur Interne (AO-ASIF, W. Dick), and 53 by angle-stable posterior plate-fixation (Steffee or Eger plates). Reduction, decompression and stabilization were achieved by these instrumentations. Results are evaluated from the points of view of neurological recovery, bony union, restoration of patients comfort and complications. Also the principles of modern management of spine-injured patients, developed through a long evolution in the last decade, are reviewed. It is stated that both segmental stabilization methods were used as routine, and they were suitable for the treatment of the most of severe thoraco-lumbar spinal injuries. Results of these methods are much better than those of the long-rod systems, but on condition that emergency neurosurgical treatment should be done in the first 6-8 hours together with early skilled and competent rehabilitation in a well trained center.]

Clinical Neuroscience

[Relation of acute and long-therm care of the spinal-cord-injured patients in up-to-date management]

KLAUBER András, ZSOLCZAI Sándor, PENTELÉNYI Tamás, MOLNÁR Ferenc

[The acute emergency management of the spinal-cord-injured patients is one of the most important steps in the long-lasting complex treatment which has great significance for the final results. The method of primary neurosurgical operation must be chosen with regard to the special aspects of subsequent rehabilitation. All conditions of emergency surgery have to be assured during the first 6-8 hours. According to the experiences of the last two decades the problems of the management of spinal-cord-injured patients originated in the shortage of financial sources, theoretical concepts and organization, lack of interest and scientific information. Even now there is no spinal-cord-injured center in Hungary which would provide for the complex management including primary neurosurgical treatment and all details up till the end of paraplegic rehabilitation. Primary treatment (either operative or conservative) and rehabilitation are performed in separate departments. Though there is a significant development in emergency spinal surgery during the last years (and it is a pity this can not be seen in rehabilitation in Hungary), it is still an important demand that emergency surgery should be performed with rehabilitation aspects. Until we have no proper financial conditions to organize spinal centers for both emergency and rehabilitation treatment, our most important task is to develop a unified rehabilitational view of all specialists involved in the complex treatment of spine-injured patients.]

Clinical Neuroscience

[Tethered cord syndrome in adults]

VÁRADY Péter, BENOIST György, PÁSZTOR Emil

[The tethered cord syndrome is resulted from the abnormally low position and traction of the conus medullaris in the lumbosacral region, that leads to progressive dysfunction of the caudal spinal segments. It originates from various ectodermal abnormalities, all due to errors of embryonic development in the 3rd-4th weeks. The disorder is manifested by progressive motor, sensory and trophic deficits in the legs and by incontinence. The adult onset is rare. The MRI is the most important procedure for pathoanatomic evaluation. The surgical aim is to stop progressivity and to cure the reversible deficits. We report our six cases and present the data of the literature concluding the caracteristics, the surgical indications and outcome of the tethered cord syndrome in adults.]

Clinical Neuroscience

[Operative treatment of craniocervical instabilities caused by rheumatoid arthritis]

TURÓCZY László, KENÉZ József, VERES Róbert, NAGY Aladár, PÁSZTOR Emil

[We have investigated and operatively treated 30 patients with craniocervical instabilities caused by rheumatoid arthritis. The evaluation of this patient-material seems to be important, because the indications of operations in the different stages of the disease are not completely clear, according to our knowledge. The atlanto-axial instabilities at the beginning stage, when the serious neurologic signs are absent, can be treated with low risk dorsal stabilization, while we believe the advanced instabilities need combined neurosurgical approach for successful treatment. We must emphasize the importance of detailed early diagnostics, and the prevention in neurosurgical approaches, in accordance of the opinions, expressed in different contributions in the literature, dealing with the subject. In 20 cases we had to perform combined surgical interventions, and only in 10 cases, the simple dorsal fixation proved to be satisfactory, which fact shows, that we got patients mainly in more serious stages. We detected a new sign ("ghost tumor") in the natural course of the disease.]

Clinical Neuroscience

[Our experiences in the conservative treatment of the compression fractures of the thoracolumbar spine]

URBÁN Ferenc, TAKÁCS Ferenc

[The authors at the DOTE Department of Traumatology made follow-up examinations of 136 patients treated for compression fractures of the thoracolumbar spine. 63 patients (46,3%) were treated with plaster corset, 73 patients (53,7%) with modified Magnus method. They compared the two methods of treatment for their possibilities and effectiveness. They used plaster corset after reposition in females under 55 years of age and in males under 60 years of age, if the patients' physical and general condition were suitable and the compression was more than 10 degrees. 47,9% of the patients treated functionally recovered well and 31,5% were in a satisfactory state. And 47,6% of the patients treated with plaster corset recovered well and 46,0% recovered satisfactorily. While in the first group i.e.those treated functionally, 17,8% of the patients had severe pain, only 6,4% of the patients treated with corset had similar pain. The authors ascertain that as the anatomical reposition of the fractures is not possible indefinitely, the insertion of the plaster corset when the compression exceeds 10–15 degrees is more suitable. When the deformity decreases, the subjective complaints of the patients decrease too. In the case of small compression, functional treatment is recommended and the patient must lie in bed to alleviate the pain. Both the methods used under appropriate conditions are useful and complement each other. ]

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