Ontario Health Coalition: Ontario-Wide Tour to Visit 15 Communities Warning of Ontario Budget Cutbacks to Health Care

Ontario Health Coalition; News Alert!!


• Ontario-Wide Tour to Visit 15 Communities Warning of Ontario Budget Cutbacks to Health Care 
  Most Ontarians don’t realize that the McGuinty government’s recent “austerity” budget will catapult the health system into another round of cuts and restructuring. With this warning, the Ontario Health Coalition is launching a 15 city tour across Ontario to prepare citizens to stand up and protect local access to health care services. The government’s budget for health care is worse than even the most radical of recommendations. With the harsh new budget, the government is planning another major round of cutbacks and restructuring that will particularly hurt patients who need hospital care, nursing home placements, outpatient clinics and long-term care. We are holding a town hall meeting to discuss the government’s plans and what they might mean for our local communities. We don’t want to see any more hardship as a result of patients unable to access the care they need. With the town hall meeting, we will launching an action plan to protect each region’s health services from further cuts.
  
  
  Please click below for our full media release and *updated* details of the tour

http://www.web.net/ohc/may72012mediarelease.pdf

Sacral Meningeal Cysts Should NOT be Dismissed as an Incidental Finding

Why are Radiologists still saying Tarlov cysts are Incidental Findings on a MRI?

I would like to thank Irish Healthcare, Sharon Gillece for sharing the following research study.

General Spine

Peter _ Yoo, MD, Non ASSR Member
Shane Lee, BA, Non ASSR Member
Nikhil Bhagat, MD, Non ASSR Member
Huey-Jen Lee, MD, Non ASSR Member

Scientific Paper

Purpose

(1) To determine the incidence of extradural meningeal cysts in adult patients who underwent routine magnetic resonance imaging (MRI) of the lumbar spine for lower back pain. (2) To describe the current classification of sacral meningeal cysts and its postulated pathophysiology. (3) Literature review of the clinical significance and management of sacral extradural meningeal cysts.

Methods & Materials

A total of 584 MRI studies of the lumber spine were retrospectively reviewed. The studies were performed for the evaluation of lower back pain and were performed between May 2005 and November 2005. Pediatric and trauma cases were excluded. Ages ranged from 18 years to 80 years. Routine MRI of the lumbar spine was performed on a 1.5 Tesla GE scanner. The study consists of sagittal T1, fast spin echo (FSE) and short TI inversion recovery (STIR) sequences of the lumbar and sacral spine. Axial proton and T2 weighted images of the disc spaces between L1 and S1 are also obtained. Post gadolinium axial and sagittal T1 weighted images are only obtained in post-spinal surgery patients.

Results

A total of 7 sacral extradural meningeal cysts were identified (1.2 %). 4 of the patients were male and 3 were female with a mean age of 49 years (range 32 years to 70 years). 5 were determined to be type I and 2 were indeterminate. All of the cysts occurred in the sacral spine. 4 cases also demonstrated coexistent disc disease of the lumbar spine and 1 case demonstrated a compression fracture of L5. 2 cases demonstrated no concurrent disc disease. Of these two patients, one patient presented with sacral and lower extremity pain with paresthesia while the other patient complained of nonspecific lower back pain.

Conclusion

The prevalence of sacral extradural meningeal cysts in our study is 1.2%. Sacral meningeal cysts have been classified into three categories: extradural cysts not containing nerve root fibers (Type I), extradural cysts containing nerve root fibers (Type II) and intradural cysts (Type III). The exact mechanism of formation of sacral extradural meningeal cysts is unknown. It has been postulated that the arachnoid membrane herniates through a dural defect, which is most likely congenital. Sacral extradural meningeal cysts are generally considered to be incidental findings. However, there are several published case reports that have attributed symptoms to these lesions and these patients have undergone surgical intervention. In our study, 2 out of the 7 cases demonstrated no coexistent disc disease. Therefore, the clinical symptoms may be related to the sacral cysts. In light of these reports and our findings, sacral extradural meningeal cysts should not be easily dismissed as an incidental finding.

References

1. Acosta FL Jr, Quinones-Hinojosa A, Schmidt MH, Weinstein PR.: Diagnosis and management of sacral Tarlov cysts. Case report and review of the literature.
Neurosurg Focus. 2003 Aug 15;15(2):E15.
2. Nabors MW, Pait TG, Byrd EB, Karim NO, Davis DO, Kobrine AI, Rizzoli HV.: Updated assessment and current classification of spinal meningeal cysts. J Neurosurg. 1988 Mar;68(3):366-77.
3. Sato K, Nagata K, Sugita Y.: Spinal extradural meningeal cyst: correct radiological and histopathological diagnosis. Neurosurg Focus. 2002 Oct 15;13(4):ecp1.
4. Rohrer DC, Burchiel KJ, Gruber DP.: Intraspinal extradural meningeal cyst demonstrating ball-valve mechanism of formation. J Neurosurg 78; 1993: 122-125.
5. Robinson Y, Reinke M, Haschtmann D, Ertel W, Heyde CE.:.Spinal extradural meningeal cyst with spinal stenosis. Spinal Cord. 2005 Nov 22; [Epub ahead of print]
6. Muthukumar N.: Sacral extradural arachnoid cyst: a rare cause of low back and perineal pain. Eur Spine J. 2002 Apr;11(2):162-6. Epub 2001 Jun 23. Review.
7. Uemura K, Yoshizawa T, Matsumura A, Asakawa H, Nakamagoe K, Nose T.: Spinal extradural meningeal cyst. Case report. J Neurosurg. 1996 Aug;85(2):354-6.
8. Langdown AJ, Grundy JR, Birch NC.: The clinical relevance of Tarlov cysts.
J Spinal Disord Tech. 2005 Feb;18(1):29-33.
9. Kendall BE, Valentine AR, Keis B.: Spinal arachnoid cysts: clinical and radiological correlation with prognosis. Neuroradiology. 1982;22(5):225-34.
10. Boukobza M, Sichez JP, Rolland E, Cornu P.: MRI evaluation of sacral cysts.
J Neuroradiol. 1993 Dec;20(4):266-71
11. Bartels RH, van Overbeeke JJ.: Lumbar cerebrospinal fluid drainage for symptomatic sacral nerve root cysts: an adjuvant diagnostic procedure and/or alternative treatment? Technical case report. Neurosurgery.1997 Apr;40(4):861-4

Images