Ependymomas are uncommon tumors that arise in the brain, spinal cord or cauda equina. Myxopapillary ependymomas is located exclusively in the conus medullaris or cauda equina, or film terminale region. In most myxopapillary ependymomas, the histological examination reveals low mitotic activity that is associated with a low MIB-1 labeling index (LI). The prognosis is generally favorable, when the appropriate treatment, including a total resection, is performed. The authors encountered a 39-year-old man with multifocal type of myxopapillary ependymomas compressing the cauda equina from the L2 to L3 level and L5-S1 level. A subtotal resection of the tumor was carried out. The histological examination revealed extremely high mitotic activity with a MIB-1 LI of 9.1%. Therefore, cranio-spinal radiation was added after surgery. The postoperative course was uneventful over the 3.5 year follow-up period.
Adult ; Brain ; Cauda Equina ; Conus Snail ; Ependymoma ; Follow-Up Studies ; Humans ; Prognosis ; Sacrococcygeal Region ; Spinal Cord

A 14-year-old girl presented with progressive paraparesis and paresthesia of one-year duration. Magnetic resonance imaging revealed a T6 vertebral hemangioma with epidural compression on the spinal cord. Following angiography and embolization, she underwent dorsal laminectomy and excision of the soft tissue component compressing the cord. In the postoperative period she had rapid worsening of lower limb power and imaging demonstrated an epidural haematoma at the operative site. The patient was taken up for urgent re-exploration and evacuation of haematoma. Postoperatively the patient complained of visual failure, headache and had multiple episodes of seizures. An magnetic resonance imaging brain showed characteristic features of posterior reversible encephalopathy syndrome (PRES) and the patient improved gradually after control of hypertension. This is the first documented case of PRES following spinal cord compression in a patient without any known risk factors. We postulate the possible mechanism involved in its pathogenesis.
Adolescent ; Angiography ; Brain ; Headache ; Hemangioma ; Hematoma ; Humans ; Hypertension ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Paraparesis ; Paresthesia ; Postoperative Period ; Risk Factors ; Seizures ; Spinal Cord ; Spinal Cord Compression

Intramedullary spinal epidermoid cysts are benign ectopic embryological growths with reported incidence of less than 1% of intramedullary tumors. In this case we report an unusual cervical intramedullary epidermid with liquid contents. A 40-year-old patient presented with progressive weakness of all four limbs of four months duration, bowel and bladder disturbances of two days duration, pain and paresthesias in all four limbs. Magnetic resonance imaging (MRI) revealed a well defined intramedullary lesion extending from C2-C3 level with widening of the cord. The lesion was hypointense on T1W images, hyperintense on T2W and fluid attenuation and inversion recovery images with thin rim of enhancement after contrast administration. Histopathological examination of the excised specimen revealed epidermal lining and keratinous material features of an epidermoid cyst. As in present case, rarely epidermoid cyst can have clear contents, and an MRI finding can closely mimic the features of arachnoid cyst, findings not classical and is different than described in literature.
Adult ; Arachnoid ; Epidermal Cyst ; Extremities ; Humans ; Hydrazines ; Incidence ; Keratins ; Magnetic Resonance Imaging ; Paresthesia ; Spinal Cord Neoplasms ; Urinary Bladder

STUDY DESIGN: We performed a prospective study to evaluate the reliability of using triggered electromyography (EMG) for predicting pedicle wall breakthrough during the placement of pedicle screw in adolescent idiopathic scoliosis surgery. PURPOSE: We wanted to correlate pedicle wall breakthrough with the triggered EMG threshold of stimulation and the postoperative computed tomography (CT) findings. OVERVIEW OF LITERATURE: Pedicle wall breakthrough has been reported to be difficult to evaluate by radiographs. Triggered EMG had been found to be a more sensitive test to detect this breakthrough. METHODS: Seven patients who underwent the insertion of 103 pedicle screws were evaluated. The triggered EMG activity was recorded from several muscles depending on the level of screw placement. The postoperative CT scans were read by a spine surgeon who was a senior fellow in orthopedics, and a musculoskeletal radiologist. RESULTS: The mean age at surgery was 12.6 years (range, 11 to 17 years). The preoperative mean Cobb angle was 54.7degrees (range, 45 to 65degrees). There were 80 thoracic screws and 23 lumbar screws. All the screws had stimulation thresholds of > or = 6 mA, except 3 screws with the stimulation threshold of < 6 mA. Ten screws (9.7%) showed violation of the pedicle wall on the postoperative CT scans. Five screws penetrated medially and another five penetrated laterally. No postoperative neurologic complications were noted in any of the seven patients. CONCLUSIONS: Measuring the stimulation threshold of triggered EMG helps to assess the pedicle screw placement. Pedicle screws that had stimulation threshold of > or = 6 mA were safe, with 90.3% reliability, as was assessed on the postoperative CT scans.
Adolescent ; Electromyography ; Humans ; Muscles ; Orthopedics ; Prospective Studies ; Scoliosis ; Spine

STUDY DESIGN: A retrospective matched cohort study. PURPOSE: To compare the results of combined Luque rod-sublaminar wiring (thoracic) and pedicle (lower lumbar) instrumentation (SLW) versus those with pedicle screw fixation (PS) for scoliosis correction in Duchenne muscular dystrophy (DMD). OVERVIEW OF LITERATURE: PS fixation is gaining popularity. Two instrumentation systems were not compared before in a matched cohort of patients. METHODS: Two groups of patients with DMD were matched according to the age at surgery, magnitude of deformity and vital capacity. Indications for surgery included loss of sitting balance, rapid decline of vital capacity and curve progression. In group 1 (22 patients) SLW fixation was used from T2/3 to pelvis or sacrum. In group 2 (18 patients) PS fixation was used from T2/3 to L5. Five patients had all level segmental PS fixations. Minimum follow-up was 2 years (range, 2 to 13 years). Radiographs, lung function tests and subjective/objective assessment were performed at standardized intervals. RESULTS: Mean Cobb angle in group 1 improved from 45.3degrees (range, 26 to 75degrees) to 17.7degrees(range, 0 to 37degrees) and mean pelvic obliquity improved from 14.5degrees (range, 8 to 28degrees) to 5.6degrees (range, 0 to 15degrees). Mean Cobb angle in group 2 improved from 42.8degrees (range, 28 to 80degrees) to 7.3degrees (range, 0 to 20degrees) and mean pelvic obliquity improved from 11.2degrees (range, 7 to 30degrees) to 2.0degrees (range, 0 to 5degrees) (p < 0.05). Mean operating time and blood loss were less in group 2 (p < 0.05). In group 1, the infection rate and instrumentation failure was higher, and subjective/objective outcomes showed no significant difference between the groups. CONCLUSIONS: PS fixation had superior correction and controlled pelvic obliquity without the need for pelvic fixation.
Cohort Studies ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Muscular Dystrophies ; Muscular Dystrophy, Duchenne ; Pelvis ; Respiratory Function Tests ; Retrospective Studies ; Sacrum ; Scoliosis ; Vital Capacity

STUDY DESIGN: Retrospective study. PURPOSE: To examine the clinical and radiologic characteristics of patients with stage 1 and 2 distractive flexion injury according to Allen's classification and who were not diagnosed immediately after injury, and to analyze the outcomes of surgical treatments. OVERVIEW OF LITERATURE: For the diagnosis of stage 1 and 2 distractive flexion injury in the lower cervical spine, attention should be paid when performing radiographs as well as when interpreting the radiographs. METHODS: The study was conducted on 10 patients (group 1) with stage 1 or 2 distractive flexion injury and who were not diagnosed immediately after injury from January 2003 to January 2009. The control group (group 2), 16 distractive flexion injury patients who were diagnosed immediately were selected. The simple radiographs, the degree of soft tissue swelling and the magnetic resonance imaging findings of the two groups were compared, and the clinical and radiologic results were examined. RESULTS: The degree of the prevertebral soft tissue swelling of group 1 was lower in group 1, and it was statistically significant (p = 0.046). The fusion was achieved in all cases (100%) in group 1, however, re-displacement as well as the loss of reduction occurred in one case, despite of delayed fusion and good clinical result. In group 2, bone fusion was achieved in 15 cases of 16 cases (94%). CONCLUSIONS: For the diagnosis of stage 1 and 2 distractive flexion injury in the lower cervical spine, it is desirable to perform computed tomography if diagnosis is not clear. Even if the diagnosis is delayed, stage 1 and 2 distractive flexion injury could be readily reduced by traction, and the treatment outcomes are considered to be comparable to those of the patients diagnosed immediately after injury.
Delayed Diagnosis ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Spine ; Traction

The intervertebral disc is characterized by a tension-resisting annulus fibrosus and a compression-resisting nucleus pulposus composed largely of proteoglycan. The most important function of the annulus and nucleus is to provide mechanical stability to the disc. Degenerative disc disease in the lumbar spine is a serious health problem. Although the three joint complex model of the degenerative process is widely accepted, the etiological basis of this degeneration is poorly understood. With the recent progress in molecular biology and modern biological techniques, there has been dramatic improvement in the understanding of aging and degenerative changes of the disc. Knowledge of the pathophysiology of the disc degeneration can help in the appropriate choice of treatment and to develop tissue engineering for biological restoration of degenerated discs.
Aging ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Joints ; Molecular Biology ; Proteoglycans ; Spine ; Tissue Engineering

We report here on an unusual case of multiple levels of asymmetric lumbar spondylolysis in a 19-year-old woman. The patient had severe low back pain of increasing intensity with lumbar instability, which was evident on the dynamic radiographs. MRI demonstrated the presence of abnormalities and the three dimensional CT scan revealed asymmetric complete spondylolysis at the left L2, L3 and L4 levels and the right L1, L2 and L3 levels. This case was treated surgically by posterior and posterolateral fusion at L2-3-4 with intersegmental fixation using pedicle screws and an auto iliac bone graft. The patient was relieved of her low back pain after the surgery.
Female ; Humans ; Low Back Pain ; Spondylolysis ; Transplants ; Young Adult

Cerebellar haemorrhages are rare life-threatening complications following spine surgery that present challenges for their diagnostic and their therapeutic management. Their patho-physiology remains unclear.
Spine

No abstract available.