Here we report a single-stage operation we performed on a patient with a large schwannoma that extended from the lower clivus to the cervico-thoracic junction caudally. A number of authors have previously performed multilevel laminectomy to remove giant schwannomas that extend for considerable length. This technique has caused cervical instability such as kyphosis or gooseneck deformity on several occasions. We removed the tumor with a left lateral suboccipital craniectomy with laminectomy only at C1 and without any subsequent surgery-related neurologic deficits. However, this technique requires meticulous preoperative evaluation on existence of Cerebrospinal fluid (CSF) cleft between the tumor and spinal cord on magnetic resonance imaging, of tumor origin located at the upper cervical root, and of detachment of tumor from the origin site.
Cerebrospinal Fluid ; Congenital Abnormalities ; Cranial Fossa, Posterior ; Humans ; Kyphosis ; Laminectomy* ; Laminoplasty ; Magnetic Resonance Imaging ; Neurilemmoma* ; Neurologic Manifestations ; Spinal Cord ; Spinal Cord Neoplasms

Hirayama disease, juvenile muscular atrophy of the distal upper limb, is a rare disease predominantly affecting the anterior horn cells of the cervical spinal cord in young men. This cervical myelopathy is associated with neck flexion. It should be suspected in young male patients with a chronic history of weakness and atrophy involving the upper extremities followed by clinical stability in few years. Herein, we report 2 cases of Hirayama disease on emphasis of diagnostic approach and describe the pathognomonic findings at flexion magnetic resonance imaging.
Anterior Horn Cells ; Atrophy ; Cervical Cord ; Humans ; Magnetic Resonance Imaging ; Male ; Motor Neuron Disease* ; Motor Neurons* ; Neck ; Rare Diseases ; Spinal Cord Diseases ; Spinal Muscular Atrophies of Childhood ; Upper Extremity

Spontaneous spinal epidural hematoma (SSEH) has been reported as a rare cause of spinal cord compression, especially in children. Clinical features are usually nonspecific, although cervicothoracic location of hematoma could be presented with progressive paraplegia. Guillian-Barré syndrome (GBS) is clinically defined as an acute peripheral neuropathy causing progressive limb weakness. Because SSEH and GBS have very similar signs and symptoms, SSEH could be misdiagnosed as GBS. Nevertheless, they can be presented together. We describe a rare case of SSEH coexisting with GBS.
Child* ; Extremities ; Guillain-Barre Syndrome ; Hematoma ; Hematoma, Epidural, Spinal* ; Humans ; Paraplegia ; Pediatrics ; Peripheral Nervous System Diseases ; Spinal Cord Compression

OBJECTIVE: This retrospective study of 13 patients who underwent surgical treatment for symptomatic lumbar synovial cyst was performed to evaluate the clinical findings and pathogenesis of lumbar synovial cyst. METHODS: The clinical characteristics of the patients were investigated by reviewing the hospital records, preoperative radiological images, and operation records. By observing preoperative CT scans Facet degeneration grade at the lesion and opposite side of pathologic level and adjacent levels were assessed and compared. RESULTS: There were 5 males and 8 females (average 65.8 year-old). Six patients presented with low back pain and leg pain, and 7 patients presented only leg pain. Most common pathologic level was L4-5. All patients underwent the cyst resection with/without decompressive laminectomy or discectomy. The additional instrumentation was not performed in all patients. No complications or recurrence was observed during average 34.5 months follow-up. There was no significant difference of facet degeneration grade between the lesion side of pathologic level and opposite side of same level or lower adjacent level. CONCLUSION: In the present study, all patients showed clinical improvement by the simple surgery without any instrumentation. No significant correlation between the occurrence of synovial cyst and the degeneration grade of facet joint was revealed.
Diskectomy ; Female ; Follow-Up Studies ; Hospital Records ; Humans ; Laminectomy ; Leg ; Low Back Pain ; Male ; Recurrence ; Retrospective Studies ; Synovial Cyst ; Zygapophyseal Joint

OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of bone cement augmented screw fixation for the patients accompanying severe osteoporosis. METHODS: Between February 2004 and August 2007, 157 patients with various spinal diseases including fractures accompanying severe osteoporosis underwent a bone cement augmented screw fixation (947 levels). About 4.8cc of polymethylmethacrylate was injected into the each vertebral body through transpedicular route. We divided the patients into two groups (Group I: Posterior fusion for compression/burst fractures or idiopathic scoliosis, Group II: Interbody fusion for various spinal diseases). Imaging and clinical features were analyzed, including bone cement augmented levels, fusion rate, clinical outcome and complications. The visual analog scale (VAS), Oswestry disability questionnaire and modified MacNab's criteria were used for the assessment of pain and functional capacity. RESULTS: In both groups, a significant improvement in VAS and Oswestry disability questionnaire was achieved. 146 out of 157 patients (93%) were graded as excellent or good result according to the modified MacNab's criteria. None of the patients experienced operative death, screw pullout or cut-up. However, there were two cases of neurologic deterioration as a result of bone cement extravasation. CONCLUSION: Bone cement augmented transpedicular screwing can reduce the possibility of screw loosening and pullout in patients with severe osteoporosis.
Humans ; Osteoporosis ; Polymethyl Methacrylate ; Surveys and Questionnaires ; Scoliosis ; Spinal Diseases

OBJECTIVE: Lumbar dynamic stabilization systems have been developed for the treatment of lumbar degenerative diseases. However, the clinical results of dynamic stabilization systems are still not well established. The purpose of this study is to assess the clinical and radiologic outcomes of lumbar dynamic stabilization using a hinged screw head system(Cosmic(R)). METHODS: Eighteen patients were followed for more than 1 year after dynamic stabilization with the Cosmic system. The following parameters were reviewed: age, sex, visual analog scale (VAS) for the leg and back, the Oswestry Disability Index (ODI), complications related to the operation, range of motion (ROM) of the adjacent segments, implantation segment and the whole lumbar spine. We compared the preoperative ODI, VAS, and ROM of the adjacent segments, implantation segment and the whole lumbar spine with the 1-year postoperative follow-up results. RESULTS: The mean preoperative ODI and VAS scores were significantly decreased after the operation (p<0.05). ROM at both the cranial and caudal adjacent segments did not change significantly postoperatively (p>0.05). The mean preoperative ROM of the implantation segment was decreased postoperatively. However, the mean ROM of the whole lumbar spine did not change significantly postoperatively (p>0.05). CONCLUSION: According to our preliminary results, lumbar dynamic stabilization using a hinged screw head system did not influence adjacent segment motion, and had improved clinical outcomes for a 1-year postoperative follow-up period.
Follow-Up Studies ; Head ; Humans ; Intervertebral Disc Degeneration ; Leg ; Lumbar Vertebrae ; Range of Motion, Articular ; Spinal Fusion ; Spine

OBJECTIVE: After endoscopic disectomy (ED), some patients may get substantial improvement just after the operation or may not. If we could expect short-term change of pain status, it would be helpful for consultation with patients. The object of this study was to present change of pain score for one month after ED in patients who showed substantial improvement of pain and who did not at postoperative one day. METHODS: From Jan 2007 to Dec 2008, 116 patients (M:F=114:2; Age, 22.4+/-5.3) were operated on endoscopic discectomy (ED) due to lumbar herniated intervertebral disc (HIVD). The operated levels were L4-5 in 90 cases and L5-S1 in 26 cases. At 30 days postoperative, outcome was assessed by Macnab's criteria. All patients were followed-up for at least one month. RESULTS: At one month postoperative, outcome was assessed (excellent, 94/116, 81%; good, 6/116, 5%; fair, 14/116, 12%, and poor, 2/116, 2%). The outcome was divided into favorable (n=100, excellent and good outcome) and unfavorable (n=16, fair and poor outcome) group. There was no difference in age, preoperative VAS on trunk and leg between groups (p>0.05). The change of pain score started to differ from the postoperative one day between groups. The VAS was reduced 61% on the trunk and 84% on the leg in a favorable group comparing preoperative score at postoperative one day. On the contrary, the pain was improved 22% on the trunk and 42% on the leg in an unfavorable group. CONCLUSIONS: If patients did not show substantial improvement at postoperative one day after endoscopic lumbar discectomy, the pain may persist for at least one month.
Diskectomy ; Endoscopy ; Humans ; Intervertebral Disc ; Leg ; Lumbar Vertebrae

OBJECTIVE: Mesenchymal stem cells (MSCs) have shown promise in potentially repairing injured spinal cord. These and similar cell types are being tested clinically, but the understanding about delivering method and subsequent results is lacking. This study was designed to compare the MSCs engraftment results after intralesional, intracisternal, or intravenous injection in a rat with spinal cord injury (SCI). METHODS: A total of 48 male Sprague-Dawley rats (300-350 g in size) were used with 12 in each group. Allogenic MSCs were cultured from human bone marrow aspirates. The SCI was induced using an NYU (New York University) impactor and MSCs were transplanted 1 week after the SCI. Behavioral testing was performed weekly for 6 weeks. The recipients were analyzed histologically to evaluate the extent of cell delivery and survival at the injury site. RESULTS: All three experimental groups showed better behavioral recovery compared with the control group since 6 weeks after stem cell injection (p<0.05). The intracisternal injection group showed the best functional improvement (p<0.05). The intralesional injection group showed the best engraftment until 4 weeks after stem cell injection (p<0.05). A number of the injected MSCs were trapped in the spleen in the intravenous injection group. CONCLUSION: Transplantation of stem cells by a variety of routes can deliver cells with the potential to repair injured spinal cord. Intracisternal injection can easily be translated to patients after some modifications, thus accelerating clinical application of cell therapies.
Animals ; Bone Marrow ; Humans ; Injections, Intralesional ; Injections, Intravenous ; Male ; Mesenchymal Stromal Cells ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; Spinal Cord Injuries ; Spleen ; Stem Cells ; Transplants

It was reported that nerve fibers were present in the inner part of lumbar intervertebral discs from patients with discogenic pain. Because there are no nerve fibers in the inner part of annulus fibrosus in normal condition, this finding suggests nerve ingrowth into the disc may be a cause of discogenic pain. Disc degeneration is often asymptomatic, thus, to understand the differences between symptomatic and asymptomatic disc, it is necessary to understand the pathogenesis of discogenic pain. We recently revealed that over 90% of the nociceptive dorsal root ganglion (DRG) neurons innervating the disc are sensitive to nerve growth factor (NGF), which is related to inflammatory pain. This indicates that discogenic pain is closely related to inflammation and NGF may play a key role. The increase of inflammatory mediators in symptomatic discs has been reported; we therefore studied the effects of disc inflammation and found that it induces sensitization of disc-innervating neurons and nerve ingrowth into the disc. More recently, it was shown that annular rupture induces nerve ingrowth, an increase of inflammatory mediators in the disc, and upregulation of calcitonin gene-related peptide, a pain-related molecule in DRGs. These findings led us to believe that annular rupture triggers inflammation and nerve ingrowth, inflammatory mediators then further promote nerve ingrowth into the disc and sensitization of disc-innervating neurons, and discogenic pain finally becomes chronic. NGF, found in symptomatic discs, may act as a key factor in generating chronic discogenic pain by sensitizing disc-innervating neurons and stimulating nerve ingrowth into the disc.
Calcitonin Gene-Related Peptide ; Diagnosis-Related Groups ; Ganglia, Spinal ; Humans ; Inflammation ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Nerve Fibers ; Nerve Growth Factor ; Neurons ; Rupture ; Up-Regulation

Deep wound infection is a serious surgical complication. The majority of patients with pyogenic spondylodiscitis can be treated non-surgically with antibiotics and immobilization. However, although surgical management of pyogenic spondylodiscitis continues to evolve, no consensus has yet been reached regarding the best surgical approaches and techniques. Anterior lumbar interbody fusion (ALIF) followed by percutaneous pedicle screw fixation (PPF) is an effective surgical option for treating postoperative pyogenic spondylodiscitis (PPS). In this report, we describe a case of PPS in a 64-year-old man who underwent ALIF with PPF.
Anti-Bacterial Agents ; Consensus ; Discitis ; Humans ; Immobilization ; Middle Aged ; Wound Infection