Giant solitary anterior cervical canal neurofibroma (GSACCN) is rarely reported in the literature. When the large lesion is ventrally located to the spinal cord, an anterolateral approach may not be ideal due to various technical challenges. In this report, we describe a case of intradural extramedullary GSACCN located at the cervical region extending from the axis to the sixth cervical vertebrae. Here we also describe a posterior technique successfully used to resect the tumour. Therefore, the posterior approach by En bloc decompressive laminectomy and laminoplasty might be used to adequately treat the lesion.
Axis, Cervical Vertebra ; Cervical Vertebrae ; Female ; Laminectomy ; Neurofibroma* ; Spinal Cord

Cervical Cord ; Cervical Vertebrae/surgery* ; Humans ; Spinal Cord Injuries/etiology* ; Thyroidectomy/adverse effects*

PURPOSE: The objective of this study was to obtain improved susceptibility weighted images (SWI) of the cervical spinal cord using respiratory-induced artifact compensation. MATERIALS AND METHODS: The artifact from B0 fluctuations by respiration could be compensated using a double navigator echo approach. The two navigators were inserted in an SWI sequence before and after the image readouts. The B0 fluctuation was measured by each navigator echoes, and the inverse of the fluctuation was applied to eliminate the artifact from fluctuation. The degree of compensation was quantified using a quality index (QI) term for compensated imaging using each navigator. Also, the effect of compensation was analyzed according to the position of the spinal cord using QI values. RESULTS: Compensation using navigator echo gave the improved visualization of SWI in cervical spinal cord compared to non-compensated images. Before compensation, images were influenced by artificial noise from motion in both the superior (QI = 0.031) and inferior (QI = 0.043) regions. In most parts of the superior regions, the second navigator resulted in better quality (QI = 0.024, P < 0.01) compared to the first navigator, but in the inferior regions the first navigator showed better quality (QI = 0.033, P < 0.01) after correction. CONCLUSION: Motion compensation using a double navigator method can increase the improvement of the SWI in the cervical spinal cord. The proposed method makes SWI a useful tool for the diagnosis of spinal cord injury by reducing respiratory-induced artifact.
Artifacts ; Cervical Cord ; Compensation and Redress ; Diagnosis ; Methods ; Noise ; Qi ; Respiration ; Spinal Cord ; Spinal Cord Injuries

A vertebral artery injury is one of the most critical complications of atlantoaxial fixation. Abnormal courses or congenital anomalies of the vertebral artery increase its risk. The authors report a case of a patient who had an atlantoaxial subluxation associated with severe spinal cord compression and a duplicated vertebral artery. The atlantoaxial subluxation, which was not reduced satisfactorily by an intraoperative head position change or direct manipulation of the atlas and axis, precluded a transarticular screw fixation. The lack of free space around the spinal cord precluded a sublaminar wiring. The duplicated vertebral artery made it difficult to insert C1 lateral mass screws and C2 pedicle screws with Harms' technique.
Axis, Cervical Vertebra ; Head ; Humans ; Spinal Cord ; Spinal Cord Compression ; Vertebral Artery*

Autophagy ; Cervical Cord ; injuries ; Humans ; Magnetic Resonance Imaging ; Spinal Cord Injuries ; complications ; diagnosis ; pathology

A 44-year-old female with cervical cord compression signs had myelographic and computerized tomographic evidence of extradural spinal cord compression without any tuberculous bony lesion or cold abscess. At surgery, cervical spinal cord was compressed by extraosseous extradural granulomatous tissue which was histologically proved a very rare localized extradural tuberculous granuloma.
Abscess ; Adult ; Cervical Cord ; Female ; Granuloma ; Humans ; Spinal Cord Compression ; Tuberculoma*

Cervical spinal cord injury is a common and serious disease in clinic, and tracheotomy combined with mechanical ventilation is an effective way to prevent respiratory complications. Although tracheotomy is used widely, there are not unified indications of tracheotomy after cervical spinal cord injury in the practical application. At the same time, the advantages and disadvantages of the application of tracheotomy in patients with cervical spinal cord injury are still on dispute. Based on the recent literature, we summarize the influence factors and meanings of tracheotomy after cervical spinal cord injury.
Cervical Cord ; injuries ; Humans ; Neck Injuries ; Respiration, Artificial ; Spinal Cord Injuries ; Tracheotomy

Dynamic spinal cord compression has been investigated for several years, but until the advent of open MRI, the use of dynamic MRI (dMRI) did not gain popularity. Several publications have shown that cervical cord compression is both static and dynamic. On many occasions the evaluation of cervical spondylotic myelopathy (CSM) is straightforward, but patients are frequently encountered with a significantly worse clinical examination than would be suggested by radiological images. In this paper, we present an extensive review of the literature in order to describe the importance of dMRI in various settings and applications. A detailed literature review was performed in the Medline and Pubmed databases using the terms “cervical spondylotic myelopathy”, “dynamic MRI”, “kinetic MRI”, and “myelomalalcia” for the period of 1980-2016. The study was limited to English language, human subjects, case series, retrospective studies, prospective reports, and clinical trials. Reviews, case reports, cadaveric studies, editorials, and commentaries were excluded. The literature search yielded 180 papers, 19 of which met inclusion criteria. However, each paper had evaluated results and outcomes in different ways. It was not possible to compile them for meta-analysis or pooled data evaluation. Instead, we evaluated individual studies and present them for discussion. We describe a number of parameters evaluated in 2661 total patients, including dynamic changes to spinal cord and canal dimensions, transient compression of the cord with changes in position, and the effects of position on the intervertebral disc. dMRI is a useful tool for understanding the development of CSM. It has found several applications in the diagnosis and preoperative evaluation of many patients, as well as certain congenital dysplasias and Hirayama disease. It is useful in correlating symptoms with the dynamic changes only noted on dMRI, and has reduced the incidence of misdiagnosis of myelopathy.
Cadaver ; Cervical Cord ; Diagnosis ; Diagnostic Errors ; Humans ; Incidence ; Intervertebral Disc ; Magnetic Resonance Imaging* ; Prospective Studies ; Retrospective Studies ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases*

In this case report, we want to introduce a successful way of applying non-invasive ventilation (NIV) with a full face mask in patients with high cervical spinal cord injury through a novel alarm system for communication. A 57-year-old man was diagnosed with C3 American Spinal Injury Association impairment scale (AIS) B. We applied NIV for treatment of hypercapnia. Because of mouth opening during sleep, a full face mask was the only way to use NIV. However, he could not take off the mask by himself, and this situation caused great fear. To solve this problem, we designed a novel alarm system. The best intended motion of the patient was neck rotation. Sensing was performed by a balloon sensor placed under the head of the patient. A beep sound was generated whenever the pressure was above the threshold, and more than three consecutive beeps within 3,000 ms created a loud alarm for caregivers.
Caregivers ; Cervical Cord* ; Head ; Humans ; Hypercapnia ; Masks ; Middle Aged ; Mouth ; Neck ; Noninvasive Ventilation* ; Spinal Cord Injuries ; Spinal Injuries

BACKGROUNDCervical spondylotic myelopathy (CSM) is a common cause of disability in elderly patients. Previous studies have shown that spinal cord cell apoptosis due to spinal cord compression plays an important role in the pathology of myelopathy. Although changes in magnetic resonance imaging (MRI) T2 signal intensity ratio (SIR) are considered to be an indicator of CSM, little information is published supporting the correlation between changes in MRI signal and pathological changes. This study aims to testify the correlation between MRI T2 SIR changes and cell apoptosis using a CSM animal model.

METHODSForty-eight rabbits were randomly assigned to four groups: one control group and three experimental chronic compression groups, with each group containing 12 animals. Chronic compression of the cervical spinal cord was implemented in the experimental groups by implanting a screw in the C3 vertebra. The control group underwent sham surgery. Experimental groups were observed for 3, 6, or 9 months after surgery. MRI T2-weighted SIR Tarlov motor scores and cortical somatosensory-evoked potentials (CSEPs) were periodically monitored. At each time point, rabbits from one group were sacrificed to determine the level of apoptosis by histology (n = 6) and Western blotting (n = 6).

RESULTSTarlov motor scores in the compression groups were lower at all time points than the control group scores, with the lowest score at 9 months (P < 0.001). Electrophysiological testing showed a significantly prolonged latency in CSEP in the compression groups compared with the control group. All rabbits in the compression groups showed higher MRI T2 SIR in the injury epicenter compared with controls, and higher SIR was also found at 9 months compared with 3 or 6 months. Histological analysis showed significant apoptosis in the spinal cord tissue in the compression groups, but not in the control group. There were significant differences in apoptosis degree over time (P < 0.001), with the 9-month group displaying the most severe spinal cord apoptosis. Spearman's rank correlation test showed that there was close relation between MRI SIR and degree of caspase-3 expression in Western blotting (r = 0.824. P < 0.001).

CONCLUSIONSClear apoptosis of spinal cord tissue was observed during chronic focal spinal compression. Changes in MRI T2 SIR may be related to the severity of the apoptosis in cervical spinal cord.

Animals ; Apoptosis ; physiology ; Cervical Cord ; metabolism ; pathology ; Magnetic Resonance Imaging ; Male ; Rabbits ; Spinal Cord Compression ; metabolism ; pathology