OBJECTIVE: Pfirrmann disc degeneration grade is one of morphologic disc degeneration grading system and it was reliable on routine T2-weighted magnetic resonance (MR) images. The purpose of this study was to evaluate the agreement of Pfirrmann disc degeneration grade, and check the alternative technique of disc degeneration grading system. METHODS: Fifteen volunteers (4 medical doctors related to spinal disease, 2 medical doctors not related to spinal disease, 6 nurses in spinal hospital, and 3 para-medicines) were included in this study. Three different digitalized MR images were provided all volunteers, and they checked Pfirrmann disc degeneration grade of each disc levels after careful listening to explanation. Indeed, all volunteers checked the signal intensity of disc degeneration at the points of nucleus pulposus (NP), disc membrane, ligaments, fat, and air to modify the quantitative Pfirrmann disc degeneration grade. RESULTS: Total 225 grade results of Pfirrmann disc degeneration grade and 405 signal intensity results of quantitative Pfirrmann disc degeneration grade were analyzed. Average interobserver agreement was "moderate (mean±standard deviation, 0.575±0.251)" from poor to excellent. Completely agreed levels of Pfirrmann disc degeneration grade were only 4 levels (26.67%), and the disagreement levels were observed in 11 levels; two different grades in 8 levels (53.33%) and three different grades in 3 levels (20%). Quantitative Pfirrmann disc degeneration showed relatively cluster distribution with the interobserver deviations of 0.41-1.56 at the ratio of NP and disc membrane, and it showed relatively good cluster and distribution indicating that the proposed grading system has good discrimination ability. CONCLUSION: Pfirrmann disc degeneration grade showed the limitation of different interobserver results, but this limitation could be overcome by using quantitative techniques of MR signal intensity. Further evaluation is needed to access its advantage and reliabilities.
Discrimination (Psychology) ; Intervertebral Disc Degeneration* ; Ligaments ; Membranes ; Spinal Diseases ; Volunteers

Relatively huge lesions in the parasellar and midline anterior skull base region are difficult to approach for radical procedures. To minimize brain retraction and achieve excellent exposure for safe manipulation within these regions, the authors have performed an extended frontal approach, a fibrontal craniotomy and a bilateral orbitofrontal osteotomy in 11 patients, and an additional transfacial maxillotomy in 1 patient. An additional removal of the orbital rim offers excellent visualization and permits unhindered surgical manipulation including postoperative reconstruction at the anterior skull base. But disadvantages include prolonged operative time and frequent ilateral olfactory denervation. Six patients with benign tumors, two patients with malignant tumors, one patient with hematoma in the ehtmoid and sphenoid sinuses, and three patients with delayed traumatic CSF rhinorheas were operated on using this approaches, with good results. The operative technique and its results are detailed.
Brain ; Craniotomy ; Denervation ; Hematoma ; Humans ; Operative Time ; Orbit ; Osteotomy ; Skull Base* ; Skull* ; Sphenoid Sinus

Giant dumbbell neurofibroma is a rare tumor which belongs to large family that is the nerve sheath tumor composed of two main types of tumors that include neurofibroma and schwannoma. Neurofibroma arises from a mesenchymal origin closer to a fibroblast which differs from the schwannoma arising from the progenitor of the schwann cell. I report on one case of giant lumbar dumbbell neurofibroma that occured in the spinal and paraspinal retoperitoneal region which was removed by combined and one-year delayed surgery.
Fibroblasts ; Humans ; Neurilemmoma ; Neurofibroma

Basilar invagination or basilar impression involves the upward displacement of the margins of the foramen magnum into the base of the skull. That this entity may be asymptomatic or associated with symptoms referable to encroachment into the posterior fossa or embarrassment of the posterior circulation is well known. Currently the authors have experienced a young male patient with basilar invagination presented with progressive myelopathy and lower cranial neuropathies due to odontoid invagination. It was thought that a posterior decompression would be hazardous;therefore, the inferior clivus, odontoid process, and anterior arch of the atlas were removed transoral-transpharyngeally and bone fusion was performed with iliac bone. Furthermore the operative result was good without any serious complication. The operation technique is detailed.
Cranial Fossa, Posterior ; Cranial Nerve Diseases ; Decompression ; Foramen Magnum ; Humans ; Male ; Odontoid Process ; Platybasia ; Skull ; Spinal Cord Diseases

The incidence of intracranial aneurysms in childhood is rare, especially in infancy. We report a case of a 45-day-old girl who presented with seizure due to a ruptured large saccular aneurysm of the middle cerebral artery(MCA) with subsequent subarachnoid, intracerebral and intraventricular hemorrhage. The baby has enjoyed an excellent clinical outcome after surgical management. The clinical features of the case and review of the literature are presented.
Aneurysm ; Female ; Hemorrhage ; Humans ; Incidence ; Infant* ; Intracranial Aneurysm* ; Seizures ; Subarachnoid Hemorrhage

OBJECTIVE: Spinal fusion operation is an effective treatment in the spinal pathology, but it could change the physiological distribution of load at the instrumented and adjacent segments. This retrospective study compared the radiological and clinical outcomes of patients undergoing lumbar fusion with semirigid rods versus rigid rods system. METHODS: Using transpedicular fixation and posterior lumbar interbody fusion at the level of L4/L5, 20 patients were treated with semirigid rods (WavefleX, SR group), and 20 patients with rigid rods (titanium, RR group). Clinical and radiological outcomes were evaluated, including visual analog score for lower back pain and leg pain, Prolo functional and economic scores, statues of implanted instruments, fusion rate, and complications during 24-month follow-up. RESULTS: Clinical scores were significantly improved until postoperative 24-month follow-up as compared with preoperative scores in both groups (p<0.05), with similar levels of improvement observed at the same time points postoperatively between the 2 groups. Prolo economic scores were significantly improved in SR group compared to RR until 12 months, but this improvement became similar after 18 months. The overall fusion rate was 94.1% until the 24-month follow-up for both groups. No significant complication was observed in both groups. CONCLUSION: The results of the present study indicate that semirigid rods system with posterior lumbar interbody fusion showed similar clinical and radiological result with rigid rods system until 2 years after instrumentation. The WavefleX rods system, as a semirigid rods with unique characteristics, may be an effective alternative treatment for patients in lumbar fusion.
Follow-Up Studies ; Humans ; Leg ; Low Back Pain ; Pathology ; Retrospective Studies ; Spinal Fusion ; Spine*

OBJECTIVE: We report a case with a long-standing history of the ankylosing spondylitis(AS) who showed multiple cerebellar infarctions with bulbar symptom owing to vertebral artery obstruction, due to anterior and vertical subluxation of atlanto-axial and atlanto-occipital joint. CLINICAL PRESENTARION: An 51-year-old male patient with swallowing difficulty, tongue deviation to the left side and severe nuchal pain and rigidity is presented. INTERVENTION: After removal of posterior portion of foramen magnum, posterior portion of left transverse foramen of axis was decompressed. CONCLUSIONS: Spontaneous anterior atlanto-axial subluxation occurs in patients with AS about 2% of presents with or without signs of spinal cord compression. Vertical subluxation occurs in 3-8% of patient with rheumatoid arthritis but it is an exceedingly rare complication of AS. Close observation and follow-up are needed in patients with AS and if subluxation occurs, good prognosis is anticipated using an early operative treatment.
Arthritis, Rheumatoid ; Atlanto-Occipital Joint* ; Axis, Cervical Vertebra ; Deglutition ; Follow-Up Studies ; Foramen Magnum ; Humans ; Infarction ; Male ; Middle Aged ; Prognosis ; Spinal Cord Compression ; Spondylitis, Ankylosing* ; Tongue ; Vertebral Artery*

Spinal epidural and subdural hematomas are uncommonly recognized conditions. These conditions can result in severe irreversible neurologic deficits, if left untreated. Like intracranial lesions, these hematomas can expand rapidly and cause sudden spinal cord and/or cauda equina compression. This case is very rare in which is a concurrence of cervical spinal epidural and subdural hematoma after motor vehicle accident without spine fracture. The pathophysiology of these entities are discussed and the radiologic diagnosis focused on MR findings are reviewed. The importance of prompt surgical treatment is emphasized to facilitate good postoperative outcome.
Cauda Equina ; Diagnosis ; Hematoma ; Hematoma, Epidural, Spinal ; Hematoma, Subdural* ; Hematoma, Subdural, Spinal ; Motor Vehicles ; Neurologic Manifestations ; Spinal Cord ; Spine*

Authors performed extrapedicular screws fixation in thoracic spines. Because patient had very narrow thoracic pedicles, classical transpedicular screws fixation could not be accomplished. In case of narrow thoracic pedicles, extrapedicular screws fixation would be a good alternative technique. We describe here a method for thoracic extrapedicular screws fixation.
Humans ; Spine

We report a case of cervical spinal epidural abcess due to Salmonella group D. A 58-year-old man complained of progressive neck pain and right arm weakness with fever. Clinical and radiographic findings including cervical magnetic resonance(MR) image showed paraspinal soft tissue inflammation of neck and abcesses in prevertebral and epidural space at C3-5 level. The patient underwent a C4 corpectomy and adjacent diskectomy and continous irrigation suction drainage. A MR image taken at second postoperative day revealed diffuse cord swelling from C2 to T1 suggesting edema and/or myelitis and then laminectomy from C3 to C6 was performed immediately to decompress the spinal cord. The patient recovered excellently and the abscess culture revealed Salmonella group D.
Abscess ; Arm ; Diskectomy ; Edema ; Epidural Abscess* ; Epidural Space ; Fever ; Humans ; Inflammation ; Laminectomy ; Middle Aged ; Myelitis ; Neck ; Neck Pain ; Salmonella* ; Spinal Cord ; Suction