OBJECTIVE: The authors report the successful use of a recently described technique of posterior fixation of the C1 lateral mass and the C2 pedicle with polyaxial screws and rods. METHODS: After posterior exposure of the C1-C2 complex, the polyaxial screws were inserted into the lateral mass of C1 and the pedicle of C2 with the guidance of anatomic landmarks and fluoroscopy. Then, the pedicle screws of each side were linked with a rod. Because the C1-C2 pedicle screw fixation was sufficiently rigid, an additional posterior wiring or structural bone graft is unnecessary. RESULTS: The early clinical and radiologic follow-up data indicated solid fusion of C1 and C2 vertebrae with no observed neural or vascular damage related to this technique. CONCLUSION: The posterior fixation of the C1-C2 complex using polyaxial screws and rods seems to be a reliable technique and an efficient alternative to the more commonly accepted procedures.
Anatomic Landmarks ; Axis, Cervical Vertebra* ; Fluoroscopy ; Follow-Up Studies ; Spine ; Transplants

OBJECTIVE: The authors compare peridural scar formation and adhesion with and without the use of Antiadhesion Barrier Gel(Adba) in an animal model of laminectomy. METHODS: Forty-five Sprague-Dawley rats underwent a two level lumbar laminectomy. The Adba was applied to randomly assigned 30 rats around the dura. Remaining 15 rats underwent same operation without the use of Adba. The rats were sacrificed 2, 4, 8 weeks after surgery by 15 numbers. A gross anatomic assessment of scar formation was done using microdissection by an observer blinded to treatment. Amount of scar formation and tenacity were compared between experimental and control group by a numerical rating system. The histological comparing was also performed. RESULTS: The amount of scar tissue and tenacity were reduced grossly and histologically at postoperative 2, 4, 8 weeks in animal model using Adba. Adba material was absorbed around 4 weeks of postoperative period in model. No special inflammatory reaction was observed, and the healing of wound was not affected by Adba. CONCLUSION: Adba significantly reduces the amount of scar formation and tenacity in rat laminectomy model without impacting the healing of operation wound and other complications.
Animals ; Cicatrix ; Fibrosis* ; Laminectomy* ; Microdissection ; Models, Animal ; Postoperative Period ; Rats* ; Rats, Sprague-Dawley ; Wounds and Injuries

Sinus histiocytosis with massive lymphadenopathy known as Rosai-Dorfman disease is characterized by painless bilateral cervical lymphadenopathy. Extranodal manifestations are uncommon and spinal involvement is rare. A 15-year-old man presented with intermittent midthoracic back pain only. He had no specific findings on neurologic examinations, hematologic and biochemical laboratory tests. Radiological examination of thoracic spine revealed collapse of T6 vertebrae with thoracic kyphosis and osteolytic lesion of T12 vertebra body. He underwent a removal of bone tumor, anterior reconstruction with mesh and pedicle screw fixation via posterior approach for pathologic confirmation and stabilization. Histopathologic study of the lesion revealed focal infiltration of large histiocytes showing emperipolesis. Immunochemistry stain of histiocytes was positive for CD68 and S-100 but negative for CD1a. This report presents a rare case and literature review of extranodal Rosai-dorfman disease in thoracic spine.
Adolescent ; Back Pain ; Emperipolesis ; Fractures, Compression* ; Histiocytes ; Histiocytosis, Sinus* ; Humans ; Immunochemistry ; Kyphosis ; Lymphatic Diseases ; Neurologic Examination ; Spine*

The clinical significance of cystic fluid motion in syringomyelia is uncertain. Because of its sensitivity to fluid motion, MR imaging was used to investigate fluid dynamics in syringomyelia by various tecniques. SPAMM (Spatial Modulation of Magnetization) MRI is one of these techniques which shows the fluid motion of syrinx in syringomyelia. After taking preimaging pulse sequence, the MR images show periodic bands due to the magnetic modulation. Motion between the time of banding and image formation is directly demonstrated as a corresponding displacement of the bands. The authors evaluated 7 patients of syringomyelia due to various causes with SPAMM MRI technique and compared preoperative SPAMM MRI findings and clinical results, postoperative size of syrinx. Among 4 patients of syringomyelia with Arnold-Chiari malformation, 3 patients showed band shift representing fluid motion of syrinx on SPAMM MRI. Clinical results of these patients were good and the size of postoperative syrinx decreased. Three patients of posttraumatic or postmeningitic syringomyelia who did not show band shift on SPAMM MRI had poor clinical courses and the sizes of postoperative syrinx remained unchanged. These results indicate that SPAMM MRI may be useful in dete rmining the type of treatment and predicting clinical results in syringomyelia.
Arnold-Chiari Malformation ; Humans ; Hydrodynamics ; Magnetic Resonance Imaging* ; Prognosis* ; Syringomyelia*

PURPOSE: We have experienced 23 patients who had underwent cervical disc replacement with Mobi-C disc prosthesis and analyzed their radiological results to evaluate its efficacy. PATIENTS AND METHODS: This study was performed on 23 patients with degenerative cervical disc disease who underwent CDR with Mobi-C disc prosthesis from March 2006 to June 2006. RESULTS: The age of the study population ranged from 31 to 62 years with mean of 43 years, and 16 male and 7 female cases. Regarding axial pain, the average preoperative VAS score was 6.47 +/- 1.4, while at final follow-up it was 1.4 +/- 0.7 (p < 0.001). The preoperatively VAS score for radiculopathy was 6.7 +/- 0.7 compared with an average score of 0 +/- 0 at the final follow-up (p < 0.001). At postoperative 6th month, Odom's criteria were excellent, good, or fair for all 23 patients (100%). 7 patients (30.4%) were classified as excellent, 15 patients (65.2%) as good, and 1 patients (4.4%) as fair. Prolo economic and functional rating scale was average 8.9 +/- 0.7 at postoperative 6th month. ROM in C2-7, ROM of FSU, and ROM in upper adjacent level were well preserved after CDR. CONSLUSION: This report would be the first document about the CDR with Mobi-C disc prosthesis in the treatment of degenerative cervical disc disease. CDR with Mobi-C disc prosthesis provided a favorable clinical and radiological outcome in this study. However, Long-term follow-up studies are required to prove its efficacy and ability to prevent adjacent segment disease.
Adult ; Cervical Vertebrae/physiopathology/*surgery ; Diskectomy/adverse effects/instrumentation/*methods ; Female ; Humans ; Joint Prosthesis/adverse effects ; Male ; Middle Aged ; Postoperative Complications/prevention & control ; Range of Motion, Articular ; Time Factors ; Treatment Outcome

PURPOSE: We performed 65 cases of posterior fusion surgery for cervical and/or high thoracic lesions using a polyaxial screw-rod system. PATIENTS AND METHODS: A total of 486 screws were implanted in 65 patients. RESULTS: Fixation of the screws was carried out over an average of 2.9 spinal segments. Upon evaluation by postoperative CT scans, twelve (2.5%) screws had suboptimal trajectories but two of these revealed radiculopathy in one patient and required screw repositioning. No vascular sequelae resulted. There has been no segmental motion in any of the cases to date. As for other complications, there was one case of dural tearing and two cases of lateral mass fractures. There were no infections or other wound healing problems or hardware failures. No patients had neurological deterioration after surgery. There were statistically significant improvements in the mean Neck Disability Index (NDI) scores and Visual Analogue Scale (VAS) scores in the preoperative and late postoperative follow-up evaluations. Although further studies are required to establish the long-term results of fusion rates and clinical outcomes. CONCLUSION: We cautiously suggest that the posterior polyaxial screw-rod system can be safely used as a primary or additional fusion method in this risky region. The successful and safe use of this method is dependent on a precise preoperative surgical plan and tactics for ensuring safe screw fixation.
Adult ; Aged ; Aged, 80 and over ; *Bone Screws ; Cervical Vertebrae/radiography/*surgery ; Female ; Humans ; Male ; Middle Aged ; Recovery of Function ; Reproducibility of Results ; Spinal Diseases/physiopathology/*surgery ; Spinal Fusion/instrumentation/*methods ; Thoracic Vertebrae/radiography/surgery ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: To report the clinical outcome of surgical treatment of spinal stenosis secondary to achondroplasia, the authors review the clinical and radiological presentation. METHODS: Five cases, two males and three females, of spinal stenosis secondary to achondroplasia were reviewed with medical records and radiologic study. The mean follow-up period was 26.8(range:10-72)months. RESULTS: In four patients, stenosis was more pronounced at lumbar area. The other patient revealed thoracolumbar and lumbar stenosis with kyphosis at thoracolumbar junction. All patients suffered from neurogenic intermittent claudication. Two patients presented with paraparesis and urinary dysfunction. On radiologic evaluation, all patients showed typical short pedicle, decreased interpedicular distance and severe stenosis. Only decompressive laminectomy was performed without fusion at lumbar area in four patients. One stage posterior interbody fusion and pedicle screw fixation was performed in one case which showed thoracolumbar stenosis and kyphosis. Radicular pain and neurogenic intermittent claudication improved after surgery. CONCLUSION: One stage posterior lumbar interbody fusion and pedicle screw fixation might be an effective method for the thoracolumbar kyphosis in patients of achondroplasia and for the cases of potential instability following decompression.
Achondroplasia* ; Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Intermittent Claudication ; Kyphosis ; Laminectomy ; Male ; Medical Records ; Paraparesis ; Spinal Stenosis*

The purpose of this study was to evaluate the clinical feasibility, benefits, and limitations of CT fluoroscopy (CTF) -guided percutaneous vertebroplasty (PVP). PVP under the guidance of CTF without additional guidance by conventional C-arm fluoroscopy was performed in a total of 29 vertebral bodies in 21 patients with vertebral compression fractures. While monitoring sectional CTF images, the needle was advanced from the skin to the target vertebra. Contrast media and polymethylmethacrylate (PMMA) were injected into the target vertebra with careful monitoring of their distribution. After the procedure, an evaluation was conducted to determine whether extraosseous leakage of PMMA occurred and whether sufficient filling of PMMA had been achieved. Needle placement into the target vertebra was easily achieved with both the transpedicular and posterolateral approaches. Injection of PMMA and venous leakage of contrast media were carefully monitored in all patients, and early detection of PMMA leaking was achieved in 5 patients. Extraosseous leakage that had not been detected during the procedure was not found upon postoperative evaluation. Pain scales were significantly decreased after the procedure, and no obvious complications occurred following the procedure CTF-guided PVP without the combined use of C- arm fluoroscopy was feasible and showed definite benefits. We believe that, in spite of some limitations, CTF-guided PVP provides an alternative technique appropriate in certain situations.
Tomography, X-Ray Computed ; Spine/radiography/*surgery ; Spinal Fractures/*surgery ; Radiation Dosage ; Polymethyl Methacrylate ; Osteoporosis/*complications ; Orthopedic Procedures/*methods ; Middle Aged ; Male ; Humans ; Fluoroscopy ; Female ; Aged, 80 and over ; Aged

PURPOSE: Standard treatment of asymptomatic spinal cord hemangioblastoma in von Hippel-Lindau (VHL) disease has yet to be established. The purpose of this study was to propose guidelines for the treatment of asymptomatic spinal cord hemangioblastomas in VHL disease. MATERIALS AND METHODS: VHL disease patients treated for spinal cord hemangioblastomas between 1999 and 2009 were included. All spinal cord hemangioblastomas were divided into three groups: Group 1, asymptomatic tumors at initial diagnosis followed with serial imaging studies; Group 2, asymptomatic tumors at initial diagnosis that were subsequently resected; and Group 3, symptomatic tumors at initial diagnosis, all of which were resected. RESULTS: We identified 24 spinal cord hemangioblastomas in 12 patients. Groups 1, 2 and 3 comprised 13, 4 and 7 tumors, respectively. Group 1 exhibited a smaller tumor volume (257.1 mm3) and syrinx size (0.8 vertebral columns) than those of Group 2 (1304.5 mm3, 3.3 vertebral columns) and Group 3 (1787.4 mm3, 6.1 vertebral columns). No difference in tumor volume or syrinx size was observed between Groups 2 and 3. Five tumors in Group 1 were resected during follow-up because symptoms had developed or the tumor had significantly grown. Finally, among 17 asymptomatic tumors at the initial diagnosis, nine tumors were resected. Only one tumor of these nine tumors resulted in neurological deficits, while five of seven symptomatic tumors caused neurological deficits. CONCLUSION: Selective resection of asymptomatic tumors before they cause neurological deficits might bring about better outcomes.
Adult ; Aged ; Aged, 80 and over ; Female ; Hemangioblastoma/etiology/*pathology/*surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome ; von Hippel-Lindau Disease/*complications

PURPOSE: A retrospective review of medical records and imaging studies. To investigate characteristic clinical features and surgical outcomes of spinal cord tumors (SCTs) of the thoracolumbar junction (TLJ). The spinal cord transitions to the cauda equina in the TLJ. The TLJ contains the upper and lower motor neurons of the spinal cord and cauda equina. As a result, the clinical features of lesions in the TLJ vary, and these anatomical characteristics may affect surgical outcome. MATERIALS AND METHODS: Pathological diagnosis, clinical features, neurological signs, and surgical outcomes were investigated in 76 patients surgically treated at our institute for SCTs arising from T11 to L2. The patients were divided into epiconus (T11-12, n=18) and conus groups (L1-2, n=58). RESULTS: Patients in the epiconus group had hyperactive deep tendon reflexes (DTRs), while those in the conus group had hypoactive DTRs (p < 0.05). Nine patients were misdiagnosed with intervertebral disc diseases (IVDs) before correct diagnoses were made. It was impossible to definitively determine the exact cause of symptoms in four patients who had both SCTs and IVDs. CONCLUSION: Among SCTs of the TLJ, the epiconus group displayed upper motor neuron syndrome and the conus group displayed lower motor neuron syndrome. SCTs of the TLJ were frequently misdiagnosed as IVDs due to symptomatic similarities. SCTs of the TLJ should be included in differential diagnosis of back and leg pain, and it is highly recommended that routine lumbar magnetic resonance imaging include the TLJ.
Cauda Equina/pathology/radiography ; Humans ; Intervertebral Disk Displacement/pathology/radiography ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Cord Compression/pathology/radiography ; Spinal Cord Neoplasms/*surgery ; Thoracic Vertebrae/*pathology/radiography ; Treatment Outcome