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

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*

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

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: 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

We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into consideration. We retrospectively reviewed the database of 3720 cases of spine operation in a single institute over 7 years (1998 April-2005 July). Nine patients who demonstrated neurologic deterioration after surgery and required surgical decompression were identified. Factors postulated to increase the postoperative epidural hematoma and to improve neurologic outcome were investigated. The incidence of postoperative epidural hematoma was 0.24%. Operation sites were cervical 3 cases, thoracic 2 cases, and lumbar 4 cases. Their original diagnoses were tumor 3 cases, cervical stenosis 2 cases, lumbar stenosis 3 cases and herniated lumbar disc 1case. The symptoms of epidural hematomas were neurologic deterioration and pain. After decompression, clinical outcome revealed complete recovery in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness or anticoagulation therapy (4 cases, 44.4%) and highly vascularized tumor (3 cases, 33.3%). The time interval to evacuation of complete recovery group (29.3 hours) was shorter than incomplete recovery group (66.3 hours). Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression.
Treatment Outcome ; Spinal Diseases/*surgery ; Risk Factors ; Retrospective Studies ; Postoperative Complications/diagnosis/*epidemiology ; Middle Aged ; Male ; Humans ; Hematoma, Epidural, Spinal/diagnosis/*epidemiology/*etiology ; Female ; Aged ; Adult

This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK(TM) (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain.
Treatment Outcome ; Spinal Fusion/*methods ; Middle Aged ; Male ; Lumbar Vertebrae/radiography/*surgery ; Joint Instability/radiography/*surgery ; Intervertebral Disk Displacement/radiography/*surgery ; Humans ; Follow-Up Studies ; Female ; Adult

We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into consideration. We retrospectively reviewed the database of 3720 cases of spine operation in a single institute over 7 years (1998 April-2005 July). Nine patients who demonstrated neurologic deterioration after surgery and required surgical decompression were identified. Factors postulated to increase the postoperative epidural hematoma and to improve neurologic outcome were investigated. The incidence of postoperative epidural hematoma was 0.24%. Operation sites were cervical 3 cases, thoracic 2 cases, and lumbar 4 cases. Their original diagnoses were tumor 3 cases, cervical stenosis 2 cases, lumbar stenosis 3 cases and herniated lumbar disc 1case. The symptoms of epidural hematomas were neurologic deterioration and pain. After decompression, clinical outcome revealed complete recovery in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness or anticoagulation therapy (4 cases, 44.4%) and highly vascularized tumor (3 cases, 33.3%). The time interval to evacuation of complete recovery group (29.3 hours) was shorter than incomplete recovery group (66.3 hours). Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression.
Treatment Outcome ; Spinal Diseases/*surgery ; Risk Factors ; Retrospective Studies ; Postoperative Complications/diagnosis/*epidemiology ; Middle Aged ; Male ; Humans ; Hematoma, Epidural, Spinal/diagnosis/*epidemiology/*etiology ; Female ; Aged ; Adult

This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK(TM) (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain.
Treatment Outcome ; Spinal Fusion/*methods ; Middle Aged ; Male ; Lumbar Vertebrae/radiography/*surgery ; Joint Instability/radiography/*surgery ; Intervertebral Disk Displacement/radiography/*surgery ; Humans ; Follow-Up Studies ; Female ; Adult