Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.
Tomography, X-Ray Computed ; Middle Aged ; Male ; Hyperesthesia/*diagnosis/etiology ; Humans ; Hematoma, Epidural, Spinal/complications/*diagnosis/radiography ; Hemangioma, Cavernous, Central Nervous System/complications/*diagnosis/radiography ; Epidural Space/radiography ; Epidural Neoplasms/complications/*diagnosis/radiography ; Cervical Vertebrae

Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.
Tomography, X-Ray Computed ; Middle Aged ; Male ; Hyperesthesia/*diagnosis/etiology ; Humans ; Hematoma, Epidural, Spinal/complications/*diagnosis/radiography ; Hemangioma, Cavernous, Central Nervous System/complications/*diagnosis/radiography ; Epidural Space/radiography ; Epidural Neoplasms/complications/*diagnosis/radiography ; Cervical Vertebrae

OBJECTIVETo explore the clinical characteristics and management of non-traumatic epidural sequestered cervical disc extrusion.

METHODSFrom January 2002 to July 2011, the clinical data of 10 patients with non-traumatic epidural sequestered cervical disc extrusion were treated by anterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection. Of them,there were 6 males and 4 females with an average age of 48.2 years old (ranged from 42 to 65), the course of disease ranged from 1 month to 4 years (mean, 15 months). All patients manifested numbness and weakness of four limbs, unstable walking and sphincter of oddi dysfunction. Preoperative MRI showed segmental cervical spinal cord compression. JOA scoring criteria was applied to evaluate preoperative and follow-up neurologic function.

RESULTSTen patients were followed up, and the duration ranged from 15 to 32 months, with an average of 21 months. No complications related to opreation occurred. Preoperative MRI showed nucelus puplposus sequestered longitudinal ligament were on equal signal on T1-weighted and corresponding pathological,while it showed equal and high signal on T2-weighted. JOA score were increased from 7.20 +/- 1.55 preoperative to 13.60 +/- 1.90 postoperative (t = -11.8, P < 0.001), and excellent in 3 cases, good in 6 cases and moderate in 1 case.

CONCLUSIONAnterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection after early diagnosis is the key to success of treating non-traumatic epidural sequestered cervical disc extrusion.

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; surgery ; Epidural Space ; diagnostic imaging ; surgery ; Female ; Humans ; Intervertebral Disc Displacement ; diagnosis ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography

Cervical disc herniation is a common disorder characterized by neck pain radiating to the arm and fingers as determined by the affected dermatome. This condition has a favorable prognosis, but pain can have a serious detrimental impact on daily activities. Epidural neuroplasty has been applied as a treatment option for cervical disc herniation; however, no study has addressed the clinical outcomes. This retrospective study evaluated the clinical outcomes of epidural neuroplasty on 128 patients for the treatment of cervical disc herniation. To measure pain-related disabilities over time, the changes of pain scores in neck and arm were evaluated using a numerical rating scale (NRS) and the neck disability index (NDI). Compared with preprocedural values, the pain NRS of neck and arm demonstrated significant improvement at day 1, and 1, 3, 6, and 12 months after the procedure (P < 0.001). Likewise, the NDI was significantly reduced at 3, 6, and 12 months after the procedure (P < 0.001). There were no serious complications. Cervical epidural neuroplasty shows good clinical outcomes in the treatment of cervical disc herniation and can be considered a treatment modality for cervical disc herniation refractory to conservative treatment.
Adult ; Aged ; Amides/administration & dosage ; Anesthetics, Local/administration & dosage ; Anti-Inflammatory Agents/administration & dosage ; Cervical Vertebrae/*radiography ; Dexamethasone/administration & dosage ; Disability Evaluation ; Epidural Space/radiography ; Female ; Follow-Up Studies ; Humans ; Hyaluronoglucosaminidase/therapeutic use ; Injections, Epidural ; Intervertebral Disc Displacement/radiography/*surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck Pain/drug therapy ; Pain/drug therapy ; Pain Measurement ; Questionnaires ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

STUDY DESIGN: A case report and review of the literature. OBJECTIVE: To discuss the intraspinal gas associated with lumberjack injury and review the literature. MATERIAL AND METHOD: A 60-year-old man developed chest pain & paraplegia by fall down from 4m height, having hypoes-thesia on T7-8 dermatome and complete motor-sensory loss below T9. RESULTS: Multiple rib fractures and hemopneumothorax were observed on chest radiograph and only mild offset was noted on plain spine lateral radiograph. CT scan reveals multiple air bubbles around epidural space at T7-8 and fracture of T7 pedicle. MRI shows rupture of both anterior and posterior longitudinal ligaments and extruded intervertebral disc of T7-8. Posterior decompression and stabilization with posterolateral fusion was performed on T5-9, but pain was persisted and paralysis was not improved after surgery. SUMMARY: The intraspinal gas of this case is supposed to be made by air migration from pleural cavity to intraspinal canal because of severe soft tissue injuries and fistula formation. Immediate and precise diagnosis with operative treatment was con-sidered to be important.
Chest Pain ; Decompression ; Diagnosis ; Epidural Space ; Fistula ; Hemopneumothorax ; Humans ; Intervertebral Disc ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Middle Aged ; Paralysis ; Paraplegia ; Pleural Cavity ; Radiography, Thoracic ; Rib Fractures ; Rupture ; Soft Tissue Injuries ; Spine ; Tomography, X-Ray Computed