STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of intradural disc herniation (IDH) around conus medullaris. SUMMARY OF LITERATURE REVIEW: IDH is rare with an incidence of less than 1% of all lumbar disc herniations. It is important to differentiate IDH from other condition with accurate diagnosis and subsequent surgical treatment. IDH has a higher risk of neurologic deficit, like conus medullaris syndrome and cauda equina syndrome. MATERIALS AND METHODS: A 62 year-old male was affected by lumbar back pain radiating to the anterolateral aspect of the right thigh for 5 days. MRI showed a mass that existed on the anterior portion of the conus medullaris. We performed partial laminectomy at the L1-L2level. The mass located anteriorly in the intradural space was eliminated after durotomy by a posterior approach. RESULTS: We confirmed the IDH for histopathology. CONCLUSIONS: IDH usually needs accurate differential diagnosis. Preoperative MRI scans are necessary to differentiate IDH from other intradural lesions. The confirmative diagnosis can be done only in the operative field.
Back Pain ; Conus Snail ; Diagnosis ; Diagnosis, Differential ; Humans ; Incidence ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Polyradiculopathy ; Spinal Cord Compression ; Thigh

There are many classifications for idiopathic scoliosis but none of these is perfect. In the treatment of idiopathic scoliosis, it is essential to understand the characteristics of each classification system and exploit their individual advantages.
Classification* ; Scoliosis*

Ossification of the yellow ligament (OYL) is a rare disease that causes myeloradiculopathy at the thoracic spine. The advances in radiographic imaging techniques have made a diagnosis of this pathological entity relatively simple. Surgical decompression and excision of the OYL is the treatment of choice if there are neurological complications from the OYL. We describe a 50-yearold male with thoracic myelopathy caused by a fractured OYL at T10-11, and suggest possible mechanism of the fracture of the OYL at the thoracolumbar spine.
Decompression, Surgical ; Diagnosis ; Humans ; Ligaments* ; Male ; Rare Diseases ; Spinal Cord Diseases* ; Spine

STUDY DESIGN: This is a retrospective study. OBJECTIVES: This study examined the MRI findings, injury mechanism, clinical findings, and prognosis of a spinal cord injury without radiographic abnormality (SCIWORA) in adults with a normal spinal canal. SUMMARY OF LITERTURE: Most reports on SCIWORA deal with the pediatric age group. However, there are few reports on the MRI findings, clinical features and outcomes in adult patients with cervical SCIWORA. MATERIALS AND METHODS: The hospital records of 753 patients, who were treated for cervical spine injury between February 1, 1994 and July 31, 2004, were reviewed. This study included the 10 subjects with no fractures or dislocation on the plain roentgenograms or cord compression caused by degenerative change or disc herniation on MRI corresponding to the location of the cord lesion. All the patients had at least a 2-year follow-up evaluation. The relationships between the MRI findings, neurological findings and outcomes were evaluated. RESULTS: The MRI findings revealed 7 cases with cord contusion, 3 cases with cord edema, 3 cases with gliosis and 3 cases with syrinx formation at the follow-up. The injury mechanism was hyperextension and hyperflexion in 7 and 3 cases, respectively. The initial motor function scores of ASIA in the edema and contusion groups was 60.7 and 43.9, respectively. At the last follow-up, the motor function scores of ASIA in the edema and contusion groups were 90 and 70.3, respectively. The Frankel grade improved by 1.3 and 1.1 in the edema and contusion groups, respectively. CONCLUSIONS: In patients with SCIWORA, the MRI findings correlated well with the clinical picture and were of prognostic significance. The cord edema group showed better clinical features than the contusion group, and prognosis was relatively good in both groups. A further careful evaluation, such as MRI, is still needed to determine the appropriate treatment for spinal cord injuries without radiographic abnormalities.
Adult* ; Asia ; Contusions ; Dislocations ; Edema ; Follow-Up Studies ; Gliosis ; Hospital Records ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Retrospective Studies ; Spinal Canal ; Spinal Cord Injuries* ; Spinal Cord* ; Spine

STUDY DESIGN: A retrospective study OBJECTIVES: To examine the mid term clinical and radiologic findings of patients treated by Posterior Lumbar Interbody Fusion (PLIF) with cages in spondylolisthesis. LITERATURE REVIEW: The clinical result of PLIF with cages is satisfactory. PLIF with cages is a useful treatment for spondylolisthesis. MATERIALS AND METHODS: Forty-two patients were followed up for more than 5 years. Their mean age was 53 years and the mean follow-up period was 68 months. Twenty-one cases were the isthmic type, and 21 cases were the degenerative type. The low back pain score, Lin s clinical result, perioperative value of slippage, anterior intervertebral disc space height, radiological change in the adjacent level and complications were evaluated. RESULTS: The preoperative lower back pain score improved from 46.7 to 86.4 points at the last follow-up (p.0.05). Thirty-eight patients (91%) showed excellent or good results. The preoperative value of slippage improved from 17.5% to 5.7% (p.0.05). The anterior intervertebral disc space height increased from 10.0 to 14.5 mm (p.0.05). There were changes in the above and lower adjacent segments in 12 cases (28%). Two of these cases required surgery. CONCLUSIONS: PLIF with cages might be an effective method in spondylolisthesis. However, the long-term follow-up showed changes in the adjacent segment.
Follow-Up Studies ; Humans ; Intervertebral Disc ; Low Back Pain ; Retrospective Studies ; Spondylolisthesis*

STUDY DESIGN: In vitro experimental study OBJECTIVES: To examine the effect of a synovial supernatant on the cell viability, osteogenic phenotype, mRNA expression of the types collagen and various transcriptional factors on osteogenesis in ligamentum flavum (LF) cells stimulated with synovial fluid from a degenerated facet joint. LITERATURE REVIEW: In degenerative lumbar spinal stenosis, hypertrophied LF or osteoarthritic hypertrophy of a facet joint often causes neurogenic claudication. The facet joint is a synovial joint with hyaline cartilage on each side. Therefore, osteoarthritis of a facet joint eventually occurs with aging and other degenerative conditions of the spine. In lumbar spinal degeneration, inflammatory mediators or cytokines are released from the facet joint tissue, which consequently affects the adjacent LF because the LF covers posterolateral aspect of the spinal canal near facet joints. However, there are no reports on the relationship between a degenerated facet joint fluid and the LF in the lumbar spine. MATERIALS AND METHODS: LF surgical specimens were obtained from patients with a lumbar spine stenosis, and the cells were isolated by enzymatic digestion. Each of the synovium tissues were weighed and recorded. Each tissue was cut into small pieces with a pair of scissors and then washed 3 times with PBS. The washed tissue pieces were then cultured for 96 hr at 37degrees C, 5% CO2 in DMEM/F-12-0.1% FBS with a density of 200 mg/ml medium. The supernatant was collected after 96 hr. In order to measure quantitatively the proliferation of cells, the AlamarBlue assay was used. The total cellular RNA was extracted from the cells and amplification reactions specific to the following types of cDNA were performed: the osteogenic master transcription factors, Dlx5, Runx2, osterix, and types collagen and osteocalcin. Alkaline phosphatase staining for the biochemical assay and western blotting for osteocalcin protein expression were performed. RESULTS: Human LF cells cultured with the supernatant from the facet synovium showed a slightly stronger AlamarBlue staining than the intensity of the control culture. RT-PCR revealed the upregulation of the osteogenic master transcription factors, Dlx5, Runx2, and osterix in the synovium supernatant group from one hour to 72 hours, and an increase in osteocalcin, types collagen I, III, V, XI levels from one hour to one week. LF cells cultured with the supernatant from the facet synovium showed positive staining for alkaline phosphatase. The level of the osteocalcin protein in the LF cells cultured with the supernatant from the facet synovium was higher than the control group. Conclusions: The supernatant of the facet joint from patients with degenerative spinal stenosis affects LF cells by increasing the level of cellular proliferation, upregulating the mRNA expression of osteocalcin, types of collagen, osteogenic transcription factors, positive alkaline phosphatase staining, and osteocalcin protein expression. Therefore, degenerated synovial fluid from the facet joint is an important mechanism of LF hypertrophy and ossification.
Aging ; Alkaline Phosphatase ; Blotting, Western ; Cell Proliferation ; Cell Survival ; Collagen ; Constriction, Pathologic ; Cytokines ; Digestion ; DNA, Complementary ; Humans ; Hyaline Cartilage ; Hypertrophy* ; Joints ; Ligamentum Flavum* ; Osteoarthritis ; Osteocalcin ; Osteogenesis ; Phenotype ; RNA ; RNA, Messenger ; Spinal Canal ; Spinal Stenosis ; Spine ; Synovial Fluid* ; Synovial Membrane ; Transcription Factors ; Up-Regulation ; Zygapophyseal Joint

STUDY DESIGN: A Cross-sectional study OBJECTIVE: This study evaluated the degree of osteoporosis of adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS) and compared bone mineral density. LITERATURE REVIEW: In osteoporosis, bone mineral density was not as dense even in the outer layer, and the cortex was thinner than normal. A larger screw doss not enhance the screw stability and can break the thin cortex in osteoporotic vertebrae. MATERIALS AND METHODS: This study reviewed the cases of consecutive patients with scoliosis, who underwent an osteoporosis examination before surgery between August 2004 and June 2006. The osteoporosis examination included DEXA in lumbar vertebrae and proximal femur. The mean osteoporotic degree of both femurs was recorded. The data was analyzed using the BMD(bone mineral density, g/cm(2)) and Z value of the BMD according to age, gender, and ethnicity. RESULTS: The mean degree of the coronal deformity was 48.4 in AIS and 62.9 in NMS. A comparison of both groups revealed a significantly lower BMD and Z value of Femur, and BMD of the vertebra in the NMS patients (p<0.05). A comparison between AIS and non-ambulant NMS showed that all parameters were significantly lower in the non-ambulant NMS (p<0.05). Neither the BMD and Z value of the AIS nor the NMS were associated with the severity of the spinal deformity. CONCLUSION: A lower BMD was measured in patients with non ambulant NMS than AIS. The degree of the osteoporosis, particularly of the non ambulant NMS patients need to be considered before undergoing surgery.
Adolescent* ; Bone Density* ; Congenital Abnormalities ; Cross-Sectional Studies ; Dioctyl Sulfosuccinic Acid ; Femur ; Humans ; Lumbar Vertebrae ; Osteoporosis ; Scoliosis* ; Spine

STUDY DESIGN: Experimental animal study OBJECTIVES: To examine the ability of human umbilical cord blood (hUCB) stem cells to target a zone of injury and to determine the efficacy of hUCB cells to ameliorate the behavioral deficits after a hUCB cell infusion in paralyzed rats. SUMMARY OF LITERTURE: Many groups have investigated the use of stem cells as potential treatments for a CNS injury. hUCB cells have recently been reported to alleviate the behavioral consequences of a stroke injury. MATERIALS AND METHODS: Thirty Sprague Dawley rats were divided into 6 groups (Gr) (Gr 1. SCI (spinal cord injury) + hUCB delivered at one day postinjury, Gr 2. SCI + hUCB delivered at 3 days postinjury, Gr 3. SCI + hUCB delivered at 5 days postinjury, Gr 4. laminectomy + hUCB, Gr 5. SCI only, Gr 6. Laminectomy only). SCI was produced by compressing the spinal cord to the level of the 8-9th thoracic spine for 1 minute with an aneurysm clip that was calibrated to a closing pressure of 50 gms. The hUCB cells (0.5 ml, 1.5x106) were administered intravenously to the rats. The rat was assessed behaviorally at one, two and three weeks using the BBB behavioral scale. Four weeks after the injury, the animals were sacrificed and the hUCB positiveresponse neural cells (mouse anti-human mitochondria monoclonal antibody=MAB 1273) at the injury level observed using optical and fluorescent microscopy. RESULTS: MAB 1273 positive cells were observed in groups 1, 2 and 3 but not in groups 4, 5 and 6. In particular, there were 870 cells distributed over an area of 1.2 mm(2) in group 3. Group 3 showed the most significant recovery over time in the open field exam, and the most improvement in another tests of incline, leg extension, and toe spread compared with group 1 (p<0.01). CONCLUSION: After infusing the hUCB stem cells to SCI rats, it was confirmed that hUCB cells migrate to an injured area and ameliorate the behavioral deficits. A hUCB infusion 5 days after the injury produced best results in terms of the number of cells and motor recovery.
Aneurysm ; Animals ; Fetal Blood* ; Humans* ; Laminectomy ; Leg ; Microscopy ; Mitochondria ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Spinal Cord Injuries ; Spine ; Stem Cells ; Stroke ; Toes ; Umbilical Cord*

STUDY DESIGN: In vitro motility assays were carried out using rat intervertebral discs (IVDs). OBJECTIVES: To demonstrate the motile properties of the cartilage endplate (CE) chondrocytes and the effect of notochordal cells on this property. LITERATURE REVIEW: Although previous in vivo studies have provided evidence for the migration of CE chondrocyte from hyaline CEs into the notochordal nucleus pulposus (NP), it is unclear if CE chondrocytes of the IVD actually have motile properties. In addition, the effect of notochordal cells on these properties has not been reported. MATERIALS AND METHODS: Notochordal cells and CE chondrocytes were harvested from three-month-old male Wistar rats and cultured separately. The motility was assayed in quadruplicate using a 48-well microchemotaxis chamber and a gelatin-coated 8-micrometer polycarbonate membrane filter. The control medium (serum-free culture medium), notochordal cells (4x, 2x, 1x and 0.5x10(6)) and concentrated conditioned medium (10-, 50-fold) where notochordal cells were cultured were loaded into the wells of the lower chamber, and CE chondrocytes were added to the wells of the upper chamber. At the end of the assays, the CE chondrocytes that migrated to the bottom side of the membrane filter were stained, counted, and compared. RESULTS: Compared with the control medium, the notochordal cells (N = 4x, 2x, 1x and 0.5x10(6)) and concentrated conditioned medium (10- and 50-fold) significantly increased the chemotactic motility of the CE chondrocytes in a number- and concentration-dependent manner (p<0.05). CONCLUSION: The CE chondrocytes of the intervertebral disc are motile, and soluble factors produced by notochordal cells induce the chemotaxis of CE chondrocytes.
Animals ; Cartilage ; Chemotaxis* ; Chondrocytes* ; Culture Media, Conditioned ; Humans ; Hyalin ; Intervertebral Disc ; Male ; Membranes ; Notochord* ; Rats ; Rats, Wistar

Thoracic fracture-dislocations reportedly lead to an 80% incidence of complete paraplegia. Thus, thoracic fracture-dislocations without cord injury are uncommon. There are a few cases of thoracic fracture-dislocations in which the neural sparing status was associated with separation of the posterior spinal structures, such as the pedicles and laminae. The authors experienced two cases of thoracic fracture-dislocations without spinal cord injury: one was a 50-year-old man who fell from the fourth floor of a building and sustained a T6-7 fracture-dislocation; and the other was a 43-year-old man who was involved in motorcycle accident and sustained a T12 fracture-dislocation. Segmental spinal instrumentation and fusion without open reduction was performed in each of the two cases and there has not been any abnormality detected on neurological examination at a minimum follow-up period of 2 years.
Adult ; Follow-Up Studies ; Humans ; Incidence ; Middle Aged ; Motorcycles ; Neurologic Examination ; Paraplegia ; Spinal Cord Injuries* ; Spinal Cord*