A 35 years old female patient was admitted to our neuro-pain clinic with symptoms of low back pain(L4, L5 level) radiated to both lower(L3, L4, L5 level) extremities that developed 6 years prior to admission. Upon initial physical examination, motor weakness or sensory deficit was absent. But on straight leg raising test, it was restricted to 60 degree in both lower extremities. Low back pain and radiating pain improved significantly after we performed epidural steroid injection. However on the next day of procedure the patient complaints more pain and started to experience severe pain during overnight for 3 days. On computer tomography(CT, L3-S1 level), we find suspicious lesion of herniated nucleus pulposus at L5-S1. Otherwise were within normal limits. Based on these symptoms, to find the other lesions, subsequently magnetic resonance imaging(MRI) was performed. Spinal tumor was seen at L2-3 level(2 2 4 cm). Neurosurgical surgery was recommended, and operation was performed. The patient was diagnosed to ependymoma after excision and cytologic studies. Even if one lesion was diagnosed, it must be put off until any other diseases or underlying cancer are ruled out. We report a patient with spinal cord tumor missed on CT, but revealed on MRI in the evaluation and management of herniated nucleus pulposus related(L5-S1) low back pain.
Adult ; Ependymoma ; Extremities ; Female ; Humans ; Leg ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Physical Examination ; Spinal Cord Neoplasms* ; Spinal Cord*

BACKGROUND: It is clinically important to know the distance of upper airway for airway management and respiratory care. The knowledge is useful for avoiding many possible complications due to endotracheal intubation by appropriate choice of endotracheal tube depth. METHODS: We investigated the distance from nose to carina according to the patient,s age, weight, height, sex with computed Tomography in 100 adults who had no anatomical abnormality of the upper airway, neck and head. RESULT: The length between upper incisor and vocal cord was 15.0+/-0.8 cm in male and 13.9+/-0.6 cm in female. The length between vocal cord and carina was 13.2+/-0.8 cm in male and 11.9+/-0.9 cm in female. The length between upper incisor and carina was 28.3 0.9 cm in male and 25.9+/-1.2 cm in female. The length between nose and vocal cord was 17.7+/-0.9 cm in male and 15.9+/-0.8 cm in female. The length between nose and carina was 30.9+/-1.2 cm in male and 27.9+/-1.3 cm in female. The distance of upper airway increased according to patient, s (n=100) height, weight and age(p<0.05). The distance of upper airway not increased according to female patient, s (n=36) age(p>0.05). CONCLUSION: The length between vocal cord and carina, nose and carina, incisor and carina increased according to patient, s (n=100) height, weight and age.
Adult ; Airway Management ; Female ; Head ; Humans ; Incisor ; Intubation, Intratracheal ; Male ; Neck ; Nose ; Vocal Cords