Klippel-Feil syndrome is characterized by congenital fusion of cervical vertebrae with a wide range of associated anomaly. The authors present a 50-year-old Klippel-Feil syndrome patient with a minor trauma followed progressive quadriparesis. He had typical radiologic findings of type II Klippel-Feil syndrome and presented progressive myelopathy due to cord compression at foramen magnum level with cervical instability. The patient underwent craniocervical decompression and fusion. The authors reviewed the pertinent literatures and discussed this rare syndrome.
Cervical Vertebrae ; Decompression ; Female ; Foramen Magnum ; Humans ; Klippel-Feil Syndrome* ; Middle Aged ; Quadriplegia* ; Spinal Cord Diseases

No abstract available.

Intraparenchymal epidermoid cyst is extermely rare. The authors treated a case of intraparenchymal, temporal lobe epidermoid cyst in 21-year old male who had presented with a generalized seizure attack and headache without any neurological deficits. The diagnosis was based on the characteristics of CT scan and MR imaging. The cyst was totally removed via transtemporal approach. Postoperative course was uneventful. The authors report this rare case with a review of the literature.
Diagnosis ; Epidermal Cyst* ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Seizures ; Temporal Lobe ; Tomography, X-Ray Computed ; Young Adult

C5 palsy is a common complication after cervical decompressive surgery, which have 0 to 30% complication rate. A 61-year-old female patient with cervical spondylotic myelopathy showed bilateral C5 palsy following circumferential decompression and fusion. Unexpectedly, bilateral C5 palsy was noted in different time points on postoperative day 2 and 8, respectively. Steroid injection and physical therapy were performed, and her motor function is recovering. Surgeons should make an effort to prevent possible C5 palsy when performing cervical decompression surgery.
Decompression* ; Female ; Humans ; Middle Aged ; Paralysis* ; Spinal Cord Diseases*

To investigate relationship between intracranial aneurysm and systemic hypertension, 190 consecutive cases of intracranial aneurysm which were treated surgically were analized in regard to the incidence of ypertension and to the effect of hypertension on their outcome. The incidence of hypertension in cases with aneurysm was higher than in general population. Multiple aneurysm patients had significantly higher incidence of hypertension than single aneurysm patients did. The amount of subarachnoid clot on postictal CT scan and neurological status on admission were not statistically different between hypertensive and normotensive group. Frequency of rebleeding was significantly higher in hypertensive group than in normotensive group. The incidence of cerebral vasospasm or hydrocephalus was statistically not significant between hypertensive group and normotensive group. The clinical outcome was similar between two groups.
Aneurysm ; Humans ; Hydrocephalus ; Hypertension* ; Incidence ; Intracranial Aneurysm* ; Tomography, X-Ray Computed ; Vasospasm, Intracranial

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

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*

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

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*

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