Symptomatic perforation of the anterior annulus fibrosus/anterior longitudinal ligament during surgery for herniated lumbar disc disease is one of the more solemn and sobering complications experienced by neurosurgeons or orthopedic surgeons. Iatrogenic vascular injuries are unusual complications of lumbar disk surgery. The incidence of such injuries is very low but probably underestimated because clinical manifestations may be extremely variable depending on the extension of trauma. Diagnosis is suspected when early signs or retroperitoneal hemorrhage appear, but may often be delayed. I experienced 5 autopsied cases of acute hemorrhage due to vascular trauma in disk surgery. A review of the literature is present and the medicolegal implications of symptomatic ventral perforations of the annulus fibrosus/anterior longitudinal ligament are discussed.
Autopsy ; Diagnosis ; Hemorrhage ; Incidence ; Longitudinal Ligaments ; Orthopedics ; Vascular System Injuries*

PURPOSE: To diagnose the extent of soft tissue damage with MRI, and to evaluate the relationship between soft tissue damage and a spinal cord injury in an extension injury to the lower cervical spine trauma. MATERIALS AND METHODS: Eighty-one patients who treated surgically for an anextension injury to the cervical spine over the past 5 years, were analyzed. All patients had undergone MRI after the injury, and for the specific grading of soft tissue damage, the grades were defined from grades 1 to 5. RESULTS: The spinal cord injury developed with more than grade 3 soft tissue damage associated with a rupture of the posterior longitudinal ligament (p<0.01). The changes in signal intensity of the spinal cord also developed according to the severity of soft tissue damage (p<0.01). There was no relationship between the soft tissue damage and the spinal cord injury in spinal stenosis (p=0.75). CONCLUSION: The extent of soft tissue damage was diagnosed precisely with MRI, and there was an close relationship between the soft tissue damage and spinal cord injury in the distractive- extension injury to the lower cervical spine trauma.
Humans ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Rupture ; Spinal Cord ; Spinal Cord Injuries ; Spinal Stenosis ; Spine*

PURPOSE: To evaluate injury patterns of facet joints and associated soft tissue injuries in patients withacute traumatic cervical facet joint injuries. MATERIALS AND METHODS: From among patients with cervical spinetrauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzedwith regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, andother associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury,intervertebral disc herniation, and spinal cord injury. RESULTS: The most common location of facet joint injurywas C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) hadbilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fractureof inferior facet was more frequent than superi-or. Patterns of fracture were vertical, transverse, or comminuted,but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facetfractures. Fractures other than facet includ-ed pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13),and spinous process(n=3). On MR im-ages, anterior longitudinal ligament injury was found in 8 patients(30%),posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelvepatients(44%) had spinal cord injuries includ-ing edema(n=8) and hemorrhage(n=4). Among patients with discabnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine. CONCLUSION: Traumatic cervical facet joint injuries were manifested as various patterns and frequentlyassoci-ated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patternshelped formulate a therapeutic plan and determine of prognosis.
Dislocations ; Humans ; Intervertebral Disc ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Imaging* ; Prognosis ; Soft Tissue Injuries ; Spinal Cord Injuries ; Spine* ; Tomography, X-Ray Computed ; Zygapophyseal Joint*

Massage is generally accepted as a safe and a widely used modality for various conditions, such as pain, lymphedema, and facial palsy. However, several complications, some with devastating results, have been reported. We introduce a case of a 43-year-old man who suffered from tetraplegia after a neck massage. Imaging studies revealed compressive myelopathy at the C6 level, ossification of the posterior longitudinal ligament (OPLL), and a herniated nucleus pulposus (HNP) at the C5-6 level. After 3 years of rehabilitation, his motor power improved, and he is able to walk and drive with adaptation. OPLL is a well-known predisposing factor for myelopathy in minor trauma, and it increases the risk of HNP, when it is associated with the degenerative disc. Our case emphasizes the need for additional caution in applying manipulation, including massage, in patients with OPLL; patients who are relatively young (i.e., in the fifth decade of life) are not immune to minor trauma.
Adult ; Facial Paralysis ; Humans ; Longitudinal Ligaments ; Lymphedema ; Massage ; Neck ; Ossification of Posterior Longitudinal Ligament ; Quadriplegia ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases ; Spinal Cord Injuries

In cases that the ossified posterior longitudinal ligament(OPLL) is so adherent to the dura, operator has no choice but to extirpate the ossified portion and the dura as a whole, and CSF leaks out through the dura defect during anterior decompression in the cervical spine. However, a postoperative CSF fistula in operative wound in the neck has not been reported yet. The authors have experienced a case that the ossified mass was so incorporated with the dura in a wide extent that a large defect had to be left in the dura and intractable CSF leakage occurred eventually. The leakage had been managed with over 10-day-long lumar drainage of CSF, however, the leakage had got even worse. In the second operation for the CSF leakage, fibrin glue(Tissel(R) was used to enhance the result of CSF leakage repair, with packing of muscle in the dura defect. Postoperatively the patient was managed with another 2-week-long lumbar drainage, followed by complete repair of the CSF fistula. The experiences we gained with this case herald that CSF fistula can be another candidate for postoperative complication in the anterior decompression for OPLL, and fibrin glue has an excellent sealing property in the management of CSF fistula.
Cerebrospinal Fluid* ; Decompression* ; Drainage ; Fibrin ; Fibrin Tissue Adhesive ; Fistula* ; Humans ; Longitudinal Ligaments* ; Neck ; Postoperative Complications ; Spine* ; Wounds and Injuries

A 77-year-old man presented with severe dyspnea, neck pain, tingling sensation in both hands, and weakness after an acute prevertebral soft tissue hematoma due to distractive-extension injury. Magnetic resonance images demonstrated an extensive hematoma accumulation, anterior longitudinal ligament and longus colli muscle injuries. We report here a case of dyspnea due to an extensive prevertebral hematoma by soft tissue injury without cervical vertebral fracture and/or dislocation and a review the relevant literature.
Aged ; Dislocations ; Dyspnea ; Hand ; Hematoma ; Humans ; Longitudinal Ligaments ; Magnetic Resonance Spectroscopy ; Muscles ; Neck Pain ; Sensation ; Soft Tissue Injuries ; Spine

PURPOSE: To determine the implications of soft tissue damage and to evaluate the correlations between the extent of soft tissue damages and spinal cord injury after a lower cervical spine trauma. MATERIALS AND METHODS: This study analyzed the medical records, plain radiograms, and MRI of the consecutive 89 patients who underwent operative treatment in the lower cervical trauma. The radiological parameters of soft tissue damage including anterior longitudinal ligament (ALL), intervertebral disc (Disc), posterior longitudinal ligament (PLL), ligamentum flavum (LF), interspinous ligament (ISL), supraspinous ligament (SSL), posterior muscle group (PM), cord compression (CC), and cord signal changes (CS) were evaluated using plain radiograms and magnetic resonance imaging. The relationship between the level of cord injury and the type of soft tissue damage, injury type and severity was determined. RESULTS: There was a significant correlation between the extent of cord injury and the injury type. Cord injury frequently occurred as a result of compressive extension (3 of 4 cases), combined injury (4 of 7 cases) and distractive extension (14 of 23 cases). On the other hand, only 11 of the 16 cases with compressive flexion had a cord injury. In the distractive-extension cord injury cases (2 out of 10 cases in stage I, 12 out of 13 cases in stage II) the frequency of cord injury increased with increasing degree of the soft tissue damage. The incidence of cord injury was higher in the distractive-flexion cases (stage I, 0 out of 6 cases, stage II, 8 out of 35 cases, stage III, 3 out of 5 cases), (p=0.082). Multiple logistic analysis revealed a significant correlation between the cord injury and soft tissue damage including parameters such as the injury type, PLL injury, CC and CS. There was more frequent cord injury encountered in patients with more extensive injuries to the posterior neck muscles (p=0.063). CONCLUSION: There was a significant correlation between the injury type and the incidence of cord injury. In distractive extension and distractive flexion, there was more increasing incidence of cord injury with increasing severity of the injury. In addition, there was a high incidence of cord injury associated with not only the injury type but also a PLL and posterior neck muscle injury.
Hand ; Humans ; Incidence ; Intervertebral Disc ; Ligaments ; Ligamentum Flavum ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Medical Records ; Neck Muscles ; Spinal Cord Injuries* ; Spinal Cord* ; Spine*

STUDY DESIGN: Two case reports. OBJECTIVES: We present two cases of quadriplegia after posterior decompression with fusion caused by a suspicious reperfusion injury of spinal cord without remarkable surgical insult. SUMMARY OF LITERATURE REVIEW: Posterior decompression and posterolateral fusion have been reported as effective procedures in patients with multilevel myelopathy. However, postoperative spinal cord injury without remarkable intraoperative technical damage has been reported in a few articles. Reperfusion mechanism was suggested as one of the leading causes and reported in some animal models. MATERIALS AND METHODS: There was one case of ossification of the posterior longitudinal ligament and one developmental multilevel stenosis that underwent laminectomy with lateral mass instrumentation. After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. RESULTS: After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. CONCLUSION: Although patients with such a medical condition are rare, it is difficult to predict postoperative swelling of the spinal cord before surgery. The surgeon should thus be aware of such rare disease conditions involving the spinal cord before the surgical procedure.
Constriction, Pathologic ; Decompression* ; Humans ; Laminectomy ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Models, Animal ; Quadriplegia ; Rare Diseases ; Reperfusion ; Reperfusion Injury* ; Spinal Cord Diseases ; Spinal Cord Injuries ; Spinal Cord*

OBJECTIVETo compare the efficacy difference in the treatment of supraspinous ligament injury between floating acupuncture at Tianying point and the conventional warm needling therapy.

METHODSNinety patients were randomized into a floating acupuncture group and a warm needling group, 45 cases in each one. In the floating acupuncture group, the floating needling technique was adopted at Tianying point. In the warm needling group, the conventional warm needling therapy was applied at Tianying point as the chief point in the prescription. The treatment was given 3 times a week and 6 treatments made one session. The visual analogue scale (VAS) was adopted for pain comparison before and after treatment of the patients in two groups and the efficacy in two groups were assessed.

RESULTSThe curative and remarkably effective rate was 81.8% (36/44) in the floating acupuncture group and the total effective rate was 95.5% (42/44), which were superior to 44.2% (19/43) and 79.1% (34/43) in the warm needling group separately (P < 0.01, P < 0.05). VAS score was lower as compared with that before treatment of the patients in two groups (both P < 0.01) and the score in the floating acupuncture group was lower than that in the warm needling group after treatment (P < 0.01). Thirty-six cases were cured and remarkably effective in the floating acupuncture group after treatment, in which 28 cases were cured and remarkably effective in 3 treatments, accounting for 77.8 (28/36), which was apparently higher than 26.3 (5/19) in the warm-needling group (P < 0.01).

CONCLUSIONThe floating acupuncture at Tianying point achieves the quick and definite efficacy on supraspinous ligament injury and presents the apparent analgesic effect. The efficacy is superior to the conventional warm-needling therapy.

Acupuncture Points ; Acupuncture Therapy ; methods ; Adolescent ; Adult ; Aged ; Female ; Humans ; Longitudinal Ligaments ; injuries ; Male ; Middle Aged ; Pain Management ; Treatment Outcome ; Young Adult

Traumatic retropharyngeal hematoma is a rare condition and may be lethal in some cases. In patients with this condition, the absence of a vertebral fracture or a major vascular injury is extremely rare. We present the case of a 92-year-old man who hit his forehead by slipping on the floor in his house. He had no symptoms at the time; however, he experienced throat pain and dyspnea at 6 hours after the injury. On arrival, he complained of severe dyspnea; therefore, an emergency endotracheal intubation was performed. A lateral neck roentgenogram after intubation showed dilatation of the retropharyngeal and retrotracheal space and no evidence of a cervical vertebral fracture. Cervical computed tomography (CT) with contrast medium revealed a massive hematoma extending from the retropharyngeal to the superior mediastinal space but no evidence of contrast medium extravasation or a vertebral fracture. However, sagittal magnetic resonance imaging (MRI) revealed an anterior longitudinal ligament (C4-5 levels) injury. We determined that the cause of the hematoma was an anterior longitudinal ligament injury and a minor vascular injury around the injured ligament. Therefore, we recommend that patients with retropharyngeal hematoma undergo sagittal cervical MRI when roentgenography and CT reveal no evidence of injury.
Aged ; Aged, 80 and over ; Hematoma ; diagnosis ; etiology ; Humans ; Longitudinal Ligaments ; injuries ; Magnetic Resonance Imaging ; Male ; Pharyngeal Diseases ; diagnosis ; etiology ; Tomography, X-Ray Computed