OBJECTIVE: To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunction in patients with spinal cord injury (SCI). METHODS: Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography. RESULTS: The constipation scores ranged from 1 to 13, and the average was 4.19+/-3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13+/-1.45. CTTs were 19.3+/-16.17, 19.3+/-13.45, 15.32+/-13.15, and 52.42+/-19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4+/-0.7, 1.8+/-0.86, 2.83+/-0.82, 2.14+/-1, and 10.19+/-2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28+/-0.7, 2.8+/-0.8, 2.35+/-0.85, and 8.45+/-1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant correlations were observed between each segmental CTT and the segmental stool retention score (p<0.05). CONCLUSION: Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.
Colon ; Constipation ; Humans ; Megacolon ; Neurogenic Bowel ; Radiography, Abdominal ; Retention (Psychology) ; Spinal Cord ; Spinal Cord Injuries

STUDY DESIGN: This is a prospective study of 85 patients. OBJECTIVES: We wanted to identify the changes of ROM and sagittal alignment of the cervical spine after laminoplasty, and we wanted to determine the preoperative factors affecting the ROM and sagittal alignment of the cervical spine after laminoplasty. SUMMARY OF THE LITERATURE REVIEW: Cervical laminoplasty is an effective procedure for decompressing multilevel spinal cord compression. It has been reported that the ROM of the cervical spine was decreased after laminoplasty. It is well known that preoperative lordosis of the cervical spine is prerequisite for performing laminoplasty. Maintaining the postoperative lordosis of the cervical spine is also important for decompressing the spinal cord after laminoplasty. MATERIALS AND METHODS: Eighty-five patients who underwent open door laminoplasty from the C3 to C7 levels were prospectively studied. The minimum follow-up was two-years. The preoperative diagnosis was cervical spondylotic myelopathy (CSM) for 52 patients, ossification of the posterior longitudinal ligament (OPLL) for 29 patients and multilevel cervical disc herniation for 4 patients. Plain cervical spine lateral radiography in the neutral, flexion and extension positions was performed preoperatively and at the two-year follow-up. The cervical lordosis or kyphosis was measured by Cobb's method. The diagnosis, degree of preoperative lordosis in the neutral position, and the degree of preoperative sagittal alignment in flexion and extension were studied as the risk factors for postoperative kyphosis. RESULTS: The preoperative ROM of the cervical spine was 29.2 degrees and the postoperative ROM was 20.3 degrees. Therefore, 30.5% of the preoperative ROM was decreased after laminoplasty. A decreased ROM of more than 50% was found in 13 patients (15.3%). Their diagnosis was CSM in 11 patients (11/52, 21.1%) and OPLL in 2 patients (2/29, 6.9%). There were no significant differences in preoperative ROM between the two groups with decreased ROM being noted in more than 50% of the patients and decreased ROM being noted in less than 50% of the patients. The preoperative lordotic angle in the neutral position was 16.2 degrees and the postoperative lordotic angle was 11.4 degrees. Kyphosis (mean: 12.2 degrees) developed in 9 patients (9/85, 10.6%) after the surgery. Their preoperative diagnosis was CSM in all patients. The preoperative lordotic angle was significantly less in the kyphotic group than in the lordotic group. The preoperative flexion was 10.2 degrees greater and the preoperative extension was 10.3 degrees less in the kyphotic group than in lordotic group. The preoperative flexion angle was 19.3 degree kyphosis and the extension angle was 8.7 degree lordosis in the kyphotic group. CONCLUSIONS: The ROM of the cervical spine was decreased 30.5% after laminoplasty. Kyphosis developed in 10.6% of the patients. The preoperative factors affecting postoperative kyphosis were the diagnosis of CSM, a preoperative lordosis less than 10 degrees and a greater preoperative flexion angle than the extension angle. Therefore, kyphosis after laminoplasty was expected in a patient with the above three preoperative factors, so other treatment options such as instrumented fusion should be considered.
Animals ; Diagnosis ; Follow-Up Studies ; Humans ; Kyphosis ; Longitudinal Ligaments ; Lordosis ; Prospective Studies ; Radiography ; Range of Motion, Articular* ; Risk Factors ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases ; Spine*

PURPOSE: To evaluate MR imaging findings of ossified posterior longitudinal ligament(OPLL) in the cervicalspine. MATERIALS AND METHODS: Retrospectively, simple radiography(n=34), CT(n=9), and MRI(n=11) of 34 patients with OPLL were reviewed. We evaluated the number of involved vertebral segment, morphologic type of lesions onaxial and sagittal imaging, spinal canal narrowing on the involved intervertebral disk level, intervertebral for aminal narrowing, relationship between spinal cord compression and morphologic type, and signal intensity onMRI. RESULTS: Average number of involved vertebral segment was 2.65(90/34). Most commonly involved vertebrallevel was C3--C4. On sagittal image, the lesions were classified to be continuous type(n=15), segmental type(n=7),mixed type(n=4), and circumscribed type(n=7). The most common type was continuous one(42%). On axial image, the lesions were classified to square type(n=13), mushroom type(n=18), hill type(n=13). The most common type was mushroom one(41%). Forty-five percent(20/44) showed spinal stenosis which exceeded 25% of anteroposterior diameter of spinal canal. Twenty-three percent(19/81) of the case showed intervertebral foraminal narrowing. T1- and T2-weighted MRI showed low signal intensity in every 11 case. Two cases showed focal high signal intensity within lowsinal intensity lesion on T1 weighted images. CONCLUSIONS: The ossified lesion of OPLL could be evaluated with simple radiography and CT. MRI displayed spinal cord compresion, intervertebral foraminal narrowing, and associated vertebral disease which maybe useful in preoperative evaluation of symptomatic patients.
Agaricales ; Humans ; Intervertebral Disc ; Longitudinal Ligaments* ; Magnetic Resonance Imaging ; Radiography ; Retrospective Studies ; Spinal Canal ; Spinal Cord ; Spinal Cord Compression ; Spinal Stenosis ; Spine*

Chlorfenapyr is a widely used, moderately hazardous pesticide. Previous reports have indicated that chlorfenapyr intoxication can be fatal in humans. We reported the first non-fatal case of chlorfenapyr-induced toxic leukoencephalopathy in a 44-year-old female with resolution of extensive and abnormal signal intensities in white matter tracts throughout the brain, brain stem, and spinal cord on serial magnetic resonance imaging.
Adult ; Brain/*radiography ; Brain Stem/radiography ; Female ; Humans ; Insecticides/*toxicity ; Leukoencephalopathies/*etiology/radiography ; *Magnetic Resonance Imaging ; Pyrethrins/*toxicity ; Spinal Cord/*radiography ; White Matter/radiography

BACKGROUND: This study examined the relationship between four radiological parameters (Pavlov's ratio, sagittal diameter, spinal cord area, and spinal canal area) in patients with a traumatic cervical spine injury, as well as the correlation between these parameters and the neurological outcome. METHODS: A total of 212 cervical spinal levels in 53 patients with a distractive-extension injury were examined. The following four parameters were measured: Pavlov's ratio on the plain lateral radiographs, the sagittal diameter, the spinal cord area, and the spinal canal area on the MRI scans. The Pearson correlation coefficients between the parameters at each level and between the levels of each parameter were evaluated. The correlation between the radiological parameters and the spinal cord injury status classified into four categories, A (complete), B (incomplete), C (radiculopathy), and D (normal) was assessed. RESULTS: The mean Pavlov's ratio, sagittal diameter, spinal cord area and spinal canal area was 0.84, 12.9 mm, 82.8 mm2 and 236.8 mm2, respectively. An examination of the correlation between the radiological spinal stenosis and clinical spinal cord injury revealed an increase in the values of the four radiological parameters from cohorts A to D. Pavlov's ratio was the only parameter showing statistically significant correlation with the clinical status (p = 0.006). CONCLUSIONS: There was a correlation between the underlying spinal stenosis and the development of neurological impairment after a traumatic cervical spine injury. In addition, it is believed that Pavlov's ratio can be used to help determine and predict the neurological outcome.
Adult ; Aged ; Analysis of Variance ; Cervical Vertebrae/*radiography ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck Injuries/*radiography ; Retrospective Studies ; Spinal Canal/pathology/*radiography ; Spinal Cord Injuries/pathology/*radiography ; Spinal Stenosis/pathology/*radiography ; Young Adult

OBJECTIVE: The purpose of this study is to evaluate the efficacy and necessity of combined anterior approach (discectomy and fusion) and posterior approach(open-door laminoplasty) in the treatment of cervical spondylotic myelopathy. METHODS: The authors reviewed 14 cases in whom combined anterior and posterior approach performed for cervical myelopathy due to simultaneous anterior and posterior pathology such as huge central disc herniation with narrow spinal canal between January 2000 and December 2002. Clinical symptoms were evaluated by Japanese Orthopaedic Association (JOA) score and then the cervical curvature, change of spinal canal to vertebral body(SC/VB) ratio and canal widening were measured and compared to the clinical symptoms. RESULTS: The mean JOA score increased from 10.4+/-3.1 preoperatively to 14.8+/-1.2 at the final follow up with a mean recovery rate 66.4%. In all cases, there were not neurologic deterioration. Mild postoperative complications developed in two cases. One patient had a limitation of range of neck motion and the other one showed kyphotic change. Postoperative radiography showed an improvement of body to canal ratios (average 0.70+/-0.08 before surgery to 1.05+/-0.12 after surgery) and mainte nance or recovery of cervical lordosis. Canal widening of antero-posterior diameter and dimension after operation is 6.8 mm, 116.61 mm2. CONCLUSION: Combined anterior and posterior procedure could be helpful in decompression of the spinal cord and good functional recovery in spondylotic myelopathy patients with combined anterior and posterior pathology such as huge disc herniation accompanying narrow spinal canal.
Animals ; Asian Continental Ancestry Group ; Decompression ; Follow-Up Studies ; Humans ; Lordosis ; Neck ; Pathology ; Postoperative Complications ; Radiography ; Spinal Canal ; Spinal Cord ; Spinal Cord Diseases*

CT myelography of the T11-L2 region was performed in 8 large-breed dogs with a clinical diagnosis of degenerative myelopathy (DM) and 3 large-breed dogs that were clinically normal. CT myelographic characteristics were recorded for each dog, at each disc level. Area measurements of the spinal cord, dural sac, vertebral canal, and vertebral body were recorded at 4 slice locations for each disc level. Mean area ratios were calculated and graphically compared, by slice location and group. In all dogs, CT myelography identified morphologic abnormalities that were not suspected from conventional myelograms. Characteristics observed with higher frequency in DM versus normal dogs were: spinal stenosis, disc protrusion, focal attenuation of the subarachnoid space, spinal cord deformity, small spinal cord, and paraspinal muscle atrophy. Mean spinal cord: dural sac, spinal cord: vertebral canal, dural sac: vertebral canal, and vertebral canal:vertebral body ratios were smaller in DM versus normal dogs at more than one disc level. Some CT myelographic characteristics in DM dogs were similar to those previously reported in humans, dogs and horses with stenotic myelopathy.
Animals ; Dog Diseases/*radiography ; Dogs ; Female ; Lumbar Vertebrae/radiography ; Male ; Myelography/*veterinary ; Spinal Cord Diseases/radiography/*veterinary ; Thoracic Vertebrae/radiography ; Tomography, X-Ray Computed/*veterinary

OBJECTIVE: The purpose of this study was to demonstrate the usefulness of digital subtraction cystography to identify communicating holes between a spinal extradural arachnoid cyst (SEAC) and the subarachnoid space prior to cyst removal and hole closure. MATERIALS AND METHODS: Six patients with SEAC were enrolled in this retrospective study. Digital subtraction cystography and subsequent CT myelography were performed for every patient. The presence and location of the communicating holes on cystography were documented. We evaluated the MRI characteristics of the cysts, including location, size, and associated spinal cord compression; furthermore, we reviewed cystographic images, CT myelograms, procedural reports, and medical records for analysis. If surgery was performed after cystography, intraoperative findings were compared with preoperative cystography. RESULTS: The location of the communicating hole between the arachnoid cyst and the subarachnoid space was identified by digital subtraction cystography in all cases (n = 6). Surgical resection of SEAC was performed in 4 patients, and intraoperative location of the communicating hole exactly corresponded to the preoperative identification. CONCLUSION: Fluoroscopic-guided cystography for SEAC accurately demonstrates the presence and location of dural defects. Preoperative digital subtraction cystography is useful for detection of a communicating hole between a cyst and the subarachnoid space.
Adult ; Arachnoid Cysts/*radiography ; Female ; Fluoroscopy ; Humans ; Image Processing, Computer-Assisted/*methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography, Abdominal ; Retrospective Studies ; Spinal Cord Compression/radiography ; Spinal Cord Diseases/*radiography ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: A retrospective review of medical records and imaging studies. To investigate characteristic clinical features and surgical outcomes of spinal cord tumors (SCTs) of the thoracolumbar junction (TLJ). The spinal cord transitions to the cauda equina in the TLJ. The TLJ contains the upper and lower motor neurons of the spinal cord and cauda equina. As a result, the clinical features of lesions in the TLJ vary, and these anatomical characteristics may affect surgical outcome. MATERIALS AND METHODS: Pathological diagnosis, clinical features, neurological signs, and surgical outcomes were investigated in 76 patients surgically treated at our institute for SCTs arising from T11 to L2. The patients were divided into epiconus (T11-12, n=18) and conus groups (L1-2, n=58). RESULTS: Patients in the epiconus group had hyperactive deep tendon reflexes (DTRs), while those in the conus group had hypoactive DTRs (p < 0.05). Nine patients were misdiagnosed with intervertebral disc diseases (IVDs) before correct diagnoses were made. It was impossible to definitively determine the exact cause of symptoms in four patients who had both SCTs and IVDs. CONCLUSION: Among SCTs of the TLJ, the epiconus group displayed upper motor neuron syndrome and the conus group displayed lower motor neuron syndrome. SCTs of the TLJ were frequently misdiagnosed as IVDs due to symptomatic similarities. SCTs of the TLJ should be included in differential diagnosis of back and leg pain, and it is highly recommended that routine lumbar magnetic resonance imaging include the TLJ.
Cauda Equina/pathology/radiography ; Humans ; Intervertebral Disk Displacement/pathology/radiography ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Cord Compression/pathology/radiography ; Spinal Cord Neoplasms/*surgery ; Thoracic Vertebrae/*pathology/radiography ; Treatment Outcome

Intramedullary spinal neurofibroma is extremely rare. A case of cervical intramedullary neurofibroma is presented in a 21-year-old man. Only 20 case have been previously reported in the literature. The site of origin is discussed with various hypotheses.
Adult ; Humans ; Male ; Myelography/methods ; Neck ; Neurofibroma/*pathology/radiography ; Spinal Cord Neoplasms/*pathology/radiography ; Tomography, X-Ray Computed