A 50-year-old male presented with acutely progressed paraplegia. His magnetic resonance imaging demonstrated two well-demarcated components with opposite signals in one cystic lesion between the T1- and T2-weighted images at the T1 spine level. The patient showed immediately improved neurological symptoms after surgical intervention and the histopathological exam was compatible with a neurenteric cyst. On operation, two different viscous drainages from the cyst were confirmed. A unique similarity of image findings was found from a review of the pertinent literature. The common findings of spinal neurenteric cyst include an isointense or mildly hyperintense signal relative to cerebrospinal fluid for both T1- and T2-weighted images. However, albeit rarer, the signals of some part of the cyst could change into brightly hyperintensity on T1-weighted images and hypointensity on T2-weighted images due to the differing sedimentation of the more viscous contents in the cyst.
Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; *Neural Tube Defects/diagnosis/physiopathology/surgery ; *Spinal Cord/pathology/surgery ; *Spinal Cord Diseases/diagnosis/physiopathology/surgery

Child ; Child, Preschool ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Spinal Cord ; abnormalities ; pathology ; Spinal Cord Diseases ; diagnosis ; pathology ; surgery ; Syndrome

A 24-year-old man with tuberculosis meningitis developed acute paraplegia and sensory disturbances 5 weeks after receiving conventional antituberculous therapy. Magnetic resonance imaging revealed an intradural extramedullary long segmental mass mimicking en plaque meningioma at the T2-T6 vertebrae levels. Prompt surgical decompression was performed. A histology examination of the mass revealed a tuberculoma. After surgery, the patient showed improved motor power and a normal bladder function. Intradural extramedullary tuberculoma of the spinal cord is rare complication of tuberculosis meningitis, which can occur as a response to conventional antituberculous therapy.
Diagnosis, Differential ; Humans ; Male ; Meningeal Neoplasms/*diagnosis ; Meningioma/*diagnosis ; Spinal Cord Diseases/*diagnosis/surgery ; Thoracic Vertebrae ; Tuberculoma/*diagnosis/surgery ; Tuberculosis, Meningeal/*diagnosis/surgery ; Young Adult

Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction clinical disease. Surgery is the main therapeutic tool for CSM. However, there are obvious differences in clinical functional recovery after operation. For the past few years, the influence factors of prognosis in cervical spondylosis myelopathic has been widely concerned. Age, nerve function, course of desease, imaging findings,surgical method and related factors became the investigative point for prognosis of cervical spondylotic myelopathy. Present viewpoint showed that the older patient, preoperative worse nerve function, longer the course of disease would result in worse outcomes. Imaging examination maybe can indicate the prognosis, but the correlation is unclear. Selection of surgical method and approach should be based on the principles of sufficient decompression, stabilize the alignment of the cervical spine, keeping backward extension of cervical spine, maintain effective decompression, preventing complications. Therefore, the treatment of cervical spondylotic myelopathy should be on the basis of pathogenic condition and imaging examination at early stage and a suitable usrgical procedure should be performed to obtain a better prognosis.
Cervical Vertebrae ; surgery ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Radiography ; Spinal Cord Diseases ; diagnosis ; diagnostic imaging ; surgery ; Spondylosis ; diagnosis ; diagnostic imaging ; surgery

BACKGROUNDOssification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy. This study was to describe a rare clinical entity of spinal cord kinking (SK) in thoracic myelopathy secondary to OLF.

METHODSThe data of 95 patients with thoracic myelopathy secondary to OLF were analyzed retrospectively. The incidence and location of SK were determined using preoperative magnetic resonance imaging (MRI). The clinical presentation and radiological characteristics in patients with SK were analyzed. Posterior en bloc laminectomy with OLF was performed, and the surgical results were evaluated.

RESULTSSK was found in seven patients (7.4%) based on preoperative MRI. The patients included one male and six females with an average age of 55.6 years (range, 48-64 years). Five patients presented with radiculomyelopathy and two presented with typical thoracic myelopathy of spastic paraparesis. In all cases, the kinking was located just above the end of the spinal cord where the conus medullaris (CM) was compressed by the OLF. The degree of SK varied from mild to severe. The tip of the CM was located between the upper third of T11 to the lower third of L1, above the lower edge of L1. With an average follow-up of 30.4 months, the modified Japanese Orthopedic Association score significantly improved from 5.7 ± 1.8 preoperatively to 8.9 ± 1.4 postoperatively (t = 12.05; P < 0.0001) with an improvement rate of 63.1 ± 12.3%.

CONCLUSIONSSK is a rare radiological phenomenon. It is typically located at the thoracolumbar junction, where the CM is compressed by the OLF. Our findings indicate that these patients may benefit from a posterior decompressive procedure.

Female ; Humans ; Ligamentum Flavum ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Ossification, Heterotopic ; complications ; Radiography ; Spinal Cord Compression ; diagnosis ; diagnostic imaging ; surgery ; Spinal Cord Diseases ; diagnosis ; diagnostic imaging ; etiology ; surgery

OBJECTIVETo detect the prevalence of spinal cord abnormality in "idiopathic" left thoracic scoliosis and analyze its clinical significance.

METHODSFrom October 1997 to October 2003, 59 "idiopathic" left thoracic scoliosis were treated, including 31 males and 28 females. The age was from 7 to 44 years with an average of 15 years. The Cobb angle was from 15 degrees to 108 degrees with average 56 degrees . The holocord MRI was made for all patients.

RESULTSThirty-three patients were found cord abnormality, including 24 Chiari malformation with syringomyelia, 5 syringomyelia, 1 Chiari malformation with syringomyelia and diastematomyelia, 1 Chiari malformation with syringomyelia and tethered cord, 1 syringomyelia with tethered cord, and 1 Dandy-Walker malformation. The prevalence of spinal cord abnormality in left thoracic scoliosis was 56%. Compared to the left thoracic scoliosis without cord abnormality, the left thoracic scoliosis with cord abnormality had been found more in males and the patients with bigger Cobb angle (P < 0.05).

CONCLUSIONSFor left thoracic scoliosis, especially male patient or patient with bigger Cobb angle, associated cord abnormality should be highly suspected. Preoperative holocord MRI is very meaningful for this kind of patients.

Adolescent ; Adult ; Child ; China ; epidemiology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Prevalence ; Scoliosis ; complications ; surgery ; Spinal Cord Diseases ; diagnosis ; epidemiology ; etiology ; Thoracic Vertebrae

Intramedullary spinal cord abscess (ISCA) is a rare infection of the central nervous system. We describe the magnetic resonance imaging (MRI) findings, including the diffusion-weighted imaging (DWI) findings, of ISCA in a 78-year-old man. The initial conventional MRI of the thoracic spine demonstrated a subtle enhancing nodule accompanied by significant edema. On the follow-up MRI after seven days, the nodule appeared as a ring-enhancing nodule. The non-enhancing central portion of the nodule appeared hyperintense on DWI with a decreased apparent diffusion coefficient (ADC) value on the ADC map. We performed myelotomy and surgical drainage, and thick, yellowish pus was drained.
Abscess/complications/*diagnosis/surgery ; Aged ; Anti-Bacterial Agents/therapeutic use ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; Drainage ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Paraplegia/etiology ; Spinal Cord Diseases/complications/*diagnosis/surgery ; Thoracic Vertebrae

OBJECTIVETo investigate the efficacy and possibly prognositic factors of anterior approach on two-level cervical spondylotic myelopathy.

METHODSA retrospective review was performed on 44 cases of two-level cervical spondylotic mydopathy from Jun. 2007 to Sep. 2009. Among the patients, 24 cases were male and 20 cases female, with an average age of (60.072 +/- 10.77) years (ranged from 39 to 80 years). The affected segments ranged from C(3.4)-C(6.7). Improvements of cervical curvature and segmental height, preoperative sagittal diameter of the spinal cord at the site of maximal compression and signal intensity changes on T2WI were respectively measured. Function of nerves was assessed according to Japanese orthopaedic association system (JOA:17 score) before and after surgery. Operation by anterior approach including: anterior corpectomy and titanium cage fusion with internal fixation, anterior corpectomy body and auto iliac bone fusion with internal fixation. Statistical analysis was made on the correlation between JOA recovery rate and prognostic factors.

RESULTSImprovements of cervical curvature was -9.1 degrees to 16.6 degrees with the mean of (1.30 +/- 5.77) degrees and improvements of segmental height was -0.3 to 12.3 mm with the mean of (4.23 +/- 3.08) mm. Sagittal diameter of the spinal cord at the site of maximal compression was 1.6 to 7.2 mm with the mean of (4.01+/- 1.25) mm. T2WI with high signal changes was in 29 cases, no change in 15 cases. Bleeding amount was 50 to 700 ml with the mean of (242.05 +/- 148.22) ml. Operative time was 90 to 250 min with the mean of (153.75 +/- 34.54) min. All patients were followed up from 6 to 31 months with an average of (17.18 +/- 7.41) months. The mean JOA score preoperatively was (12.73 +/- 2.23); at the final follow-up, the JOA score was(15.09 +/- 1.91); and the recovery rate was (60.01 +/- 26.98)%. According to standard of JOA scoring, 16 cases obtained excellent result, 12 good, 15 fair and 1 poor. The effect of anterior approach had correlations with age, time of course, preoperative JOA score, sagittal diameter of the spinal cord at the site of maximal compression and signal intensity changes on T2WI, but had no correlations with operation time, bleeding amount and improvements of cervical curvature and segmental height.

CONCLUSIONTwo-level cervical spondylotic myelopathy can achieve good effect through anterior approach. The extent of the spinal cord compression may be a reliable and direct factor to judge effect.

Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Spinal Cord Diseases ; complications ; diagnosis ; diagnostic imaging ; surgery ; Spondylosis ; complications ; diagnosis ; diagnostic imaging ; surgery ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome