The present study has been carried out to enhance the specificity of computed tomography (CT) in diagnosing herniated nucleus pulposus (HNP) of the lumbar spine by the application of measure-set (MS) technic. MSCT scans of 20 patients with proven diagnosis of HNP were reviewed prospectively to sort out features of diagnostic value. Eleven were men and 9 were women with the mean age being 40 years. MSCT scan revealed dislocation of the center of the nucleus pulposus (NP) in direction of herniation in 75%, "permeation" of the annulus fibrosus (AF) by HNP material and a clear disruption of the outermost layer of AF in all patients. The site and grade of the protrusion of HNP beyond the normal saliancy of AF could be easily evaluated in 90%. The present study saliancy of AF could be easily evaluated in 90%. The present study revealed that MSCT can demonstrate four characteristic findings of HNP enabling one to directly and semiquantitatively assess the pathologic changes of NP.
Adult ; Female ; Humans ; Male ; Spinal Diseases/diagnosis/*radiography ; *Tomography, X-Ray Computed

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*

OBJECTIVE: To assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings. MATERIALS AND METHODS: A total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard. RESULTS: The MD, LD, and RD cut-off values were 1.079 × 10⁻³, 1.719 × 10⁻³, and 0.749 × 10⁻³ mm²/sec, respectively, and that of FA was 0.475. Sensitivity, specificity, positive predictive value and negative predictive value were: 100 (4/4), 44.8 (13/29), 20 (4/20), and 100 (13/13) for MD; 100 (4/4), 27.6 (8/29), 16 (4/25), and 100 (8/8) for FA; 100 (4/4), 58.6 (17/29), 25 (4/16), and 100 (17/17) for MD∩FA; 100 (4/4), 68.9 (20/29), 30.8 (4/13), and 100 (20/20) for LD∩FA; and 75 (3/4), 68.9 (20/29), 25 (3/12), and 95.2 (20/21) for RD∩FA in percentage value. Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024) and MD and RD∩FA (p = 0.024). CONCLUSION: Fractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI.
Adult ; Aged ; Aged, 80 and over ; Cervical Vertebrae ; *Diffusion Tensor Imaging ; Echo-Planar Imaging ; Female ; Humans ; Male ; Middle Aged ; ROC Curve ; Sensitivity and Specificity ; Severity of Illness Index ; Spinal Cord Compression/*diagnosis/pathology/radiography ; Spinal Cord Diseases/*diagnosis/pathology/radiography

Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation, however it is still rare and underdiagnosed. Magnetic resonance imaging findings such as spinal cord edema and dilated and tortuous perimedullary veins play a pivotal role in the confirmation of the diagnosis. However, spinal angiography remains the gold standard in the diagnosis of SDAVF. Classic angiographic findings of SDAVF are early filling of radicular veins, delayed venous return, and an extensive network of dilated perimedullary venous plexus. A series of angiograms of SDAVF at different locations along the spinal column, and mimics of serpentine perimedullary venous plexus on MR images, are demonstrated. Thorough knowledge of SDAVF aids correct diagnosis and prevents irreversible complications.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Central Nervous System Vascular Malformations/*diagnosis/epidemiology/etiology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Diseases/diagnosis ; Spine/radiography

This study aimed to examine the diagnostic accuracy and clinical efficacy of initial CT-guided percutaneous biopsy of the vertebral lesions. A total of 305 percutaneous biopsies of the vertebral lesions were performed under either CT guidance (n=127) or C-arm guidance (n=178). The diagnostic accuracy rate was evaluated by comparing the histopathological diagnosis with the ultimate diagnosis. The histopathological diagnosis was consistent with the ultimate diagnosis in 108 (85.0%, 108/127) cases of CT-guided biopsy and in 135 (75.8%, 135/178) cases of C-arm guided biopsy and there was a significant difference. The accuracy of diagnosis based on biopsies varied with different diseases, including primary benign or malignant tumors, metastatic tumors, inflammatory lesions and fractures. A second biopsy or further examinations were required for patients with negative result obtained in the initial biopsy. The complication rate was 3.1% (4/127) in CT-guided biopsy and 7.3% (13/178) in C-arm guided biopsy. In conclusion, CT-guided percutaneous biopsy is an accurate and safe technique for biopsy of the vertebral lesions.
Biopsy, Needle ; methods ; Diagnosis, Differential ; Humans ; Radiography, Interventional ; adverse effects ; methods ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Spinal Diseases ; diagnosis ; Tomography, X-Ray Computed ; adverse effects ; methods

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

Hepatic myelopathy is a rare complication of chronic liver disease that is associated with extensive portosystemic shunts. The main clinical feature of hepatic myelopathy is progressive spastic paraparesis in the absence of sensory or sphincter impairment. Early and accurate diagnosis of hepatic myelopathy is important because patients with early stages of the disease can fully recover following liver transplantation. Motor-evoked potential studies may be suitable for the early diagnosis of hepatic myelopathy, even in patients with preclinical stages of the disease. Here we describe two patients who presented with spastic paraparesis associated with a spontaneous splenorenal shunt and without any previous episode of hepatic encephalopathy. One patient experienced improved neurologic symptoms after liver transplantation, whereas the other patient only received medical treatment, which did not prevent the progression of spastic paraparesis.
Adult ; Disease Progression ; Evoked Potentials, Motor/physiology ; Hepatitis B, Chronic/complications/diagnosis ; Hepatitis C, Chronic/complications/diagnosis ; Humans ; Liver Cirrhosis/*complications/diagnosis ; Liver Transplantation ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Paraparesis, Spastic/etiology/pathology ; Renal Veins/*radiography ; Spinal Cord Diseases/*diagnosis/etiology/radiography ; Splenic Vein/*radiography ; Tomography, X-Ray Computed ; Vascular Fistula/*radiography

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

Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive myelopathy. This condition has recently seen an increased frequency of diagnosis, possibly due to increased awareness and the use of magnetic resonance (MR) imaging. ISCH is characterised by herniation of the thoracic spinal cord through an anterior or anterolateral dural defect. Patients usually present with a Brown-Séquard-like syndrome, which is gradually progressive and may evolve into severe paraparesis. This disease has a characteristic radiological appearance, and in most cases, excellent postsurgical outcome. We report ISCH and its imaging appearance in a 31-year-old woman with classical presentation, and discuss the current concepts regarding the aetiopathogenesis, radiological features and management of the disease.
Adult ; Female ; Hernia ; diagnosis ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Radiography ; Spinal Cord ; diagnostic imaging ; pathology ; physiopathology ; Spinal Diseases ; diagnosis ; diagnostic imaging

Adult ; Bone Cysts, Aneurysmal ; diagnostic imaging ; pathology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone ; pathology ; Humans ; Osteosarcoma ; pathology ; Radiography ; Spinal Diseases ; diagnostic imaging ; pathology ; surgery ; Spinal Neoplasms ; pathology ; Spine ; diagnostic imaging ; pathology ; surgery