Pelvic reconstruction after sacral resection is challenging in terms of anatomical complexity, excessive loadbearing, and wide defects. Nevertheless, the technological development of 3D-printed implants enables us to overcome these difficulties. Here, we present a case of sacral osteosarcoma surgically treated with hemisacrectomy and sacral reconstruction using a 3D-printed implant. The implant was printed as a customized titanium prosthesis from a 3D real-sized reconstruction of a patient's CT images. It consisted mostly of a porous mesh and incorporated a dense strut. After 3-months of neoadjuvant chemotherapy, the patient underwent hemisacretomy with preservation of contralateral sacral nerves. The implant was anatomically installed on the defect and fixed with a screw-rod system up to the level of L3. Postoperative pain was significantly low and the patient recovered sufficiently to walk as early as 2 weeks postoperatively. The patient showed left-side foot drop only, without loss of sphincter function. In 1-year follow-up CT, excellent bony fusion was noticed. To our knowledge, this is the first report of a case of hemisacral reconstruction using a custom-made 3D-printed implant. We believe that this technique can be applied to spinal reconstructions after a partial or complete spondylectomy in a wide variety of spinal diseases.
Drug Therapy ; Follow-Up Studies* ; Foot ; Humans ; Osteosarcoma* ; Pain, Postoperative ; Prostheses and Implants ; Sacrum ; Spinal Diseases ; Spinal Fusion ; Titanium ; Weight-Bearing

The metastasis of uterine leiomyosarcoma to the neck node has not been reported previously and the radiotherapy has been rarely used for the metastatic lesion of the other sites. We report a case of neck metastasis from a uterine leiomyosarcoma, which developed 10 months after surgery and postoperative pelvic radiotherapy. It also involved the parapharyngeal space, adjacent spine, and spinal canal. The metastatic neck mass was inoperable, and was treated by neck radiotherapy (6,000 cGy) and chemotherapy including taxol and carboplatin. The mass has regressed progressively to a nearly impalpable state. She has never developed spinal cord compression syndrome, and has maintained good swallowing for eight months since the neck radiotherapy and chemotherapy. Since the extensive metastatic neck mass showed good local response to high dose radiotherapy and chemotherapy, both treatments may be considered for an unresectable metastatic leiomyosarcoma.
Carboplatin ; Deglutition ; Drug Therapy* ; Leiomyosarcoma* ; Lymphatic Diseases* ; Neck ; Neoplasm Metastasis ; Paclitaxel ; Radiotherapy* ; Spinal Canal ; Spinal Cord Compression ; Spine

STUDY DESIGN: A review of related literatures of diagnosis and treatment of spinal tuberculosis. OBJECTIVES: The aim of the study was to discuss treatment strategies by understanding of emerging problems related to spinal tuberculosis. SUMMARY OF LITERATURE REVIEW: Owing to modern diagnostic modalities, development of prevention and chemotherapy, the incidences of tuberculosis infection including spinal tuberculosishave been decreasing. Moreover, these medical these improvements of medical and surgical treatments the improvement of surgical techniques for spinal tuberculosis reduced the incidence of kyphosis or neurologic complications such as Pott's paralysis. MATERIALS AND METHODS: Review of related literatures. RESULTS: Recently,the occurrence of multi-drug resistant strain, an increasing number of opportunistic infections and an atypical presentation in spinal tuberculosis are emerging as new challenges. CONCLUSIONS: An appropriate diagnosis and surgical interventions are our obligation as clinicians dealing with this unique infectious disease to minimize the complications for the treatment of spinal tuberculosis.
Communicable Diseases ; Diagnosis ; Drug Therapy ; Incidence ; Kyphosis ; Opportunistic Infections ; Paralysis ; Spine* ; Tuberculosis* ; Tuberculosis, Spinal

A non-ambulatory dog with tetraparesis following a pain episode that had evolved over 2 months was submitted for medical treatment and diagnosed with intervertebral disk disease at C3-C4 and dorsal extradural compression at C1-C2 and C3-C4 using myelography and computed tomography. The dog experienced ambulation recovery after 15 days of treatment with only electroacupuncture and Chinese herbal medicine, with marked improvement occurring after only 10 treatments. Six months of followup demonstrated that the dog was stable and had no recurrence of symptoms. Therefore, it was concluded that the combination of electroacupuncture and Chinese herbal medicine was responsible for motor rehabilitation.
Animals ; Cervical Vertebrae/*pathology ; Dog Diseases/*drug therapy/*therapy ; Dogs ; Drugs, Chinese Herbal/*therapeutic use ; Electroacupuncture/methods/*veterinary ; *Intervertebral Disk ; Myelography/veterinary ; Spinal Cord Compression/radiography/therapy/*veterinary ; Spinal Diseases/drug therapy/therapy/*veterinary ; Treatment Outcome

We report a case of 54-yr-old woman who presented with 4-extremities weakness and sensory changes, followed by cervical spinal cord lesion in magnetic resonance imaging. Based on the suspicion of spinal tumor, spinal cord biopsy was performed, and the histology revealed multinucleated giant cells, lymphocytes and aggregated histiocytes within granulomatous inflammation, consistent with non-caseating granuloma seen in sarcoidosis. The patient was treated with corticosteroid, immunosuppressant and thalidomide for years. Our case indicates that diagnosis of spinal cord sarcoidosis is challenging and may require histological examination, and high-dose corticosteroid and immunosuppressant will be a good choice in the treatment of spinal cord sarcoidosis, and the thalidomide has to be debated in the spinal cord sarcoidosis.
Adrenal Cortex Hormones/therapeutic use ; Biopsy ; Central Nervous System Diseases/drug therapy/pathology ; Female ; Humans ; Immunosuppressive Agents/*therapeutic use ; Magnetic Resonance Imaging ; Middle Aged ; Sarcoidosis/drug therapy/pathology ; Spinal Cord/*pathology ; Spinal Cord Diseases/drug therapy/*pathology ; Thalidomide/*therapeutic use

The repairing and regeneration of peripheral nerves is a very complex biological and cytological process, its mechanism is unclear so far, and thus results in the lack of specific and effectual therapy and medicament. Chinese herbs and their effective components have their own inimitable predominance in promoting peripheral nerve regeneration, such as their multi-factorial, multi-target and multi-functional action, abundant source, inexpensive, etc. In this paper, the experimental studies reported in recent 5 years concerning the effects of Chinese herbs or their active components on peripheral nerve repairing and regeneration are reviewed in respects of the integral level, cellular level, molecular level and gene level.
Animals ; Drug Evaluation, Preclinical ; Drugs, Chinese Herbal ; pharmacology ; Nerve Regeneration ; drug effects ; Peripheral Nervous System Diseases ; drug therapy ; Spinal Cord Injuries ; drug therapy

Bone is a common metastatic site of cancer. Bone metastasis reduces life expectancy and results in serious symptoms and complications such as bone pain, pathological fractures, and spinal cord compression, decreasing quality of life by restricting sleep and mobility. Treatment for bone metastasis includes drugs (pure analgesics, hormones, cytotoxic chemotherapy, and bisphosphonates, among others), external radiation therapy, surgery, and radionuclide therapy using bone-targeting radiopharmaceuticals. Particulate radiation with α- or β-rays is used as a bone-targeting radiopharmaceutical in radionuclide therapy. β-Emitters have lower energy and a longer range than α-emitters and have less tumoricidal activity and deliver more radiation to adjacent normal tissue. Therefore, the main therapeutic effect of bone-targeting β-emitters such as ⁸⁹Sr-dichloride is bone pain palliation rather than enhanced survival. In contrast, α-emitters such as ²²³Ra-dichloride have high energy and a short range, resulting in greater tumoricidal activity and less radiation damage to adjacent normal tissue. Treatment with bone-targeting α-emitters can improve survival and decrease bone pain. This review focuses on the principles and clinical utility of several clinically available bone-targeting radiopharmaceuticals in metastatic bone disease.
Analgesics ; Bone Diseases ; Diphosphonates ; Drug Therapy ; Fractures, Spontaneous ; Life Expectancy ; Neoplasm Metastasis ; Quality of Life ; Radiopharmaceuticals ; Spinal Cord Compression

Ossification of the posterior longitudinal ligament (OPLL) can be defined as an ectopic ossification in the tissues of spinal ligament showing a hyperostotic condition. OPLL is developed mostly in the cervical spine and clinical presentations of OPLL are majorly myelopathy and/or radiculopathy, with serious neurological pathology resulting in paralysis of extremities and disturbances of motility lowering the quality of life. OPLL is known to be an idiopathic and multifactorial disease, which genetic factors and non-genetic factors including diet, obesity, physical strain on the posterior longitudinal ligament, age, and diabetes mellitus, are involved into the pathogenesis. Up to now, surgical management by decompressing the spinal cord is regarded as standard treatment for OPLL, although there might be the risk of development of reprogression of ossification. The molecular pathogenesis and efficient therapeutic strategy, especially pharmacotherapy and/or preventive intervention, of OPLL has not been clearly elucidated and suggested. Therefore, in this review, we tried to give an overview to the present research results on OPLL, in order to shed light on the potential pharmacotherapy based on molecular pathophysiologic aspect of OPLL, especially on the genetic/genomic factors involved into the etiology of OPLL.
Diabetes Mellitus ; Diet ; Drug Therapy ; Extremities ; Ligaments ; Longitudinal Ligaments ; Obesity ; Ossification, Heterotopic ; Paralysis ; Pathology ; Quality of Life ; Radiculopathy ; Spinal Cord ; Spinal Cord Diseases ; Spine

Acupuncture Therapy ; Adolescent ; Adult ; Ataxia ; congenital ; drug therapy ; therapy ; Child ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Male ; Moxibustion ; Spinal Cord Diseases ; congenital ; drug therapy ; therapy ; Young Adult

OBJECTIVETo evaluate the clinical effects of Simo Decoction Oral Liquid for the treatment of gastrointestinal dysfunction after stable thoracolumbar fractures.

METHODSFrom May 2005 to July 2008, 81 patients with stable thoracolumbar fractures were randomly divided into treatment group (41 cases) and control group (40 cases) according to a random digits table. The treatment group included 32 males and 9 females with an average age of (47.19 +/- 5.18) years old ranging from 21 to 55 years, and the course was from 1 to 45 hours with an average of (7.83 +/- 1.29) hours. The control group included 30 males and 10 females with an average age of (46.31 +/- 3.72) years ranging from 20 to 54 years,and the course was from 1.5 to 43 hours with an average of (8.15 +/- 1.63) hours. The treatment group were dealed with Simo Decoction Oral Liquid,and the control group with neostigmine for acupoint block in bilateral Foot-Three-Li. The recovery of gastrointestinal function and the first passage of gas by anus were compared.

RESULTSThe time of recovery of gastrointestinal function in treatment group (7.27 +/- 3.14) h was shorter than that in control group (10.12 +/- 3.62) h. The time of first passage of gas by anus in treatment group (15.39 +/- 13.70) h was significantly shorter than that in contral group (24.02 +/- 18.11) h. The total effective rate in treatment group was higher than that in control group.

CONCLUSIONBoth the treatment group and the control group have clinical effects in treatment of the restoration of gastrointestinal dysfunction after the stable thoracolumbar fractures, but the treatment group has more remarkable therapeutic effect and less side effects.

Adult ; Female ; Gastrointestinal Diseases ; drug therapy ; Gastrointestinal Motility ; drug effects ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Spinal Fractures ; complications ; Thoracic Vertebrae ; injuries