Schwannomas are relatively common, benign tumors that are thought to arise from the nerve sheath cell. Schwannomas of the C1 root are extremely rare and seldom invade lateral masses because they gradually increase in size and can extend through the wide space behind the lateral mass instead of the intervertebral foramen. We present here an unusual case of a benign schwannoma that aggressively invaded the lateral mass of C-1.
Female ; Humans ; Middle Aged ; Neoplasm Invasiveness ; Neurilemmoma/*pathology ; Spinal Neoplasms/*pathology ; Spinal Nerve Roots/*pathology

OBJECTIVETo observe the morphological characteristics of sacral fracture under different impact loads.

METHODTen fresh pelvic specimens were loaded in dynamic or static state. A series of mechanical parameters including the pressure strain and velocity were recorded. Morphological characteristics were observed under scanning electron microscope.

RESULTSThe form of sacral fracture was related to the impact energy. Under low energy impact loads, ilium fracture, acetabulum fracture and crista iliaca fracture were found. Under high energy impact loads, three types of sacral fracture occurred according to the classification of Denis: sacral ala fracture, Type I fracture; sacral foramen cataclasm fracture, Type II fracture; central vertebral canal fracture, Type III fracture. Nerve injury of one or two sides was involved in all three types of sacral fracture. The fracture mechanism of sacrum between the dynamic impact and static compression was significantly different. When the impact energy was above 25 J, sacral foramen cataclasm fracture occurred, involving nerve root injury. When it was below 20 J, ilium and sacral fracture was most likely to occur. When it was 20 approximately 25 J, Type I fracture would occur. While in the static test, most of the fracture belonged to ilium or acetabulum fracture. The cross section of sacrum was crackly and the bone board of Haversian system was brittle, which could lead to separation of bone boards and malposition of a few of cross bone boards.

CONCLUSIONSIn dynamic state, sacrum fracture mostly belongs to Type I and Type II, and usually involves the nerve roots. Sacrum fracture is relevant to the microstructures, the distribution of the bone trabecula, the osseous lacuna and the Haversian system of sacrum. The fracture of ilium and acetabulum more frequently appears in static state, with slight wound of peripheral tissues.

Biomechanical Phenomena ; Humans ; Male ; Microscopy, Electron, Scanning ; Sacrum ; injuries ; pathology ; Spinal Fractures ; pathology ; physiopathology ; surgery ; Spinal Nerve Roots ; injuries

Lumbar foraminal pathology causing entrapment of neurovascular contents and radicular symptoms are commonly associated with foraminal stenosis. Foraminal neuropathy can also be derived from inflammation of the neighboring lateral recess or extraforaminal spaces. Conservative and interventional therapies have been used for the treatment of foraminal inflammation, fibrotic adhesion, and pain. This update reviews the anatomy, pathophysiology, clinical presentation, diagnosis, and current treatment options of foraminal neuropathy.
Constriction, Pathologic ; Decompression ; Diagnosis ; Electric Stimulation ; Fibrosis ; Foraminotomy ; Ganglia, Spinal ; Inflammation ; Lumbosacral Region ; Pain Management ; Pathology ; Radiculopathy ; Spinal Nerve Roots

The authors report on a case of primary malignant melanoma of the 7th cervical spinal nerve root in a 45-year-old woman. Neuro-radiological features of this extra-dural mass were suggestive of a nerve sheath tumor. The lesion underwent total gross resection through the anterolateral approach. The patient's postoperative course was uneventful. Histopathological investigation confirmed malignant melanoma. There was no evidence of tumor recurrence or other melanotic lesions on regular follow-up examinations until the postoperative eighth month. When treating a common, benign-looking lesion of the cervical spinal nerve root, surgeons should be aware of the potential to encounter such a malignant tumor.
Cervical Vertebrae ; Female ; Human ; Melanoma/*pathology/surgery ; Middle Aged ; Nerve Sheath Tumors/*pathology/surgery ; Peripheral Nervous System Neoplasms/*pathology/surgery ; Spinal Nerve Roots/*pathology

BACKGROUNDAlthough three-dimensional MRI (3D-MRI) of short T1 inversion recovery turbo spin-echo (STIR TSE) has showed superior to two-dimensional MRI (2D-MRI) in showing the spinal cord and lumbar nerve roots, it remains difficult in demonstrating radicular vein at present. We have found that short T1 inversion recovery long time echo (STIR LONG TE) was better in showing radicular vein. To further study the methods and character of the 3D-MRI of lumbar nerve root, ganglions and radicular vein in normal and lumbar disc herniation (LDH) adults, in the present study, we evaluated two 3D-MRI techniques, STIR TSE and STIR LONG TE for demonstrating lumbar nerve roots and especial radicular vein in normal and LDH adults.

METHODSTwelve normal adult persons and 19 LDH patients were included in this study; special oblique coronal location was adopted. STIR TSE and STIR LONG TE were performed in all participants, and the detection rates of radicular vein and nerve root of L3, L4, L5, S1 were calculated. The grading system was used in grading compromise of the intraspinal extradural lumbar nerve root, ganglion and radicular vein in LDH patients, and all the grading injury of nerve root, ganglion and radicular vein had been evaluated.

RESULTSThe definite rate of radicular vein (DRRV) of 3D-MRI of STIR LONG TE was significantly different from that of STIR TSE. DRRV of STIR LONG TE was L3, 91.7%, L4, 100%, L5, 100%, S1, 100% and that of STIR TSE was L3, 33.3%, L4, 37.5%, L5, 58.3%, S1, 45.8% in normal adults. It showed no difference between STIR LONG TE and STIR TSE in the detection rate of nerve root. The different patho-injuries of nerve root, ganglion and radicular vein could be seen in all LDH patients by the 3D-MRI of STIR LONG TE. The mean score of Japanese Orthopaedic Association (JOA) was 16.16, and 29 nerve roots were calculated in all the study. The mean grading injury of nerve root was 2.17, that of nerve root ganglion was 1.28, that of radicular vein was 1.83, and the mean co-grading injury of nerve root, ganglion and radicular vein was 5.31. The correlation coefficient was 0.478 (P = 0.010) between the score of JOA and that of radicular vein.

CONCLUSIONThe 3D-MRI of STIR LONG TE is superior to STIR TSE for not only detecting the lumbar nerve root, ganglion and especial radicular vein in normal adults, but also displaying their patho-injuries degree in LDH patients.

Adult ; Aged ; Female ; Humans ; Intervertebral Disc Displacement ; pathology ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Spinal Nerve Roots ; blood supply ; pathology ; Veins ; pathology

BACKGROUNDDeafferentation pain is a kind of chronic pain syndrome and hard to manipulate. To evaluate the effectiveness and safety of junctional dorsal root entry zone (DREZ) coagulation, 23 consecutive patients with intractable deafferentation pain syndrome were studied.

METHODSTwenty-three patients underwent junctional DREZ coagulation (C5-T1 for upper extremities and L2-S1 for lower extremities) under general anesthesia. The pain severity was evaluated by the short McGill pain questionnaire (MPQ) and the visual analog scale (VAS), and the depression and anxiety of patients were assessed by Hamilton rating scale for depression (HRSD), Hamilton anxiety scale (HAMA), self-rating anxiety scale (SAS) and self-rating depression scale (SDS).

RESULTSAll the patients experienced significant pain reduction immediately after surgery. The scales of short MPQ and VAS at pre-operation, 6-month and 12-month follow-up were 31.5 +/- 3.4 and 8.8 +/- 1.5, 6.5 +/- 1.9 and 2.5 +/- 2.2, 7.1 +/- 2.1 and 2.9 +/- 1.9, respectively. The postoperative scores comparing to pre-operative scores showed a statistically significant difference (P < 0.01). The depression and anxiety state was also significantly relieved. At 12-month follow-up 6 patients had complete pain relief, 11 had excellent results with more than 75% pain relief, 17 had good results with more than 50% pain relief (73.9%). The main postoperative complications were transient slight hemiplegia (8), hypesthesia and paresthesia (15), a bearing down feeling of affected extremity (6), and deep sensory disability in the lower limbs (4) on the operated side. Because of the long time and prone position of the operation, 13 cases had a transient hyperalgesia in the upper chest.

CONCLUSIONDREZ coagulation is a safe and effective procedure in the treatment of deafferentation pain syndromes.

Adult ; Aged ; Causalgia ; pathology ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; methods ; Pain Measurement ; Spinal Nerve Roots ; surgery ; Treatment Outcome

OBJECTIVETo observe the pinching action to the nerve root by the lumbar disc herniation and facet or lamina (ligamentum flavum) and evaluate its clinical meaning.

METHODSSeventy-one patients were divided into 3 groups according to the size of distance between protrusion of nuclear and facet or lamina (ligamentum flavum). The degree of the straight leg raising of the affected side (SLR) and the sagittal index (SI) of lumbar disk herniation were measured and analyzed among them.

RESULTSThere was no corelation between the affected degree of SLR and sex, age and SI of patient (P > 0.05). The coefficient between distance group and the affected degree of SLR is-0.878 7 (P < 0.01).

CONCLUSIONThe degree of the surrounding compression by the protrusion of nuclear and facet or lamina (ligamentum flavum) reflects the injuried severity of the nerve root.

Adolescent ; Adult ; Female ; Humans ; Intervertebral Disc Displacement ; complications ; diagnostic imaging ; pathology ; Ligamentum Flavum ; pathology ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nerve Compression Syndromes ; etiology ; Spinal Nerve Roots ; injuries ; Tomography, X-Ray Computed

BACKGROUNDSchwannoma is the tumor arising mainly from the cranial and spinal nerves. Bilateral vestibular schwannoma is the hallmark of neurofibromatosis type 2 (NF2). The NF2 gene has been cloned with comprehensive analysis of its mutations in schwannoma. However, most studies focused on vestibular schwannoma. There are differences in proliferation of tumor cell and ultrastructure between vestibular and spinal schwannomas. It is unknown whether genetic alterations in vestibular schwannoma are different from those in non-vestibular schwannoma. We analyzed the loss of heterozygosity (LOH) on chromosome 22 in patients with sporadic schwannoma including vestibular and spinal schwannomas and correlated this genetic alteration with tumor proliferation.

METHODSIn 54 unrelated patients without clinical NF1 or NF2, 36 patients had sporadic vestibular schwannoma, and 18 dorsal spinal root schwannoma. Four highly polymorphic linkage to NF2 gene microsatellite DNA markers (D22S264, D22S268, D22S280, CRYB2) were used to analyze LOH. The proliferative index was evaluated by Ki-67 and proliferative cell nuclear antigen (PCNA) immunostaining. Student's t test was used to analyze the difference of the proliferative index between schwannoma with LOH and that without LOH. The difference of the frequency of LOH in vestibular and spinal schwannomas was investigated by the chi-square test.

RESULTSTwenty-three schwannomas (42.6%, 23/54) showed allele loss. The frequency of LOH in vestibular schwannoma was significantly higher than that in spinal schwannoma (chi2 = 5.14, P < 0.05). The proliferative index of schwannoma with LOH was significantly higher than that without LOH (tki-67 = 2.97, P = 0.0045; tPCNA = 2.93, P = 0.0051).

CONCLUSIONSLOH on chromosome 22 is a frequent event in the tumorigenesis of sporadic schwannoma. And, there is a correlation between LOH on chromosome 22 and proliferative activity in schwannoma. The frequency of LOH in vestibular schwannoma is significantly different from that in spinal schwannoma.

Adult ; Aged ; Cell Proliferation ; Chromosomes, Human, Pair 22 ; Female ; Genes, Neurofibromatosis 2 ; Humans ; Loss of Heterozygosity ; Male ; Middle Aged ; Neurilemmoma ; genetics ; pathology ; Neuroma, Acoustic ; genetics ; Spinal Cord Neoplasms ; genetics ; Spinal Nerve Roots

OBJECTIVETo explore the occurrence, prevention and cure prognosis of segment root polsy (especially in C5 palsy) after cervical decompression surgery.

METHODSFrom February 2006 and December 2008,162 patients were operated with cervical decompression through approach for anterior or posterior in our hospital. Among them, 10 cases occurred SRP after operation included 6 males and 4 females aged from 40 to 68 with an average of 53 years old. These cases were treated with dehydration, trophic nerve, hyperbaric oxygenation. The clinical data were retrospective analzed.

RESULTSTen patients were followed up from 8 months to 3 years with an average of 2.4 years. It was observed that all the patients recovered during a period of 4.4 months on average (ranging from 3 weeks to 8 months).

CONCLUSIONSRP(especially in C5 palsy) is one of the common complications of anterior or posterior cervical decompression surgery. SRP is usually the result of various nosogenesis. As there was no effective treatment, conservative treatment is usually adopted with optimistic prognosis.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paralysis ; diagnosis ; etiology ; physiopathology ; prevention & control ; Prognosis ; Recovery of Function ; Retrospective Studies ; Spinal Nerve Roots ; pathology ; physiopathology

OBJECTIVETo investigate the incidence of C5 nerve root palsy after multi-segmental cervical decompression through different approaches.

METHODSThis study was conducted among 375 patients undergoing multi-segmental cervical decompression in anterior corpectomy and fusion fixation, anterior cervical corpectomy and fusion fixation + posterior decompression and fusion fixation, posterior cervical laminectomy decompression, fusion and internal fixation, and posterior laminoplasty and fusion groups. The exclusion criteria included lack of follow-up data, spinal cord injury preventing preoperative or postoperative motor testing, or surgery not involving the C5 level. The incidence of C5 palsy was determined and the potential risk factors C5 palsy were analyzed including age, sex, revision surgery, preoperative weakness, diabetes, smoking, number of levels decompressed, and a history of previous upper extremity surgery.

RESULTSOf the 375 patients, 60 patients were excluded and the data of 315 patients were analyzed, including 146 women and 169 men with a mean age of 57.7 years (range 39-72 years). The overall incidence of C5 nerve palsy was 6.03% (19/315) in these patients; in the subgroups receiving different surgeries, the incidence was 8.62% in the cervical road laminectomy and fusion fixation group, 7.79% in the anterior cervical corpectomy and fusion fixation + posterior decompression and fusion and internal fixation, 4.68% in the anterior corpectomy and fusion fixation group, and 3.85% in the posterior laminoplasty and fusion group. No significant difference was found in the incidences among the subgroups, but men were more likely than women to develop cervical nerve root palsy (8.28% vs 3.42%, P<0.05).

CONCLUSIONThe overall incidence of C5 nerve palsy following postoperative cervical spinal decompression was 6.03% in our cohort. The incidence of C5 nerve palsy did not differ significantly following different cervical decompression surgeries, but the incidence was the highest in the posterior cervical laminectomy and fusion and internal fixation group.

Adult ; Aged ; Cervical Vertebrae ; innervation ; Decompression, Surgical ; adverse effects ; Female ; Fracture Fixation, Internal ; Humans ; Incidence ; Laminectomy ; adverse effects ; Male ; Middle Aged ; Neck ; Paralysis ; pathology ; Risk Factors ; Spinal Nerve Roots ; physiopathology