STUDY DESIGN: It is a case series involving clinical presentation, radiological findings, surgical technique and long term outcome of Non-dysraphic intramedullary spinal cord lipomas in adults along with the review of the literature. PURPOSE: The purpose of the study is to find out from our series as well as from literature what determines the long term outcome and how it can be improved in patients diagnosed to have intramedullary spinal cord lipomas. OVERVIEW OF LITERATURE: Non-dysraphic spinal intramedullary lipomas in adults are extremely rare. Majority of cases occur in children and in cervico-dorsal regions. Only eight cases of dorso-lumbar spinal lipomas without spinal dysraphism in adults have been reported in the English literature till 2013. METHODS: Here we report our experience with three such cases in the dorsolumbar region and discuss the surgical technique and the long term outcome of such cases. RESULTS: Review of literature and from our own cases we conclude that long term outcome after surgery is determined by the preoperative neurological status. CONCLUSIONS: Earlier surgical intervention with preserved neurological status results in better outcome. Radical subtotal excision without producing iatrogenic postoperative neurological deficit should be the goal of the surgery and it stabilizes the disease process in the long run. When early clinico-radiological signs of recurrence develop, such patient's to be reoperated immediately to prevent them from developing a fixed neurological deficit.
Adult* ; Child ; Humans ; Lipoma* ; Recurrence ; Spinal Cord Neoplasms ; Spinal Cord* ; Spinal Dysraphism

STUDY DESIGN: Clinical adjacent segment pathology (CASP) is common after cervical disc surgery. A critical examination of 320 patients operated for cervical disc prolapse revealed that CASP can also occur in patients with congenital and degenerative fusion of cervical spine. This has not been studied in depth and there is a need for a practically applicable classification of CASP. PURPOSE: To develop a new classification scheme of CASP. OVERVIEW OF LITERATURE: A review of the literature did not reveal a practically applicable classification incorporating the occurrence of CASP in congenital and degenerative fusion cases. METHODS: This was a retrospective analysis of 320 patients operated (509 disc spaces) on for cervical disc prolapse. Cases (n=316) were followed-up for 3-11 years. Random sampling of 220 patients with postoperative magnetic resonance imaging (MRI) in 165 cases was analyzed. RESULTS: Six symptomatic CASP cases required resurgery (1.9%), eight cases involved MRI proven CASP with axial neck pain only and 13 patients were asymptomatic with radiological adjacent segment pathology (RASP). The frequency rate was 8.5% (27/316). Four cases of congenital or degenerative fusion of vertebra developed CASP requiring surgery. CASP is classified as primary or secondary follows. Primary A1 was congenital fusion of vertebra and primary A2 was degenerative fusion of the vertebra. Secondary, which was after cervical disc surgery, comprised B1 (RASP in asymptomatic patients), B2 (CASP in patients with axial neck pain), and B3 (CASP with myeloradiculopathy). B3 was subdivided into single-level CASP (B3a) and multiple-level CASP (B3b). CONCLUSIONS: Symptomatic CASP requiring resurgery is infrequent. CASP can occur in patients with congenital and degenerative fusion of the cervical spine. A new classification for CASP along with treatment strategy is proposed. Patients in Primary CASP and B3 CASP require resurgery while others require only observation.
Classification* ; Humans ; Magnetic Resonance Imaging ; Neck ; Neck Pain ; Pathology* ; Prolapse ; Retrospective Studies ; Spine

STUDY DESIGN: A retrospective study was undertaken to delineate the characteristics of non-traumatic sequestrated epidurally migrated cervical disc prolapse. PURPOSE: To present first case series of eight such cases diagnosed preoperatively and to discuss their magnetic resonance imaging (MRI) characteristics and their management. OVERVIEW OF LITERATURE: Non-traumatic spontaneous migration of the sequestrated disc fragment epidurally behind cervical vertebral body is rare. Only ten cases have been reported in literature. METHODS: Detailed clinico-radiological profiles of these 8 cases are presented. In six cases their clinical picture was suggestive of cervical myelopathy. MRI scan showed single level epidural migrated disc behind body of C4, C6, and C7 in six patients and two cases with multiple levels (C5-C6). In six cases, anterior corpectomy with excision of the disc was performed and the seventh patient underwent dorsal laminectomy. The eighth patient chose not to undergo surgery. RESULTS: T1 images of the MRI scan showed an isointense signal in all the 8 cases. T2 images revealed a varying intensity. In six cases who underwent anterior corpectomy, there was a rent in the posterior longitudinal ligament. Among those in two cases multiple disc fragments were seen. In the rest four cases, a single large fragment was observed. These patients improved after anterior corpectomy and disc excision. There was no improvement in the patient who had undergone dorsal laminectomy. The eighth patient who refused surgery progressively deteriorated. CONCLUSIONS: We opine that MRI scan especially T1 images are useful in these cases. We prefer to treat these cases through anterior corpectomy with excision of the sequestrated disc which proved to result in excellent outcome.
Humans ; Laminectomy ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Cord Diseases