OBJECTIVE: To explore short-term effectiveness of floating island laminectomy surgery in treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum. METHODS: A total of 31 patients with thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum between January 2019 and April 2022 were managed with floating island laminectomy surgery. The patients comprised 17 males and 14 females, aged between 36 and 78 years, with an average of 55.9 years. The duration of symptoms of spinal cord compression ranged from 3 to 62 months (mean, 27.2 months). The lesions affected T _1-6 in 4 cases and T _7-12 in 27 cases. The preoperative neurological function score from the modified Japanese Orthopaedic Association (mJOA) was 4.7±0.6. Surgical duration, intraoperative blood loss, and complications were recorded. The thoracic MRI was conducted to reassess the degree of spinal cord compression and decompression after operation. The mJOA score was employed to evaluate the neurological function and calculate the recovery rate at 12 months after operation. RESULTS: The surgical duration ranged from 122 to 325 minutes, with an average of 204.5 minutes. The intraoperative blood loss ranged from 150 to 800 mL (mean, 404.8 mL). All incisions healed by first intention after operation. All patients were followed up 12-14 months, with an average of 12.5 months. The patients' symptoms, including lower limb weakness, gait disorders, and pain, significantly improved. The mJOA scores after operation significantly increased when compared with preoperative scores ( P<0.05), gradually improving with time, with significant differences observed among 1, 3, and 6 months ( P<0.05). The recovery rate at 12 months was 69.76%±11.38%, with 10 cases exhibiting excellent neurological function and 21 cases showing good. During the procedure, there were 3 cases of dural tear and 1 case of dural defect. Postoperatively, there were 2 cases of cerebrospinal fluid leakage. No aggravated nerve damage, recurrence of ligamentum flavum ossification, or postoperative thoracic deformity occurred. CONCLUSION The floating island laminectomy surgery is safe for treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum, effectively preventing the exacerbation of neurological symptoms. Early improvement and recovery of neurological function are achieved.
Humans ; Male ; Spinal Stenosis/diagnostic imaging* ; Female ; Laminectomy/methods* ; Ligamentum Flavum/pathology* ; Middle Aged ; Aged ; Thoracic Vertebrae/surgery* ; Adult ; Decompression, Surgical/methods* ; Treatment Outcome ; Ossification, Heterotopic/surgery* ; Spinal Cord Compression/etiology* ; Spinal Cord Diseases/etiology* ; Magnetic Resonance Imaging

OBJECTIVETo explore the imaging characteristics and operation outcomes of intramedullary schwannoma in thoracolumbar spine.

METHODSFrom June 2005 to December 2012,17 patients with intramedullary schwannoma in thoracolumbar spine were operated through posterior approach, including 11 males and 6 females with an average age of 53 years old ranging from 46 to 67 years old. The courses of disease ranged from 3 to 5 years (averaged 3.3 years). Thoracic patients manifested chest and back pain,numbness and inability on lower limb gradually, unsteady gait. Lumbar patients manifested low back pain,radiating pain and numbness on lower limb, intermittent claudication. Preoperative VAS score was 5 to 8 with an average of 6.12. Eleven patients suffered from never injury, 4 cases were grade C, 5 cases were grade D and 2 cases were grade E according to Frankel classification. Three patients were injured on thoracic segments, 5 patients were on thoracolumbar segments, 3 patients on lumbar segments and 6 patients on lumbosacral segment confirmed by CT and MRI. Five patients were epidural, 12 were intradural extramedullary. Six patients underwent spinal decompression and tumor resection simply, eleven patients underwent spinal decompression, tumor resection, internal fixation and bone graft fusion.

RESULTSNo injury of blood vessel or spinal cord occurred during operation, cutting healed well. All patients were followed up from 12 to 60 months with an average of 32 months. Chest and back pain, low back pain, radiating pain and numbness on lower limb were improved significantly. VAS score at final follow-up was 0 to 3 (averaged 1.5). According to Frankel classification, 5 cases were grade D, and 6 cases were grade E at final follow-up.

CONCLUSIONMRI is an effective method in diagnosis of intramedullary schwannoma in thoracolumbar spine. Operative method is choosed by imaging expression, and the aim is effectively decompression of spine, reconstruction of stability of spine.

Aged ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurilemmoma ; pathology ; surgery ; Spinal Neoplasms ; pathology ; surgery ; Thoracic Vertebrae ; surgery

OBJECTIVE: To investigate the clinical efficacy and feasibility of surgical treatment for thoracic spinal tuberculosis with intraspinal abscesses by internal fixation, unilateral vertebral lamina limited decompression, debridement, together with interbody and posterior fusion via a posterior only approach.
 METHODS: A total of 37 pantients (24 males and 13 females) with thoracic spinal tuberculosis complicated with intraspinal abscess lesions were admitted to our hospital, with age 13-68(39.7 ± 9.1) years old. Spinal lesions of segmental kyphosis Cobb angle was 8°-62° (29.6° ± 3.6°). Frankel grade system was used to assess neurological function. According to the system, there were 3, 7, 19 and 8 cases for grade B, C, D and E, respectively. All 37 cases were treated with internal fixation, unilateral vertebral lamina limited decompression, debridement, together with interbody and posterior fusion via a posterior only approach.
 RESULTS: The mean duration for follow-up was 24-90 (53.0 ± 15.7) months. Intraoperative dural tear occurred in 1 cases with cerebrospinal fluid leakage after operation; 2 cases showed postoperative neurological complications; delayed wound healing occurred in 2 cases. The postoperative kyphotic angle was 5°-21° (8.3° ± 1.3°). The kyphotic angle was 8°-26° (10.1° ± 1.9°) at the last follow-up. By the time of the last follow-up, all patients with preoperative neurological symptoms improved at different degree. According to Frankel classification, 2 cases recovered from grade B to D, 1 case from grade B to E, 3 cases from grade C to D, 4 cases from grade C to E, 13 cases from grade D to E. No failure in fixation and pseudarthrosis. All patients obtained satisfactory bone graft fusion.
 CONCLUSION Posterior internal fixation, unilateral vertebral lamina limited decompression, debridement, together with interbody and posterior fusion might be a effective and feasible method for treatment of thoracic spinal tuberculosis with intraspinal abscess lesions.
Abscess ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Bone Transplantation ; Child ; Debridement ; Decompression, Surgical ; Female ; Fracture Fixation, Internal ; Humans ; Kyphosis ; pathology ; Male ; Middle Aged ; Postoperative Complications ; Spinal Fusion ; Thoracic Vertebrae ; surgery ; Treatment Outcome ; Tuberculosis, Spinal ; pathology ; surgery ; Young Adult

BACKGROUNDThe treatment strategies for multilevel thoracic ossification of the posterior longitudinal ligaments (T-OPLL) were rarely reported. The aim of this study was to investigate the clinical outcomes and complications of circumferential decompression for multilevel T-OPLL and compare two different methods in the management of the OPLL (resection or floating).

METHODSData of sequentially treated patients who received surgical treatment for thoracic spinal stenosis caused by multilevel T-OPLL from January 2005 to February 2012 were retrospectively reviewed. Based on the surgical approaches applied, the patients were divided into two groups. Group A consisted the patients who received posterior decompression and group B consisted the patients who received circumferential decompression via the posterior approach. Group B was further divided into two subgroups: subgroup 1 (the resection group) where the OPLL was completely resected and subgroup 2 (the floating group) where the OPLL was floated.

RESULTSA total of 49 patients were included in the study. Fourteen patients with single posterior decompression were included in group A and 35 patients who received circumferential decompression were included in group B. In group B, 29 patients had complete resection of the ossified posterior longitudinal ligaments, while the other six underwent a flotation procedure. The follow-up data were available in 39 patients. Mean JOA scores improved from 5.4 ± 1.8 to 7.5 ± 2.8 in group A and from 3.7 ± 1.8 to 7.9 ± 2.4 in group B. The main complications included cerebrospinal fluid (CSF) leakage and postoperative neurologic deterioration (ND). Twenty-three of the 25 cases with postoperative CSF leakage achieved a complete recovery at the last follow-up and 12 of the 15 cases with ND achieved some neurological improvement at the last follow-up.

CONCLUSIONSCircumferential decompression via the posterior approach is an effective surgical method for thoracic spinal stenosis caused by multilevel OPLL of the thoracic spine. Patients who receive complete resection of the ossified posterior longitudinal ligaments may have better recovery rate than the "floating" group.

Adult ; Decompression, Surgical ; methods ; Female ; Humans ; Longitudinal Ligaments ; pathology ; surgery ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; surgery ; Retrospective Studies ; Thoracic Vertebrae ; surgery ; Treatment Outcome

OBJECTIVE: We report magnetic resonance imaging (MRI) findings on focal anterior displacement of the thoracic spinal cord in asymptomatic patients without a spinal cord herniation or intradural mass. MATERIALS AND METHODS: We identified 12 patients (male:female = 6:6; mean age, 51.7; range, 15-83 years) between 2007 and 2011, with focal anterior displacement of the spinal cord and without evidence of an intradural mass or spinal cord herniation. Two radiologists retrospectively reviewed the MRI findings in consensus. RESULTS: An asymmetric spinal cord deformity with a focal dented appearance was seen on the posterior surface of the spinal cord in all patients, and it involved a length of 1 or 2 vertebral segments in the upper thoracic spine (thoracic vertebrae 1-6). Moreover, a focal widening of the posterior subarachnoid space was also observed in all cases. None of the patients had myelopathy symptoms, and they showed no focal T2-hyperintensity in the spinal cord with the exception of one patient. In addition, cerebrospinal fluid (CSF) flow artifacts were seen in the posterior subarachnoid space of the affected spinal cord level. Computed tomography myelography revealed preserved CSF flow in the two available patients. CONCLUSION: Focal anterior spinal cord indentation can be found in the upper thoracic level of asymptomatic patients without a spinal cord herniation or intradural mass.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cerebrospinal Fluid/physiology ; Female ; Hernia/pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Diseases/pathology/*radiography/surgery ; Spine/pathology/radiography ; Thoracic Vertebrae/pathology/*radiography ; Tomography, X-Ray Computed ; Young Adult

No abstract available.
Adolescent ; Back Pain/diagnosis/*etiology/surgery ; Decompression, Surgical ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Osteoblastoma/*complications/pathology/radiography/surgery ; Pain Measurement ; Radiotherapy, Adjuvant ; Spinal Neoplasms/*complications/pathology/radiography/surgery ; *Thoracic Vertebrae/pathology/radiography/surgery ; Tomography, X-Ray Computed ; Treatment Outcome

Adult ; Antigens, CD20 ; metabolism ; Cervical Vertebrae ; pathology ; Eosinophilic Granuloma ; complications ; metabolism ; pathology ; surgery ; Follow-Up Studies ; Hodgkin Disease ; complications ; metabolism ; pathology ; surgery ; Humans ; Ki-1 Antigen ; metabolism ; Male ; Middle Aged ; Spinal Neoplasms ; complications ; metabolism ; pathology ; surgery ; Thoracic Vertebrae ; pathology

OBJECTIVETo investigate the clinical features and prognosis of bone metastases in colorectal cancer patients.

METHODSThe clinical data of 104 cases of colorectal cancer with bone metastasis were collected and retrospectively analyzed.

RESULTSAmong all the 104 patients included, 45 (43.3%) patients had multiple bone metastases, and 59 (56.7%) patients had single bone metastasis. Pelvis (46.1%) was the most common site, followed by thoracic vertebrae (41.3%), lumbar vertebrae (40.4%), sacral vertebrae (29.8%) and ribs (29.8%). One hundred and two patients (98.1%) were complicated with other organ metastases. The median time from colorectal cancer diagnosis to bone metastasis was 16 months, and the median time from bone metastasis to first skeletal-related events (SREs) was 1 month. The most common skeletal-related events (SREs) were the need for radiotherapy (44.2%), severe bone pain (15.4%) and pathologic fracture (9.6%). The median survival time of patients with bone metastases was 10.0 months, and 8.5 months for patients with SREs. ECOG score, systemic chemotherapy and bisphosphonate therapy were prognostic factors by univariate analysis (all P < 0.05). ECOG score and systemic chemotherapy were independent prognostic factors by Cox multivariate analysis.

CONCLUSIONSBone metastasis in colorectal cancer patients has a poor prognosis and the use of chemotherapy and bisphosphonates may have a benefit for their survival.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bone Density Conservation Agents ; therapeutic use ; Bone Neoplasms ; drug therapy ; radiotherapy ; secondary ; Colorectal Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Diphosphonates ; therapeutic use ; Female ; Follow-Up Studies ; Fractures, Bone ; etiology ; Humans ; Lumbar Vertebrae ; pathology ; Male ; Middle Aged ; Pain ; etiology ; Pelvic Bones ; pathology ; Prognosis ; Retrospective Studies ; Ribs ; pathology ; Sacrum ; pathology ; Spinal Cord Compression ; etiology ; Spinal Neoplasms ; drug therapy ; radiotherapy ; secondary ; Thoracic Vertebrae ; pathology ; Young Adult

Paraganglioma is a rare neuroendocrine neoplasm observed in patients of all ages, with an estimated incidence of 3/1,000,000 population. It has long been recognized that some cases are familial. The majority of these tumors are benign, and the only absolute criterion for malignancy is the presence of metastases at sites where chromaffin tissue is not usually found. Some tumors show gross local invasion and recurrence, which may indeed kill the patient, but this does not necessarily associate with metastatic potential. Here, we report a case of vertebral metastatic paraganglioma that occurred 19 months after the patient had undergone partial cystectomy for urinary bladder paraganglioma. We believe this to be a rarely reported bone metastasis of paraganglioma arising originally within the urinary bladder. In this report, we also provide a summary of the general characteristics of this disease, together with progress in diagnosis, treatment, and prognosis.
Chromogranin A ; metabolism ; Cystectomy ; Female ; Humans ; Middle Aged ; Paraganglioma ; metabolism ; pathology ; secondary ; surgery ; Phosphopyruvate Hydratase ; metabolism ; Prognosis ; Radionuclide Imaging ; Spinal Neoplasms ; diagnostic imaging ; secondary ; surgery ; Synaptophysin ; metabolism ; Technetium ; Thoracic Vertebrae ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms ; metabolism ; pathology ; surgery

OBJECTIVETo compare the long-term influence of vertebral fixation through or across the affected vertebra on vertebral morphology.

METHODSClinical data of 48 patients with simple thoracic and lumbar spinal fractures who were admitted between Jan. 2008 and Dec. 2010 were analyzed retrospectively. Among them 36 cases (28 males and 8 females) were fixed through the injured vertebra (group A) and 12 cases (8 males and 4 females) were fixed across the injured vertebra (group B). All patients were followed up for 6-36 months (mean 11.5 months). The vertebral body height, endplate angle and neurofunction were compared between the two groups before surgery, a week after surgery and at the end of the follow-up period.

RESULTSThere was no statistically significant difference in vertebral body height,endplate angle and neurofunction before operation between group A and B (P > 0.05). Vertebral body height and endplate angle improved in both groups a week after operation and at the end of the follow-up period as compared with those before operation (P < 0.05), and the efficacy in group B was significantly better than that in group A (P < 0.05). There was no significant difference in neurofunction between the two groups (P > 0.05).

CONCLUSIONThe fixation method through the injured vertebra had a better reduction effect, more stable fixation, and a better long-term effect on vertebral morphology than that across the injured vertebra in the treatment of thoracolumbar vertebral fractures.

Adult ; Female ; Humans ; Lumbar Vertebrae ; injuries ; pathology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; pathology ; surgery