No abstract available.
Animals ; Growth Hormone* ; Prolactin* ; Rats*

325 patients underwent emergency evacuation of traumatic intracranial hematomas over a 5-year period. Ten(3%) developed delayed contralateral epidural hematomas. These hematomas were not present on initial computed tomography(CT) scan, but repeat CT scan after craniectomy showed sizable hemorrhage. The authors analyzed 10 cases with delayed post-traumatic contralateral epidural hematoma according to their etiology, hematoma types on computerized tomography, initial Glasgow Coma Scale(GCS) & follow up Glasgow Outcome Scale(GOS). 1) Delayed development of post-traumatic contralateral epidural hematoma after evacuation of initial hematoma occurred in 10 of the 325 head injured patients, an incidence rate of 3%. 2) The important factors affecting patients outcome were the initial GCS & the time interval after surgery. 3) Eight patients were found to have a skull fracture at the site of delayed epidural hematoma formation(80%). 4) The results of delayed contralateral epidural hematoma was 50% good, 50% bad and had a mortality rate of 30%.
Coma ; Craniocerebral Trauma ; Emergencies ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Head ; Hematoma* ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Traumatic ; Mortality ; Skull Fractures ; Tomography, X-Ray Computed

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic, progressive, inflammatory disorder characterized by marked fibrosis of the spinal dura mater with unknown etiology. According to the location of the lesion, it might induce neurologic deficits by compression of spinal cord and nerve root. A 58-year old female with a 3-year history of progressive weakness in both lower extremities was referred to our institute. Spinal computed tomography (CT) scan showed an osteolytic lesion involving base of the C6 spinous process with adjacent epidural mass. Magnetic resonance imaging (MRI) revealed an epidural mass involving dorsal aspect of cervical spinal canal from C5 to C7 level, with low signal intensity on T1 and T2 weighted images and non-enhancement on T1 weighted-enhanced images. We decided to undertake surgical exploration. At the operation field, there was yellow colored, thickened fibrous tissue over the dura mater. The lesion was removed totally, and decompression of spinal cord was achieved. Symptoms improved partially after the operation. Histopathologically, fibrotic pachymeninges with scanty inflammatory cells was revealed, which was compatible with diagnosis of idiopathic hypertrophic pachymeningitis. Six months after operation, motor power grade of both lower extremities was normal on physical examination. However, the patient still complained of mild weakness in the right lower extremity. Although the nature of IHSP is generally indolent, decompressive surgery should be considered for the patient with definite or progressive neurologic symptoms in order to prevent further deterioration. In addition, IHSP can present as an osteolytic lesion. Differential diagnosis with neoplastic disease, including giant cell tumor, is important.
Decompression ; Diagnosis ; Diagnosis, Differential ; Dura Mater ; Female ; Fibrosis ; Giant Cell Tumors ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Meningitis* ; Neurologic Manifestations ; Physical Examination ; Spinal Canal ; Spinal Cord

Synovial chondromatosis (SC) in the spine is rare. There are few reports of associated cervical radiculopathy and there has not been a case reported of regrowing cervical SC. Here we report a 21-year-old man with a SC of a cervical facet joint that extended into the intervertebral foramen and compressed the cervical nerve root. The same symptom developed three years following the first operation. Computed tomography (CT) scans and Magnetic resonance imaging (MRI) showed multiple calcified nodules anterior to the right facet joint of C6-7 that extended into the intervertebral foramen. A mass removal was performed just as in the previous operation with a subtotal facetectomy. When vertebral SC is suspected, complete removal involving the bone and synovium should be considered as the standard treatment option.
Chondromatosis, Synovial ; Humans ; Magnetic Resonance Imaging ; Radiculopathy ; Spine ; Synovial Membrane ; Young Adult ; Zygapophyseal Joint

OBJECTIVE: The purpose of this study is to introduce a simple yet effective technique to secure the posterior elements in the open position after expansive open-door laminoplasty and to evaluate factors contributing to surgical results after laminoplasty. METHODS: Twenty two myelopathic or radiculopathic patients with multilevel cervical canal stenosis or ossification of the posterior longitudinal ligament were treated with an expansive open-door laminoplasty. Thirteen patients were cervical spinal stenosis and the other 9 patients were diagnosed as the ossification of the posterior longitudinal ligament. The posterior elements were stabilized in the open position with titanium miniplates without spacers. Morphometric analysis was performed on preoperative and postoperative plain radiographs to obtain spinal canal dimensions and to monitor construct integrity. RESULTS: The mean preoperative sagittal canal diameter was 10.3+/-2.2mm. These dimensions increased to 17.4+/-2.8mm after surgery. Most patients improved from the myelopathy or the radiculopathy and the mean recovery rate was 52.4+/-17.1%. The titanium miniplate constructs did not fail during the follow-up period (mean, 38.5 months) and the decompression was maintained. Serious complications such as instability and kyphosis did not develop in any cases. There were no significant factors that predict surgical outcome. CONCLUSION: Expansive open-door laminoplasty using titanium miniplates can be easily performed and is effective technique for decompression and maintenance of the spinal canal diameter.
Constriction, Pathologic* ; Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Longitudinal Ligaments ; Radiculopathy ; Spinal Canal ; Spinal Cord Diseases ; Spinal Stenosis ; Titanium*

Spinal extradural arachnoid cysts (SEACs) are relatively rare cause of compressive myelopathy. SEACs can be either congenital or acquired, but the etiology and the mechanism for their development are still unclear. A number of cases have been reported in the literature, and the one-way valve mechanism is the most widely accepted theory which explains the expansion of cysts and spinal cord compression. We report two cases of SEAC in this article. Patients had intermittent, progressive cord compressing symptoms. MRI image showed large SEAC which caused compression of the spinal cord. Pre-operative cystography and CT myelography were performed to identify the communicating tract. Pre-operative epidural cystography showed a fistulous tract. The patients underwent primary closure of the dural defect which was a communicating tract. The operative finding (nerve root herniation through the tract) suggested that the SEAC developed through a check-valve mechanism. Postoperatively, the patients had no surgical complications and symptoms were relieved. Based on our experience, preoperative identification of the communicating tract is important in surgical planning. Although surgical excision is the standard surgical treatment, primary closure of the dural defect which was a communicating tract can be an acceptable surgical strategy.
Arachnoid Cysts ; Arachnoid* ; Humans ; Magnetic Resonance Imaging ; Meningocele ; Myelography ; Spinal Cord ; Spinal Cord Compression

OBJECTIVE: We sought to determine minimum 4 years of clinical outcomes including fusion rate, revision rate and complications of patients who underwent placement of rectangular stand-alone cages. METHODS: Thirty-three cases of degenerative spine that had been followed for at least 4-years were reviewed retrospectively. Cages were inserted at L4-L5 level or L5-S1 in 27 or in 6 cases respectively. Visual analogue scale (VAS), Odom's criteria, fusion rate, intervertebral disc height and lumbar lordosis were determined pre- and post-operatively on standing x-rays. Amount of intra- and postoperative blood loss, total volume transfused, duration of surgery and perioperative complications were also evaluated. RESULTS: The mean VAS score of back pain and sciatica were improved from 8.0 and 7.0 points to 3.4 and 2.4 during 1 years follow-up visit and the scores was raised gradually. Also, during the follow-up, 94% of patients showed excellent or good outcomes by the Odom's criteria. Intervertebral disc height was increased from 8.2+/-1.4mm to 9.2+/-1.9mm at the first year of follow-up, however, found to be decreased and stabilized to 8.3+/-1.8mm after 2 years. The fusion rate was approximately 91% after 4 year postoperative. The segmental angle of lordosis was increased significantly by two years but it was not maintained after four years. A statistically insignificant change in total lumbar lordosis was also observed. Three patients (9%) had experienced perioperative complications. CONCLUSION: The use of rectangular stand-alone cages for posterior lumbar interbody fusion (PLIF) resulted in a various degree of subsidence and demonstrate very low complication rate, high functional stability and improved clinical outcomes in patients with degenerative lumbar disc disease.
Animals ; Back Pain ; Follow-Up Studies* ; Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Lordosis ; Postoperative Hemorrhage ; Retrospective Studies ; Sciatica ; Spine

A 42-year-old man was admitted to our hospital with complaints of low back pain and intermittent right thigh pain. Twelve weeks before admission, the patient received intradiscal electrothermal therapy (IDET) at a local hospital. The patient still reported low back pain after the procedure that was managed with narcotic analgesics. Follow-up magnetic resonance imaging (MRI) was performed, and his referring physician thought the likely diagnosis was spondylodiscitis at the L4–5 spinal segment with a small epidural abscess. At admission to our department, the patient reported aggravated low back pain. Blood test results, including the erythrocyte sedimentation rate and C-reactive protein levels, were slightly elevated. Biopsy samples of the L4, L5 vertebral bodies and disk were obtained. The material underwent aerobic, anaerobic, fungal, mycobacterial cultures and histologic examination. Results of all cultures were negative. Histologically, necrosis of the bone was evident from the number of empty osteocyte lacunae. In addition, there was no evidence of infection based on biopsy results. No antibiotic treatment was administered on discharge. Repeat computed tomography and MRI performed 12 months after IDET showed a bony defect in the L4 and L5 vertebral bodies, and a decrease in the size of the L4–5 intervertebral disc lesion. We report a case of lumbar vertebral osteonecrosis induced by IDET and discuss etiology and radiologic features.
Adult ; Biopsy ; Blood Sedimentation ; C-Reactive Protein ; Diagnosis ; Discitis ; Epidural Abscess ; Follow-Up Studies ; Hematologic Tests ; Humans ; Intervertebral Disc ; Low Back Pain ; Magnetic Resonance Imaging ; Narcotics ; Necrosis ; Osteocytes ; Osteonecrosis* ; Spine* ; Thigh

Charcot spinal arthropathy is a rare, progressive type of vertebral joint degeneration that occurs in the setting of any preexisting condition characterized by decreased afferent innervation to the extent that normal protective joint sensation in the vertebral column is impaired. The authors report on a case of Charcot arthropathy of the lower lumbar spine mimicking a spinal tumor following cervical cord injury.
Joints ; Preexisting Condition Coverage ; Sacrum ; Sensation ; Spinal Cord Injuries* ; Spinal Cord* ; Spine*

Superficial siderosis of the central nervous system(SSCNS) is a rare disease characterized by hemosiderin deposition on the surface of the central nervous system. We report a case of SSCNS originating from the thoracic spine, presenting with neurological deficits including, sensorineuronal hearing loss, ataxia, and corticospinal and dorsal column tract signs. The patient underwent dural repair with an artificial dural patch. Clinical findings were elicited by neurological examination, imaging studies, and intraoperative findings, and these were addressed through literature review.
Ataxia ; Central Nervous System* ; Hearing Loss ; Hemosiderin ; Humans ; Neurologic Examination ; Rare Diseases ; Siderosis* ; Spine*