This article was withdrawn by the authors' request.

This article was withdrawn by the authors' request.

Epidermoid tumors of the central nervous system are infrequent(2%) and can occur congenitally or iatrogenically. Since Choremis et. al. reported intradural-extramedullary epidermoid tumor after repeated lumbar puncture, several cases have been reported. We experienced a case of epidermoid inclusion cyst after single lumbar puncture in a 7-year-old boy and report the clinical and radiologic findings with relevant literatures.
Central Nervous System ; Child ; Humans ; Male ; Spinal Puncture*

STUDY DESIGN: This is a retrospective review on the spinal abnormalities in Marfan syndrome. OBJECTIVES: To analyze clinical and radiological features of the spine in Marfan syndrome. SUMMARY OF LITERATURE: Scoliosis & kyphosis are common spinal abnormalities in Marfan syndrome. Other spinal abnormalities associated with Marfan syndrome are rarely reported in the literature. MATERIALS AND METHODS: The spinal abnormalities which can be associated with Marfan syndrome were analyzed in 32 patients who were diagnosed as Marfan syndrome. Coronal and sagittal curvatures on whole spine standing film were evaluated with Cobb's method. Uncommon spinal abnormalities which can be associated with this syndrome, such as spondylolisthesis and dural ectasia were also evaluated. RESULTS: Scoliosis was identified in 18 of 32 patients(56.3%). The mean scoliotic angle was 26 degrees and thoracic curve was most common. Thoracic kyphosis, lumbar lordosis and thoracolumbar kyphosis were measured as 27 degrees +/- 13 degrees ( 0 degrees ~ 53 degrees), -42 degrees +/- 13 degrees( -10 degrees ~ -70 degrees ) and 9 degrees +/- 12 degrees ( -5 degrees ~ 4 5 degrees) respectively. Spondylolisthesis was present in two cases(6.3%), one of which was 15% slip and the other was 50% slip. Two cases of dural ectasia were confirmed with MRI. CONCLUSION: Marfan syndrome showed high incidence of scoliosis(56.3%) and thoracolumbar kyphosis(50%). The frequency of spondylolisthesis was only slightly higher than that in the general population. The dural ectasia is a common but little known abnormality. Therefore it has a significant diagnostic value without clinical importance. In Marfan syndrome, we should keep these common and uncommon spinal abnormalities in mind.
Animals ; Dilatation, Pathologic ; Humans ; Incidence ; Kyphosis ; Lordosis ; Magnetic Resonance Imaging ; Marfan Syndrome* ; Retrospective Studies ; Scoliosis ; Spine ; Spondylolisthesis

STUDY DESIGN: This case report presents a rare case of Aspergillus osteomyelitis of the vertebra in an immunocompetent host. OBJECTIVES: To discuss the iatrogenic Aspergillus spondylitis after posterior instrumentation in an immunocompetent patient and review the pertinent literatures. SUMMARY OF BACKGROUND DATA: Aspergillus spondylitis is very rare especially in immunocompetent host. Treatment requires early debridement and continuous medication with antifungal drugs. RESULT: This report discusses a case that occured in an immunocompetent 60 year-old woman who had posterolateral fusion with posterior instrumentation for T12 burst fracture. After a few months of operation, she complained chronic back pain and progressive neurologic compromise. The MR imaging showed an epidural mass compressing the spinal cord, so hardware removal and curettage was done at neurosurgical department. Her symptoms were not improved after hardware removal, so anterior decompression and fusion was done again. The biopsy of the epidural mass showed septated hyphae which is the characteristic of Aspergillosis. With aggressive surgical debridement and continuous treatment with amphotericin B, follow-up examination at postoperative 2 years showed neurologic improvement about 2 grades by Frankel classification.
Amphotericin B ; Aspergillosis ; Aspergillus* ; Back Pain ; Biopsy ; Classification ; Curettage ; Debridement ; Decompression ; Female ; Follow-Up Studies ; Humans ; Hyphae ; Magnetic Resonance Imaging ; Middle Aged ; Osteomyelitis ; Spinal Cord ; Spine ; Spondylitis*

PURPOSE: To evaluate the results of expansive laminoplasty and to investigate the validity of various factors as prognostic indicators. MATERIALS AND METHODS: We studied retrospectively 37 patients between August 1993 and August 1998. The severity of the pre- and postoperative myelopathy was determined with the Japanese Orthopaedic Association (JOA) score. The recovery ratio was calculated. We divided the patients into two groups with good and fair outcomes, and then assessed for prognostic factors such as preop JOA scores, ages, sex, trauma, duration, Pavlov ratios, compression ratios and signal change in cord on T2W MRI. RESULTS: In 19 patients the percentage recovery of JOA score was higher than 50%, while in 18 patients it was lower than 50%. There were no significant differences in regards to history of trauma, sex, and duration, there was a tendency of good results when there were no changes in the signal in cord on T2W MRI. There were significant differences in the preoperative JOA scores, Pavlov ratios and compression ratios. CONCLUSION: The preoperative JOA score, Pavlov ratio, compression ratio and high signal intensity on T2W MRI can be used to predict prognosis.
Asian Continental Ancestry Group ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Retrospective Studies ; Spinal Cord Diseases*

PURPOSE: To define possible mechanism of posture-dependent symptom of spinal stenosis by measuring the effect of low back motion on the morphologic change of intervertebral disc and spinal canal. MATERIALS AND METHODS: Twenty healthy young volunteers underwent magnetic resonance imaging (1.5T MR scanner, GE) while supine with their lumbar spine in neutral, flexed, extended, and right and left rotational positions. The axial MR images at the middle of the intervertebral disc of L3-4 and L4-5 were analyzed to measure the difference of the size and shape of the disc and spinal canal in each posture. RESULTS: Extension decreased the sagittal diameters and the cross-sectional areas of the dural sac and spinal canal and increased the thickness of ligamentum flavum, whereas flexion had the opposite effects. The gap between convex posterior disc margin and anterior margin of facet joint of each side, represented as subarticular sagittal diameter, increased with flexion and decreased with extension or rotation. The directions of the rotation did not result any asymmetry of the subarticular sagittal diameter, but right rotation resulted thickening of right ligamentum flavum. The shape and dimensions of disc did not significantly change according to the positions of low back. CONCLUSIONS: With extension or rotation, the thickness of ligamentum flavum increased and posterior margin of the intervertebral disc was approximated to facet joint secondary to posterior movement of upper vertebral body without any change of shape and size of the disc. These phenomena result decrease of the size of spinal canal and dural sac in extension or rotation posture in young healthy people and may explain the posture-dependent symptom of spinal stenosis.
Intervertebral Disc ; Ligamentum Flavum ; Magnetic Resonance Imaging ; Posture ; Spinal Canal* ; Spinal Stenosis ; Spine ; Volunteers ; Zygapophyseal Joint

PURPOSE: To identify the changes of bony landmarks with rotation and to compare the reliability and accuracy of Perdriolle's method before and after training on the exact bony landmarks. MATERIALS AND METHODS: Simple A-P radiographs were taken with rotation from 5 degree to 50 degree at 5 degree interval using 10 dry human vertebrae (2 sets of T3, T6, T9 8 L3) with no bony abnormality. Axial rotation was measured before and after training on the exact bony landmarks by three observers, twice for each radiographs. Repeated measures of ANOVA were used for inter- < intraobserver variance and regression analysis for root mean square error and deviation of differences. RESULTS: Mamillary process, inner margin of lamina, proximal and distal costovertebral joints, upper margin of concave pedicle and tip of the transverse process on the convex side confused the exact outline of the pedicle, while neural foraminal margin was helpful in identifying the location of the indistinct convex pedicle and concave vertebral border. Of the 660 measurements before and after training 372 and 397 errors were made, respectively, of which 88.9% and 88.5% were within +/-5 degree(P > 0.05). Incidence of error greater than 5 degree was high at upper thoracic vertebra and 20 degree-40 degree of rotation regardless of training. The effects of training, however, was greatest at T3 and 20 degree-40 degree of rotation. Inter- < intraobserver variance was diminished at T3 and at the rotation between 20 degree-40 degree after training. CONCLUSIONS: We could conclude that training on the exact bony landmarks did not reduce the overall error incidence. Accuracy and reliability, however, was increased at T3 after training and the efficacy of training was more evident in moderate vertebral rotation than in small or large vertebral rotation.
Humans ; Incidence ; Joints ; Spine

PURPOSE: To evaluate the clinical features and assess the MRI measurements of the stenosis quantitatively in patients undergoing surgery for level one lumbar stenosis. The goal of this study was to correlate MRI measurements with clinical features and define whether the measurements have prognostic value. MATERIALS AND METHODS: From October 1994 to October 1996, 31 patients with level one lumbar spinal stenosis underwent posterior decompression and posterolateral fusion with instrumentation. Average age of the patients at the time of surgery was 56 years (range, 34-77 years). There were 11 men and 20 women. Most commonly involved level was L4-L5 (29 patients). All patients were evaluated before surgery and at defined intervals of 6 weeks, 3 months, 6 months, 1 year after surgery and at last follow up. The average follow up period was 29 months (range, 19-43 months). Clinical features of the patients were back pain, radiating pain, intermittent neurogenic claudication and gross pain score. MRI measurements of the patients were measured by anteroposterior diameter of spinal canal, canal area, foraminal area and depth of lateral recess. A statistical analysis was performed with the Chi-square test and Mann Whitney test. RESULTS: Patients with smaller spinal canal area (area < or = 80 mm2) showed more improvement in radiating pain than patients with large area (area>80 mm2) (P<0.05) and tendency toward improving claudication and pain score (P>0.05). Other MRI measurements did not correlate with the preoperative and postoperative clinical features. CONCLUSIONS: In conclusion, spinal canal area measured on the MR image seems to have some prognostic value in patients undergoing surgery for level one lumbar stenosis.
Back Pain ; Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Male ; Spinal Canal ; Spinal Stenosis*

PURPOSE: This study was undertaken to increase the knowledge of the intra- and extra-spinal alignments and to help recovery of sagittal alignment in operation by measuring the normal values of the spinal alignment in relation to hip axis as well as those of the thoracic, thoracolumbar junction, lumbar and lumbosacral junction of sagittal alignment and their correlation. MATERIALS AND METHODS: Whole spine standing lateral radiographs were taken in young 100 adults without spinal abnormalities clinically and radiographically. Intraspinal alignment was measured with angles of thoracic kyphosis, lumbar lordosis, maximum thoracic kyphosis, maximum lumbar lordosis, angle of the thoracolumbar junction, sacral inclination, segmental angles and disc angles respectively with special emphasis on lumbar lordosis. Extraspinal alignment was measured with sacropelvic angle, spinopelvic balance and spinal balance in relation to hip axis. Correlations among these parameters were analyzed. RESULTS: Lumbar lordosis and thoracic kyphosis were measured -49 degree(-22 - -79 degree) and 32 degree(6 degree-56 degree), respectively. Slight amount of kyphosis in thoracolumbar junctional area was considered normal. Lumbar lordosis had significant correlation with thoracic kyphosis and sacral inclination. However, there was no correlation between thoracic kyphosis and sacral inclination. Lowest two lumbar segments comprised 71% of total lordosis. Lumbar lordosis usually started at L1-2 and gradually increased at each level caudally to the sacrum. Sacropelvic angle, spinopevlic balance and spinal balance were measured -11 degree(-6 degree - 24 degree), -4 cm (-10 - 2 cm), and -2 cm (-7 - 4 cm) respectively with C7 positioned posterior to hip axis mostly. CONCLUSIONS: There was a wide range of normal sagittal alignment of the thoracic and lumbar spines, and normal values of these alignments were not easily defined. Therefore, normal patterns of sagittal curvature and sagittal balance should be more emphasized.
Adult ; Animals ; Axis, Cervical Vertebra ; Hip ; Humans ; Kyphosis ; Lordosis ; Reference Values ; Sacrum ; Spine*