A Retrospective Study of 39 Patients Treated With Anterior Approach of Thoracic and Lumbar Spondylodiscitis: Clinical Manifestations, Anterior Surgical Treatment, and Outcome.

The aim of this study is to report our 39 patients treated with anterior debridement and autologous iliac bone grafting with or without anterior instrumentation, which is the presumed treatment of choice for thoracic or lumbar spondylodiscitis.Our patients underwent surgical treatment of spondylodiscitis using anterior debridement and autologous iliac bone grafting with or without anterior instrumentation and were analyzed with a mean follow-up of 8 years (range, 2-11 years). Kaneda 2-rod system instrumentation was used in 12 patients, in total. Clinical outcomes were assessed by the Frankel grade. Radiographic fusion was characterized based on 3-dimensional computed tomography.Of the whole group, 20 patients suffered from tuberculous spondylodiscitis and 19 suffered from hematogenous spondylodiscitis. Pathogens responsible for pyogenic infection included Staphylococcus aureus (4 patients), Pseudomonas aeruginosa (3 patients), and Brucella melitensis (1 patient). Fifteen patients had thoracic involvement, 20 had lumbar involvement, and 4 had thoracolumbar junction involvement. Preoperative neurological deficits were noted in 13 of the 39 patients. In terms of Frankel grade, 8 patients have improved, 4 have remained the same, and 1 patient has worsened during the follow-up period. Imaging-documented fusion was achieved in 23 of 27 patients in the graft group (85% fusion rate) and 11 of 12 patients in the graft + Kaneda instrumentation group (91% fusion rate).There was no instrumentation failure, loosening, or graft-related complication such as slippage or fracture of the graft. This approach demonstrated a good recovery rate of neurological functions and a high fusion rate.

Co-existence of L5-S1 disc herniation and conus medullaris ependymoma.

INTRODUCTION: The lumbar disc herniations are seen very common than spinal ependymomas in the neurosurgery polyclinic routine. PRESENTATION OF CASE: In our case, both pathologies were seen at the most frequently located levels compatible with the literature. Aim of this case report is, to remind once more that, different pathologies can be found at the same time in a single patient; differential diagnosis must be done very carefully. DISCUSSION: The routine Computed Tomography (CT) imaging for low back pain can not show the conus medullaris pathology. Spinal tumors or other similar pathologies should be kept in mind for differential diagnosis. A good medical history and a good physical examination must be completed before the final diagnosis. CONCLUSION: Viewing of spinal canal with Magnetic Resonance Imaging (MRI) will be useful for the patients who we intend to do disc surgery.

Reactive changes of disc space and foreign body granuloma due to bone wax in lumbar spine.

Bone wax is a well-known agent used to prevent bleeding from the bone that can be used in different surgical procedures. Bone wax is a safe agent, but it may rarely lead to significant foreign body reactions. In this report, we present a patient who developed bone wax-related disc space foreign body granuloma following L4 total laminectomy, extremely rare complication.

Nasal-subfrontal giant schwannoma.

Subfrontal schwannomas are rare lesions. They can be misdiagnosed as olfactory meningiomas or neuroblastomas. We report a case of giant schwannoma involving the anterior cranial fossa; the frontal and ethmoid sinuses and nasal cavities. The patient presented with a year-long history of increasingly severe headache associated with insomnia. Examination revealed no neurological deficit except for the anosmia. Magnetic Resonance Imaging revealed a 9x5x3 cm intranasal-subfrontal extraaxial mass. Nasal biopsy indicated the presence of a schwannoma. The lesion was totally removed through a bifrontal craniotomy and the skull base was repaired with periosteal flap, fibrin glue and a split craniotomy graft. In addition to the cosmetic advantages over standard transfacial approaches, the extended subfrontal approach also provides early dissection of neural tissues, avoiding an inadvertent cerebrospinal fluid leak.

Primary primitive neuroectodermal tumor of the lumbar extradural space.

Primary spinal primitive neuroectodermal tumors (PNETs) of the extradural space are very rare; only 10 cases have been reported in the English language literature. The histopathological diagnosis of primary spinal PNETs has been discussed for many years. These tumors have a rapidly progressive course, and there is no current consensus on the optimal therapeutic approach for these patients. The authors present a case of primary PNET located in the lumbar extradural space in a 13-year-old girl and report the clinical, radiological, histopathological, and surgical findings. They compare their findings with those from the other 10 cases reported in the literature and review relevant literature.

Unilateral acute foot drop due to diffuse axonal injury after head trauma.

Acute foot drop due to diffuse axonal injury (DAI) has not been previously described in the literature. In this report, we present a patient with unilateral acute foot drop caused by a DAI lesion after head trauma.

Is it possible to start the treatment based on immediate cytologic evaluation of core needle biopsy of the spinal lesions?

Core needle biopsy is widely used to diagnose spinal lesions. Final histopathological report of the specimen usually can be given after several days. These several days delay may prevent early treatment in some patients. Our aim was to investigate if treatment of spinal lesions could be started according to the immediate cytologic evaluation of the core needle biopsy. The cytological materials of the 213 core needle spinal biopsy were prepared immediately after biopsy procedure. Of these biopsies, only 101 core needle biopsy had a final diagnosis which formed the backbone of the current study. Cytological materials of these cases were compared with both histopathologic results of the core biopsy and with final diagnosis obtained by open surgery or clinical follow up. According to final diagnoses 40 patients had infections, 59 patients had neoplasms and 2 patients had no pathology. When the diagnosis that determines the treatment is considered, the overall success rates (positive predictive value:PPV) of cytology and histology were 0.65 and 0.76 respectively. Moreover when the specific diagnosis were analyzed separetely in the subgroups of tuberculous infection, lymphoma and plasmacytoma; PPV of both cytological and histological assessments was 1.00. In spinal metastasis, PPV was 0.97 for cytology and 1.00 for histology. Rapid cytologic interpretation of core needle biopsy material is a useful and reliable tool to determine the spinal lesions which require urgent treatment. When the cytological specimen reveals the diagnosis of spinal metastasis, lymphoma, plasmacytoma or tuberculosis, the treatment may be started without waiting the result of the histological examination.

Percutaneous computed-tomography-guided biopsy of the spine: 229 procedures.

OBJECTIVES: Percutaneous biopsy of the spine is an effective and well-evaluated procedure. Only very few series containing more than a hundred patients have been reported so far and there is no agreement about the factors affecting the diagnostic rate. We aimed to find out if there is any factor influencing the success rate of the spinal biopsy using our biopsy series. METHODS: Two hundred and twenty-nine procedures were performed in 201 patients between November 2001 and August 2005. All procedures were performed under computed tomography guidance. The side was chosen according to the extension of the lesion. When the lesion was in the midline or extended to both sides, we preferred to obtain biopsy from the right side. The puncture point and the needle trajectory were planned on both lateral computed tomography scout scan and axial scans. RESULTS: We found that the diagnostic rate was not affected by the variables such as age, gender, type and diameter of the biopsy needle, diagnosis as well as lesion localization and level. The success rate of the repeat biopsies was considerably lower than the first procedures. CONCLUSIONS: The diagnostic rate is not affected by any of the variables but the approach, chosen can vary with the level, localization, and lesion characteristics.