Routine sagittal whole-spine magnetic resonance imaging in finding incidental spine lesions.

PURPOSE: To examine the efficacy and feasibility of T2-weighted whole-spine sagittal magnetic resonance imaging (MRI) screening for all patients who undergo MRI of the lumbar spine for any indication. METHODS: A review of 1145 consecutive T2-weighted whole-spine sagittal MRI screening sequences performed for lumbar spine imaging was undertaken for the purposes of documenting the incidence and clinical significance of thoracic and cervical spine incidental findings, as well as to establish correlation between these pathologies and those found in the lumbar spine. RESULTS: Out of the 1145 patients included in the study, 103 (9%) patients had incidental findings thought to be significant. These findings included cervical spinal stenosis (n = 85), thoracic disc herniation (n = 9), syrinx (n = 5), intradural tumor (n = 2), and signal changes within the spinal cord (n = 2). In follow-up exams, 35 patients had clinically significant findings which included cervical myelopathy (n = 25), thoracic myelopathy (n = 3), syrinx (n = 5) and intradural tumor (n = 2). Among the 172 patients presenting with lumbar spinal stenosis, 42 (24.4%) had such incidental findings, and of those 41 (23.8%) had cervical stenosis with spinal cord compression (p < 0.0001). CONCLUSION: T2-weighted whole-spine sagittal screening is useful in demonstrating clinically relevant incidental findings in any patients undergoing MRI of the lumbar spine. There is a statistically significant correlation between lumbar spinal stenosis and cervical spinal stenosis with spinal cord compression.

Gas forming infection of the spine: a systematic and narrative review.

PURPOSE: Gas forming infection (GFI) of the spine is a rapidly progressive and potentially life-threatening infection. It can be a consequence of aetiologies such as Emphysematous Osteomyelitis (EOM), Necrotizing Fasciitis (NF), and Gas-containing Spinal Epidural Abscess (Gas-containing SEA). This review aims to summarize the characteristics of these subtypes of GFI, describing their aetiology, diagnosis, management, and prognosis. METHODS: PubMed, Embase, Web of Science and the Cochrane Database were systematically searched for studies reporting on gas forming infections of the spine or a known subtype. Cases of post-operative and iatrogenic spinal infection were excluded. RESULTS: The literature review revealed 35 studies reporting on 28 cases of EOM, three cases of NF involving the spine and seven cases of Gas-containing SEA. Thirty studies reporting on 32 cases of GFI were available for data analysis. The mean age of the patients was 60.9 years and a concomitant diagnosis of diabetes mellitus was reported in 57.5% of patients infected. Fever and back pain were the most common presenting symptoms. The lumbar spine was the most commonly affected spinal segment. Mortality from EOM, NF and Gas-containing SEA were 34.8, 100 and 28.5%, respectively. DISCUSSION: Gas forming infection of the spine is a rare condition with an extremely poor prognosis, requiring early and aggressive surgical treatment. A multi-disciplinary approach is necessary for management. Nonetheless, even in cases of early recognition and optimal management, multisystem failure may still occur, and mortality rates remain high due to the aggressive nature of this infection. LEVEL OF EVIDENCE: Systematic review of level IV studies.

Association between lumbosacral transitional vertebrae and spinal pathologies based on T2 whole-spine sagittal magnetic resonance imaging.

PURPOSE: To assess the association between 4, 5, or 6 lumbar spine vertebrae and the presence of lumbar spinal pathologies. METHODS: We reviewed all MRI reports and images performed between August 1st, 2018 and July 31st, 2019. Lumbar spine pathologies such as disc herniation, lytic spondylolisthesis, and spinal stenosis were recorded. The reviewer studied the T2 sagittal screening of the entire spine and counted down manually from C2 to T12 on the assumption that there are seven cervical and twelve dorsal vertebrae. We then recorded whether there were four, five, or six lumbar vertebrae. RESULTS: Our work incorporated a total of 1985 patients for whom T2-weighted entire spine sagittal MR images were obtainable. The study cohort's average age was 52.2 ± 15.9 years, comprising 944 males and 1041 females. One hundred and thirty-three patients (6.7%) had 4 lumbar-type vertebrae; 1799 (90.6%) had 5 lumbar-type vertebrae; and 53 (2.7%) had 6 lumbar-type vertebrae. There was a statistically significant difference between the rates of 6 lumbar-type vertebrae in males versus females (p < 0.05). There was a statistically significant difference with more spinal stenosis patients in the 6 lumbar-type vertebrae compared to the 4 or 5 lumbar-type vertebrae groups (p < 0.001). CONCLUSION: Our study shows that spinal stenosis is significantly more common in patients with 6 lumbar-type vertebrae.

Height Gain Prediction in Adolescent Idiopathic Scoliosis Based on Preoperative Parameters.

BACKGROUND: The purpose of the study was to identify preoperative parameters which are associated with height gain after corrective surgery for adolescent idiopathic scoliosis (AIS) and their use to preoperatively quantify the potential for height gain after AIS correction. METHODS: Our study included 87 consecutive patients with AIS who underwent posterior fusion. Patients' height was measured the day before surgery and before their discharge. Demographic and radiologic variables were analyzed for predictability of height gain. RESULTS: The mean height gain was 3.85 cm. We have found a statistically significant correlation between height gain and the following measures: preoperative thoracic curve, preoperative thoracolumbar curve, preoperative thoracic kyphosis, flexibility of the main thoracic and thoracolumbar curves, and number of fused levels (all P<0.05). Patients with Lenke type 1 and 2 had statistically less height gain compared with patients with Lenke type 3, 4, 6. CONCLUSION: Most of the scoliosis patients with Lenke type 1 and 2 will gain up to 3 cm after surgery while most of the patients with Lenke type 3, 4, 6 will gain more than 3 cm. Most patients with Lenke type 3, 4, 6 with a major curve of less than 60 degrees will gain up to 4 cm, while most of those with a major curve of more than 60 degrees will gain more than 4 cm. Patient with a positive thoracic sagittal modifier tend to have more height gain after surgery.

Clinical and Radiographical Characteristics in Male and Female Adolescent Idiopathic Scoliosis Surgical Candidates.

BACKGROUND: Gender differences in adolescent idiopathic scoliosis (AIS) have been documented in curve progression, response to bracing, and outcomes of surgical treatment. However, limited information is available about the relation between gender and scoliosis curve patterns and radiographical characteristics. OBJECTIVES: To evaluate the effect of gender on curve pattern and compare clinical and radiographical characteristics between male and female patients with AIS. METHODS: We conducted a retrospective review of prospectively collected data that compared clinical and radiographical characteristics between male and female surgical candidates. Demographic and clinical data including age at presentation, gender, family history of scoliosis, brace treatment history, clinical coronal balance, shoulder asymmetry, and hump size were recorded. All patients graded their pain with the use of a visual analogue scale (VAS) on a scale from 0 to 10. Radiographs of the spine were reviewed to determine the type of curve according to the Lenke classification, Cobb angle, thoracic kyphosis angle, and the Risser sign. Radiologic coronal balance was recorded. Curve flexibility was determined by measuring the thoracic and lumbar curves magnitude on side bending radiographs. RESULTS: The study included 163 patients with AIS including 35 males and 128 females patients. Although a trend toward more flexible major thoracic curves in females was noticed, there was no statistically significant difference between the 2 groups. CONCLUSIONS: In this study we were not able to demonstrate any clinical nor radiological statistical differences between male and female patients who are candidate for surgical treatment.

Seven years follow-up for total lumbar facet joint replacement (TOPS) in the management of lumbar spinal stenosis and degenerative spondylolisthesis.

PURPOSE: To evaluate the feasibility and clinical improvement of a total posterior arthroplasty system in the surgical management of lumbar degenerative spondylolisthesis and or spinal stenosis. METHODS: During a 1-year period (June 2006 to July 2007), ten patients were enrolled in a non-randomized prospective clinical study. The primary indication was neurogenic claudication due to spinal stenosis with single-level degenerative spondylolisthesis. Patients were evaluated with X-rays and MRI scans, visual analog scale (VAS) for back and leg pain, the Oswestry disability questionnaire, and the SF-36 health survey preoperatively, at 6 weeks, 3 months and 6 months and at 1, 2, 3 and 7 years postoperatively. RESULTS: The VAS score for back pain dropped from 56.2 preoperatively to 12.5 at 6 weeks and 19 at 7 years follow-up. The VAS score for worse leg pain dropped from 83.5 before surgery to 13 at 6 weeks and 8.8 at 7 years follow-up. The ODI dropped from 49.1 preoperatively to 13.5 at 6 weeks and 7.8 at 7 years follow-up. MRI examination at 7 years after surgery did not demonstrate stenosis adjacent to the stabilized segment. Spondylolisthesis did not progress in any of the cases. One patient had a symptomatic L3-L4 far lateral disc herniation 5 years after surgery whose symptoms resolved with non-operative treatment. In one patient, conversion to posterolateral fusion was performed due to an early device malfunction. CONCLUSION: In patients with spinal stenosis and degenerative spondylolisthesis, decompression and posterior arthroplasty with the TOPS System can maintain clinical improvement and radiologic stability over time.

The relation between location of cervical cord compression and the location of myelomalacia.

OBJECTIVE: The purpose of this study was to examine the relationship between the location of the cervical cord compression and the increased signal intensity within the cervical cord on T2-weighted imaging (T2WI) in patients with cervical myelopathy and myelomalacia. MATERIALS AND METHODS: We reviewed 1,615 MRI reports from January 2011 to May 2013 from a single institution. Of the 1,615 reports reviewed, 168 patients were diagnosed with increased signal intensity within the cervical spine on T2WI. After applying the exclusion criteria 82 patients were included in the study. The MRIs of these 82 patients were then reviewed and the location of the increased signal intensity on T2WI in relation to the location of the pressure on the spinal cord was recorded. RESULTS: In more than 50 % of the cases the lesions with increased signal intensity on T2WI either were located distal to the pressure on the spinal cord or started at the level of the pressure and extended to an area distal to the pressure. In 26 out of the 92 lesions with increased signal intensity on T2WI, the lesion started proximal to the pressure on the spinal cord and extended distal to it. In only 3 out of the 92 lesions, the lesion with increased signal intensity on T2WI was solely located proximal to the pressure on the spinal cord. In 5 other cases the lesion with increased signal intensity on T2WI started proximal to the level of pressure on the spinal cord and extended into the level of pressure on the spinal cord (p < 0.001; Table 1). CONCLUSION: Cervical myelomalacia may appear proximal, distal or at the level of the compressed cord. It rarely appears solely proximal to the pressure area on the cord.

Pediatric scoliosis surgery--is postoperative intensive care unit admission really necessary?

BACKGROUND: It is common practice for patients to be admitted to the intensive care unit following scoliosis surgery, because of the prolonged anesthesia, the need for efficient pain control and the known immediate postoperative complications. However, this may be unnecessary in many patients. PURPOSE: We aimed to establish possible associations between pre- and perioperative parameters and early postoperative complication rates, in particular the need for prolonged mechanical ventilation (>1 day), and the presence of major complications in children undergoing primary spinal fusion by thoracolumbar spine instrumentation. METHODS: We conducted a retrospective review of children undergoing primary scoliosis surgery at a university-affiliated general hospital from 1998 to 2008. RESULTS: Surgical approaches were as follows: anterior spinal fusion, posterior spinal fusion, and combined anterior and posterior fusion. Prior to mid-2005, anesthesia included morphine; thereafter, remifentanil was used. Major complications correlated significantly with neuromuscular scoliosis (NMS) (OR, 4.94; 95% CI, 1.02-24.05), comorbidity conditions (OR, 3.47; 95% CI, 1.16-10.42), and anterior or combined fusion (OR, 7.81; 95% CI, 2.12-28.57). Late extubation correlated significantly with NMS (OR, 31.25; 95% CI, 1.06-100.00) and morphine use during anesthesia (OR, 17.91; 95% CI, 1.44-222.9). CONCLUSIONS: Relatively young, healthy idiopathic scoliosis children receiving intraoperative remifentanil sedation and undergoing posterior fusion can be successfully managed in regular wards in the immediate postoperative period. However, intensive care unit admission should be considered in NMS patients, patients with comorbidity conditions, those undergoing anterior or combined spinal fusion, and patients whose anesthesia involves long-acting opioids.

Otolith dysfunction as a possible cause for the development of idiopathic scoliosis.

BACKGROUND: To investigate whether otolith system, as a major contributor to muscles for postural control, might play a role in the pathogenesis of idiopathic scoliosis (IS). METHODS: Cervical vestibular-evoked myogenic potentials (VEMP) testing was applied to investigate the otolith function in patients with IS. Twenty-nine healthy patients (mean age 13.5±2.5 y, 4 males) were included. In all but 2 patients, the major curve deviation was to the right and the mean angle deviation was 49.7±21.6 degrees. Nineteen age-matched individuals (10 males) served as controls. RESULTS: The P13 (first positive wave) latencies were comparable in both groups. Patients with IS had significantly longer N23 (first negative wave) latencies than controls. A high correlation between the age and N23 latencies on the right was found in IS patients. A link between the scoliosis angle and VEMP latencies could not be demonstrated.The VEMP amplitudes were higher in patients than in controls, whereas the amplitude asymmetry ratio was similar in both groups. CONCLUSIONS: This work brings further evidence for vestibular abnormalities in patients with IS. Prospective studies are needed to elucidate a possible causative relationship between otolith dysfunction and the development of scoliosis. LEVEL OF EVIDENCE: III.

Predictors of back pain in adolescent idiopathic scoliosis surgical candidates.

BACKGROUND: There are contradictory reports on the overall prevalence of back pain in the adolescent population compared with adolescent idiopathic scoliosis (AIS) patients. Most reports do not investigate pain in patients with AIS but try to identify in which subgroup of patients with AIS an underlying pathology should be excluded. The objective of this study was to find whether AIS in operative candidate patients is a painful condition and to try and find clinical and radiologic predisposing factors, which will help us to predict patients who are going to have pain. METHODS: Candidates who had to undergo an operative treatment for AIS between October 2004 and October 2009 in our institution, were enrolled to the study. Pain was graded with the use of visual analogue scale (VAS) on a scale from 0 to 10. We recorded the age at presentation, sex, menarchal status, family history of scoliosis, brace treatment history, and neurological findings. Radiologic parameters recorded were: the type of curve according to the Lenke classification, Cobb angle, thoracic kyphosis angle, apex vertebra rotation, Risser grade, coronal balance, and curves flexibility. RESULTS: Seventy patients with AIS were included in this study. Fifty patients (71%) reported of some kind of back pain with 34 patients (48%) grading their pain as ≥5 on the VAS.Patients in whom scoliosis was diagnosed in older age and patients with a more rigid lumbar curve had statistically significant higher VAS scores (P=0.014, P=0.036). Patients who were treated with a brace had a statistically significant lower VAS scores (P=0.019). CONCLUSIONS: Back pain is common in patients with AIS who are candidates for operative treatment. The following parameters correlate with worse back pain: older age at diagnosis, no use of brace, and rigid lumbar curve. LEVEL OF EVIDENCE: Type III.

Who is at risk of receiving inadequate care for osteoporosis following fragility fractures? A retrospective study.

BACKGROUND: Osteoporosis is considered the most common bone disease in humans and the most common cause of fractures. OBJECTIVES: To identify possible risk factors associated with a low level of care for osteoporosis in patients presenting acutely with the major types of fragility fractures, as well as in patients who remain undertreated following their discharge. METHODS: We conducted a retrospective questionnaire-based cohort study. We searched our databases for patients admitted acutely with proximal humerus, distal forearm, thoraco-lumbar spine, and proximal femur fractures. A questionnaire was used to evaluate osteoporotic care including a referral to DEXA and any associated prescribed medication. RESULTS: The study group included 114 patients or their caregivers. The osteoporosis care rate rose from 56.1% (n = 64) before admission to 71% (n = 81) at follow-up. Significant risk factors associated with a decreased care rate prior to admission were the presence of fewer than three comorbidities and a combination of male gender and young age. Continued neglect at follow-up was associated with the opposite risk factors, such as older age, multiple comorbidities, and polypharmacy. An additional finding was that treated patients had a significantly increased likelihood of presenting with vertebral fractures. CONCLUSIONS: While the association of osteoporosis with the elderly may decrease screening rates among younger and healthier patients, fragility fractures may be viewed as "endstage" bone disease, rendering osteoporotic care inefficient.

Fusion's Location and Quality within the Fixated Segment Following Transforaminal Interbody Fusion (TLIF).

Transforaminal interbody fusion (TLIF) has gained increased popularity over recent decades and is being employed as an established surgical treatment for several lumbar spine pathologies, including degenerative spondylosis, spondylolisthesis, infection, tumor and some cases of recurrent disc herniation. Despite the seemingly acceptable fusion rates after TLIF (up to 94%), the literature is still limited regarding the specific location and quality of fusion inside the fixated segment. In this single-institution, retrospective population-based study, we evaluated all post-operative computed tomography (CT) of patients who underwent TLIF surgery at a medium-sized medical center between 2010 and 2020. All CT studies were performed at a minimum of 1 year following the surgery, with a median of 2 years. Each CT study was evaluated for post-operative fusion, specifically in the posterolateral and intervertebral body areas. The fusion's quality was determined and classified in each area according to Lee's criteria, as follows: (1) definitive fusion: definitive bony trabecular bridging across the graft host interface; (2) probable fusion: no definitive bony trabecular crossing but with no gap at the graft host interface; (3) possible arthrosis: no bony trabecular crossing with identifiable gap at the graft host interface; (4) definite pseudarthrosis: no traversing trabecular bone with definitive gap. A total of 48 patients were included in this study. The median age was 55.6 years (SD ± 15.4). The median time from surgery to post-operative CT was 2 years (range: 1-10). Full definitive fusion in both posterolateral and intervertebral areas was observed in 48% of patients, and 92% showed definitive fusion in at least one area (either posterolateral or intervertebral body area). When comparing the posterolateral and the intervertebral area fusion rates, a significantly higher definitive fusion rate was observed in the posterolateral area as compared to the intervertebral body area in the long term follow-up (92% vs. 52%, p < 0.001). In the multivariable analysis, accounting for several confounding factors, including the number of fixated segments and cage size, the results remained statistically significant (p = 0.048). In conclusion, a significantly higher definitive fusion rate at the posterolateral area compared to the intervertebral body area following TLIF surgery was found. Surgeons are encouraged to employ bone augmentation material in the posterolateral area (as the primary site of fusion) when performing TLIF surgery.

Traumatic Posterior Atlantoaxial Dislocation With an Associated Fracture: A Systematic Review.

STUDY DESIGN: Systematic review. OBJECTIVE: To investigate the clinical presentation, mechanism of injury, patients' characteristics, diagnosis, treatment, and prognosis of traumatic posterior atlantoaxial dislocation with fracture (TPAD). BACKGROUND: TPAD is an extremely rare entity, with a limited number of cases reported in the literature. Although rare, a thorough understanding of the pathogenesis and management of such cases is required due to the high risk of spinal cord compression and the severity of neurological deficits. We conducted a systematic review of all cases of TPAD with fractures reported in the literature. METHODS: This systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. Relevant literature was retrieved from the Pubmed database. All published English-written studies involving human subjects with relevant data regarding TPAD were included. RESULTS: Two case series and 20 case reports published between 1924 and 2021 describing 28 patients with TPAD were included. The median age at presentation was 51.5 years, with male predominance (83%). The most common fracture pattern was Anderson and D'alonzo type II odontoid fracture (78%). Neurological exam at presentation was intact in 52% of patients. The primary diagnostic imaging was computed tomography employed in 96% of cases. The management consisted of 2 stages protocol, initially, a temporary axial traction was employed (54%), and later definitive surgical treatment was employed (93%). The posterior surgical approach was favored in 82% of cases. CONCLUSION: TPAD with fracture occurred in the majority of cases with Anderson and D'alonzo type II odontoid fracture, predominantly in males. Diagnosis is usually established based on computed tomography imaging; further imaging may not be indicated as it does not seem to alternate the patient's management course. Surgical intervention was employed in almost all cases, with favored results through posterior C1-C2 fusion. LEVEL OF EVIDENCE: Level-IV.

Reversing the concept: correction of adolescent idiopathic scoliosis using the convex rod de-rotation maneuver.

PURPOSE: To show the radiological results of adolescent idiopathic scoliosis (AIS) patients treated with posterior fusion using all-pedicle-screw construct with correction carried out using a convex rod reduction technique. METHODS: Between October 2004 and June 2007, 42 AIS patients were treated with posterior fusion using all-pedicle-screw construct with correction done through the convex side. Two patients were lost to follow-up and were not included in the study. Forty patients had a minimum follow-up of 2 years. Patients were evaluated for the deformity correction in coronal and sagittal planes and for spinal balance. RESULTS: The mean preoperative Cobb angle of the major curve and secondary minor curves was 60° and 41°, respectively. Immediate postoperative mean Cobb angle of the major curve and secondary minor curves was 17° and 13°, respectively. Postoperative 2-year average major curve loss of correction was 7 %. Postoperative 2-year average minor curve loss of correction was 5 %. Preoperative thoracic kyphosis of 28° was changed to 22° in 2-years follow-up. The loss of thoracic kyphosis was most noted in hyperkyphotic patients. CONCLUSIONS: The correction of AIS by convex-sided pedicular screws yields a coronal correction comparable to what is described in the literature for segmental concave-sided screws.

What is the best way to apply the Spurling test for cervical radiculopathy?

BACKGROUND: A diagnosis of cervical radiculopathy is based largely on clinical examination, including provocative testing. The most common maneuver was described in 1944 by Spurling and Scoville. Since then, several modifications of the original maneuver have been proposed to improve its value in the diagnosis of cervical radiculopathy. QUESTIONS/PURPOSES: We assessed the ability of six known variations of the Spurling test to reproduce the complaints of patients diagnosed with cervical radiculopathy. METHODS: We prospectively enrolled 67 patients presenting with cervical radicular-like symptoms and concordant radiographic findings. Each patient underwent six distinct provocative cervical spine maneuvers by two examiners, during which three parameters were recorded: (1) pain intensity (VAS score), (2) paresthesia intensity (0 - no paresthesia, 1 - mild to moderate, and 2 - severe), and (3) characteristic pain distribution (0 - no pain, 1 - neck pain only, 2 - arm pain only, 3 - pain elicited distal to the elbow). The interobserver reliability of the reported VAS score (measured by the intraclass coefficient correlation) ranged from 0.78 to 0.96 and the calculated kappa values of the categorical parameters ranged from 0.58 to 1.0 for paresthesia intensity and from 0.63 to 1.0 for pain distribution. Differences in scores elicited between the two examiners for the 67 patients were resolved by consensus. RESULTS: A maneuver consisting of extension, lateral bending, and axial compression resulted in the highest VAS score (mean, 7) and was associated with the most distally elicited pain on average (mean, 2.5). The highest paresthesia levels were reported after applying extension, rotation, and axial compression (mean, 1). These maneuvers, however, were the least tolerable, causing discontinuation of the examination on three occasions. CONCLUSIONS: Whenever cervical radiculopathy is suspected our observations suggest the staged provocative maneuvers that should be included in the physical evaluation are extension and lateral bending first, followed by the addition of axial compression in cases with an inconclusive effect.

The XVS System During Open Spinal Fixation Procedures in Patients Requiring Pedicle Screw Placement in the Lumbosacral Spine.

OBJECTIVE: This pilot study was undertaken to evaluate the safety, performance, and usability of the Xvision-Spine (XVS) System (Augmedics, Arlington Heights, IL) during open spinal fixation procedures in patients requiring pedicle screw placement in the lumbosacral spine. METHODS: The XVS System is an augmented reality head-mounted display (HMD) based on a computer navigation system designed to assist surgeons in accurately placing pedicle screws. It uses an HMD-mounted tracking camera to provide optical tracking technology, and provides the surgeon a translucent direct near-eye display of the navigated surgical instrument's location relative to the computed tomographic image. We report the preliminary results of a prospective series of all consecutive patients who underwent augmented reality-assisted pedicle screw placement in the lumbosacral vertebrae at 3 institutions. Clinical accuracy for each pedicle screw was graded with Gertzbein-Robbins scores by 2 independent and blinded neuroradiologists. RESULTS: The 19 study participants included 8 men and 11 women with a mean age of 59.13 ± 12.09 and 59.91 ± 12.89 years, respectively. Seventeen procedures were successfully completed via the XVS System. Two procedures were not completed due to technical issues with the system's intraoperative scanner. A total of 86 screws were inserted. The accuracy of the XVS System was 97.7%. CONCLUSIONS: The XVS System's performance in accurate placement of pedicle screws in the lumbosacral vertebrae had an overall accuracy of 97.7%. These preliminary results were comparable to the accuracy of other manual computer-assisted navigation systems reported in the literature.

Management of symptomatic vertebral hemangioma: follow-up of 6 patients.

STUDY DESIGN: Retrospective study. OBJECTIVE: To analyze our experience in the treatment of symptomatic vertebral hemangioma, review the relevant literature, and propose a management algorithm. SUMMARY OF BACKGROUND DATA: Hemangioma is one of the commonest benign neoplasms affecting the vertebral column. These usually dormant lesions may become symptomatic by causing pain, neurologic deficit, or both. Several treatment modalities are available in the management of such symptomatic conversion. METHODS: The clinical and radiographic data of 6 patients diagnosed with symptomatic vertebral hemangioma and treated at our medical center over a period of 10 years were reviewed and analyzed retrospectively. RESULTS: Six patients were diagnosed with symptomatic vertebral hemangioma between 1998 and 2008. The lesions occupied the thoracic, lumbar, or multiple segments. Our patients presented with either simple or radicular back pain. One patient had muscle weakness, 3 revealed sensory impairment, and the remaining 2 were neurologically intact. Four patients underwent preoperative transarterial embolization followed by laminectomy and vertebroplasty of the affected level and 2 patients were treated with vertebroplasty alone. A 35-year-old woman presented during pregnancy. Her clinical course during evaluation was complicated by an acute pulmonary embolic event that necessitated installation of an inferior vena cava filter. All patients had an overall uneventful postoperative course and reported symptomatic relief to varying degrees, at an average follow-up period of 35 months. CONCLUSIONS: Symptomatic hemangioma involving the vertebral column may pose a therapeutic challenge, often requiring the active involvement of several disciplines. A review of the relevant literature, however, discloses only few management algorithms for such lesions. The coupling of preoperative transarterial embolization followed by vertebroplasty, with or without surgical decompression depending on the patients' presenting symptoms, is a relatively safe treatment and may offer long-term symptomatic relief in these patients. Other aspects of treatment are further discussed.

[Treatment for Pott's disease with neurological complication].

Tuberculosis of the spine (Pott's disease) is the most common skeletal involvement in tuberculosis, and is often accompanied with neurological deficiency. Surgical treatment was previously the mainstay of therapy in cases of Pott's disease with neurological deficiency, but since clinical recovery was found in patients awaiting surgery, conservative management with antibiotic treatment as a first Line treatment has been advocated. This conservative approach may improve the patients' neurological status while avoiding the morbidity and mortality of surgical treatment.

Safety and Efficacy of Dietary Agmatine Sulfate in Lumbar Disc-associated Radiculopathy. An Open-label, Dose-escalating Study Followed by a Randomized, Double-blind, Placebo-controlled Trial.

Objective. Agmatine, decarboxylated arginine, was shown in preclinical studies to exert efficacious neuroprotection by interacting with multiple molecular targets. This study was designed to ascertain safety and efficacy of dietary agmatine sulfate in herniated lumbar disc-associated radiculopathy. Study Design. First, an open-label dose escalation study was performed to assess the safety and side-effects of agmatine sulfate. In the follow-up study, participants diagnosed with herniated lumbar disc-associated radiculopathy were randomly assigned to receive either placebo or agmatine sulfate in a double-blind fashion. Methods. Participants in the first study were recruited consecutively into four cohorts who took the following escalating regimens: 1.335 g/day agmatine sulfate for 10 days, 2.670 g/day for 10 days, 3.560 g/day for 10 days, and 3.560 g/day for 21 days. Participants in the follow-up study were assigned to receive either placebo or agmatine sulfate, 2.670 g/day for 14 days. Primary outcome measures were pain using the visual analog scale, the McGill pain questionnaire and the Oswestry disability index, sensorimotor deficits, and health-related quality of life using the 36-item short form (SF-36) questionnaire. Secondary outcomes included other treatment options, and safety and tolerability assessment. Results. Safety parameters were within normal values in all participants of the first study. Three participants in the highest dose cohort had mild-to-moderate diarrhea and mild nausea during treatment, which disappeared upon treatment cessation. No other events were observed. In the follow-up study, 51 participants were randomly enrolled in the agmatine group and 48 in the placebo. Continuous improvement of symptoms occurred in both groups, but was more pronounced in the agmatine (analyzed n = 31) as compared with the placebo group (n = 30). Expressed as percent of baseline values, significantly enhanced improvement in average pain measures and in quality of life scores occurred after treatment in the agmatine group (26.7% and 70.8%, respectively) as compared with placebo (6.0% [P

Diabetes mellitus as a risk factor for the development of lumbar spinal stenosis.

BACKGROUND: Diabetes mellitus is a multi-organ disorder affecting many types of connective tissues, including bone and cartilage. Certain skeletal changes are more prevalent in diabetic patients than in non-diabetic individuals. A possible association of diabetes mellitus and lumbar spinal stenosis has been raised. OBJECTIVES: To compare the prevalence of diabetes mellitus in patients with spinal stenosis, degenerative disk disease or osteoporotic vertebral fractures. METHODS: A cross-sectional analysis was performed of 395 consecutive patients diagnosed with spinal stenosis, degenerative disk disease or osteoporotic vertebral fractures. All the patients were examined by one senior author in the outpatient orthopedic clinic of a large general hospital between June 2004 and January 2006 and diagnosed as having lumbar spinal stenosis (n=225), degenerative disk disease (n=124), or osteoporotic vertebral fractures (n=46). RESULTS: The prevalence of diabetes mellitus in the three groups (spinal stenosis, osteoporotic fracture, degenerative disk disease) was 28%, 6.5% and 12.1%, respectively, revealing a significantly higher prevalence in the spinal stenosis group compared with the others (P=0.001). The higher prevalence of diabetes in the stenotic patients was unrelated to the presence of degenerative spondylolisthesis. CONCLUSIONS: There is an association between diabetes and lumbar spinal stenosis. Diabetes mellitus may be a predisposing factor for the development of lumbar spinal stenosis.