Chronic neck pain in a child: a case of osteoblastoma of the C5 cervical vertebra.

Osteoblastoma is a primary bone-forming tumour that usually occurs in the second decade with an affinity to the posterior elements when found in the spine. Its occurrence in the early first decade is uncommon and often causes a diagnostic dilemma. It usually has a late presentation and the symptoms may be non-specific which may lead the clinician to overlook this particular entity. We present a case of osteoblastoma of the posterior elements of the C5 vertebra in a pre-adolescent child who was diagnosed and successfully managed with surgical resection in a timely fashion that led to favourable recovery postoperatively.

Utility of Repeat MRI in Patients With Degenerative Cervical Disease.

Existing guidelines regarding indications for initial cervical spine magnetic resonance imaging (MRI) do not indicate when to perform repeat MRI in patients with previously documented degenerative disease. This study evaluates the efficacy of repeat MRI in patients with previously diagnosed degenerative cervical disease. Between 2013 and 2018, 153 patients (102 women, 51 men; mean age, 55 years; range, 19-81 years) without a history of trauma or surgery underwent cervical spine MRI 2 or more times at our institution indicated for symptoms of neck pain with or without radiculopathy. The MRI reports of repeat studies were reviewed and compared with index studies for notable changes. Notable radiographic changes were defined as any progression of the existing degenerative disease. Fifty-three of 153 (35%) patients demonstrated progression on repeat MRI. Forty-nine of the 53 patients demonstrating progression had new or worsening symptoms prior to their follow-up study (P=.03). Twenty-nine of 35 (83%) patients with new or worsening radiculopathy progressed on MRI (P<.01). Nine of 10 (90%) patients with new upper motor neuron findings demonstrated progression (P=.01). Axial neck pain alone was not statistically linked to MRI progression (P=.1). Twenty-five (16.3%) patients underwent operative management for their disease. Only 12 (48.0%) of the surgical patients presented MRI progression (P=.1). In the absence of new or worsening degenerative cervical symptoms, additional MRI studies are unlikely to reveal any radiographic progression or change clinical management from nonoperative to operative. [Orthopedics. 2023;46(2):98-102.].

[Cervicalgia and interescapular pain by cervical osteochondroma: About a case] / Cervicalgia y dolor interescapular por osteocondroma cervical: A propósito de un caso

Background and objective: Osteochondroma is the most frequent benign bone tumor, it can present in solitary or multiple form. Only 1 to 4% of osteochondromas are found in the spine and the most frequent of these is located at the cervical level. Of all spinal osteochondromas, only 0.5% develop insidious and progressive symptoms of medullary compression, either in the form of myelopathy or radiculopathy. These tumors do not grow once the bone maturation is complete, so if the clinic appears, it does so mainly in young patients, between 20 and 30 years old. Methodology: young male with asymptomatic one year evolution posterior cervical tumor, that begins with cervicalgia and interscapular pain, without alarm symptoms. Surgical resection of the tumor is decided. Results: the pathological result describes the tumor as an osteochondroma. Six months after the intervention, the patient did not report cervicalgia or interscapular pain with a good state of scarring and cervical mobility. Conclusion: Regarding the management of these tumors, surgical treatment, by means of their resection, is indicated, if the patients present symptoms, with good functional results and a low number of complications. Its management in asymptomatic cases is controversial.

Antecedentes y objetivo: El osteocondroma es el tumor óseo benigno más frecuente, puede presentarse de forma solitaria o múltiple. Solo el 1 al 4% de los osteocondromas se encuentran en la columna vertebral y de ellos el más frecuente es el localizado a nivel cervical. De todos los osteocondromas espinales solamente el 0,5% desarrollan síntomas insidiosos y progresivos de compresión medular, ya sea en forma de mielopatía o radiculopatía. Estos tumores no crecen una vez completada la maduración ósea, por lo que si la clínica aparece, lo hace principalmente en pacientes jóvenes, entre 20 y 30 años. Metodología: varón joven con tumoración cervical posterior asintomática de un año de evolución que comienza con cervicalgia y dolor interescapular, sin síntomas de alarma. Se decide resección quirúrgica del tumor. Resultados: el resultado anatomopatológico describe la tumoración como un osteocondroma. A los 6 meses de la intervención el paciente no refiere cervicalgia ni dolor interescapular con buen estado de cicatriz y movilidad cervical. Conclusión: Respecto al manejo de estos tumores, el tratamiento quirúrgico, mediante su resección, está indicado, si los pacientes presentan sintomatología, con buenos resultados funcionales y bajo número de complicaciones. Siendo controvertido su manejo en casos asintomáticos.

Burden of neck pain and associated factors among smart phone user students in University of Gondar, Ethiopia.

BACKGROUND: Mobile technology has spread rapidly around the globe. In 2018 the numbers of mobile subscribers in Ethiopia hit 66.2 million. Musculoskeletal complaints related to smartphone use in different body parts have been reported ranging from 8.2% to 89.9%. Neck pain has the highest prevalence rate, which ranges from 17.3% to 67.8%. However, there is limited evidence on the burden of neck pain related to Smartphone usage and no research is done in Ethiopia. Therefore, this study was conducted to determine the burden of neck pain and factors associated with smartphone use in Ethiopia. PURPOSE: The objective of this study was to identify the prevalence and factors associated with neck pain among smartphone users at University of Gondar. METHODS: Institutional based cross-sectional study was conducted from November to December 2019 to determine the prevalence and associated factors of neck pain, with a sample of 845 university student smartphone users at University of Gondar, Ethiopia. A self-administered questionnaire adapted from the Nordic musculoskeletal questionnaire was used to collect data. Independent variables which had a significant association were identified using logistic regression models. Results were reported by using texts and frequency distribution tables. RESULTS: Out of 845 questionnaires distributed, 808 students responded; hence, the response rate was 95.6%. The overall prevalence of neck pain among smart phone users in the past 12 months was 47.4% (95% CI, 44.1-50.9%). Attending 5th year (AOR: 3.907, 95% CI: 1. 952-7.82) and 6th year (AOR: 2.93,95% CI: 1,304-6.59), regular physical exercise (AOR: 2.405, 95% CI: 1.549-3.734), cigarette smoking (AOR: 5.415, 95% CI: 2.685-10.919), residency (AOR: 1.681, 95% CI: 1.181-2.391), break while using smartphone (AOR: 3.253 95% CI: 2.252-4.699), used smartphone > 6 hour per day (AOR: 2.782 (1.528 95% CI: 1.528-5.063), used other devises (AOR: 3.158 95% CI: 2.128-4.689), number of social media used daily (AOR: 2.007 95% CI: 1.228-3.2788), used devise for playing game (AOR: 1.484 95% CI: 1.024-2.15) were factors significantly associated with neck pain. CONCLUSION: The current study depicted that nearly half of the study participants reported neck pain in the past 12 months. Attending last year of university, personal characteristics, use of smart phone for longer period, playing game, not taking break, other electronic device use, increased number of social media use were associated with neck pain among smartphone users.

Sexual dimorphism of the posterior cervical spine muscle attachments.

Cervical spinal injury and neck pain are common disorders with wide physical implications. Neck pain and disability are reported to occur in females more often than in males, and chronic or persistent neck pain after whiplash is twice as common in females. Female athletes also sustain a higher percentage of concussions compared to male athletes. Still, while sexual differences in clinical presentation and outcome are well-established, the underlying etiology for the disparity remains less clear. It is well-established that the origin and insertion landmarks of posterior neck muscles are highly variable, but we do not know if these interindividual differences are associated with sex. Expanding our knowledge on sexual dimorphism in the anatomy of the cervical muscles is essential to our understanding of the possible biomechanical differences between the sexes and hence improves our understanding as to why females suffer from cervical pain more than males. It is also of paramount importance for accurate planning of posterior cervical spine surgery, which cuts through the posterior cervical musculature. Therefore, our main objective is to characterize the anatomy of posterior neck musculature and to explore possible sexual differences in the location of their attachment points. Meticulous posterior neck dissection was performed on 35 cadavers, 19 females, and 16 males. In each specimen, 8 muscle groups were examined bilaterally at 45 osseous anatomical landmarks. Muscles and their attachment sites were evaluated manually then photographed and recorded using Microscribe Digitizer technology built into 3D models. A comparison of attachment landmarks between males and females for each muscle was conducted. Out of the eight muscles that were measured, only two muscles demonstrated significant sex-related anatomical differences-Spinotranversales (splenius capitis and cervicis) and Multifidus. Male Spinotransversales muscle has more attachment points than female. It showed more cranial insertion points in the upper cervical attachments (superior nuchal line, C1 posterior tubercle, and mastoid process) and more caudal insertion points in the spinous processes and transverse processes of the lower cervical and upper thoracic vertebrae. Thus, the male subjects in this study exhibited a greater coverage of the posterior neck both cranially and caudally. Female Multifidus has more attachment points on the spinous processes and articular processes at middle and lower cervical vertebrae and at the transverse processes of the upper thoracic vertebrae. All remaining muscles exhibited no sexual differences. Our findings highlight, for the first time, a sexual dimorphism in attachment points of posterior cervical musculature. It reinforces the notion that the female neck is not a scaled version of the male neck. These differences in muscle attachment could partially explain differences in muscle torque production and range of motion and thus biomechanical differences in cervical spine stabilization between sexes. It sheds a much-needed light on the reason for higher whiplash rates, concussion, and chronic cervical pain among females. Surgeons should take these sexual morphological differences into consideration when deliberating the best surgical approach for posterior cervical surgery.

A Retrospective Analysis on Cervical Spine Magnetic Resonance Imaging Findings in Patients with Neck Pain in a Tertiary Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Neck pain is a common health problem throughout the world causing significant individual disability and economic burden on health care facility. Many factors are mentioned as a cause or association in relation to neck pain, of which degenerative and posttraumatic cause are the main ones. The aim of this study is to assess cervical spine Magnetic Resonance Imaging (MRI) patterns in patients presented with neck pain. METHODS: A retrospective analysis of 160 patients who had cervical spine Magnetic Resonance Imaging (MRI) for evaluation of a neck pain was done. The study was conducted between February to August 2018 at Tikur Anbessa Specialized Hospital. The patients' clinical history and magnetic resonance imaging reports were reviewed from their medical records. All patients who have cervical spine Magnetic Resonance Imaging (MRI) for a neck pain were included in the study. Those patients with acute traumatic neck pain were excluded. RESULTS: From a total of 160 patients, 71(44.4%) were males and 89(55.6%) were females. Degenerative cervical spine findings such as intervertebral disc degenerations were seen in 127(79.4%) patients. Non-degenerative imaging findings such as neoplasm and infection were seen in 10(6.3%) patients only. The MRI was normal in 23(14.4%) of them. CONCLUSION: The most common cause of neck pain from this study is degenerative changes of the cervical spine, which was predominant in the older age groups. Non-degenerative causes such as neoplasm and infection were less common findings.

Posterior Percutaneous Transpedicular Endoscopic Approach for Treating Single-Segment Cervical Myelopathy.

BACKGROUND: Standard posterior percutaneous endoscopic cervical discectomy (PECD) is considered an effective minimally invasive surgery. Although standard PECD can be used to treat radiculopathy with relatively minimal trauma, it is still a challenge to use this approach for treating myelopathy. OBJECTIVE: This report is aimed at first describing a posterior transpedicular approach under endoscopy for myelopathy and evaluating the feasibility and short-term clinical effects of this approach. METHODS: In our retrospective analysis between Feb. 2016 to Mar. 2017, 16 patients managed with PECD using the posterior transpedicular approach for symptomatic single-segment myelopathy. Surgery involved drilling 1/2 to 2/3 of the medial portion of the pedicle under endoscopy to provide sufficient space and an appropriate angle for inserting the endoscope into the spinal canal, followed by ventral decompression of the spinal cord. Computed tomography and magnetic resonance imaging were used to evaluate pedicle healing and spinal cord decompression. The primary outcomes included a visual analog scale (VAS) scores of axial neck pain and Japanese Orthopaedic Association (JOA) scores of neurological conditions. RESULTS: All patients completed a 1-year follow-up examination. The mean duration of surgery was 95.44 ± 19.44 min (52-130 min). The fluoroscopy duration was 5.88 ± 1.05 (4-7). The VAS scores of axial pain significantly improved from 6.94 ± 0.75 preoperatively to 2.88 ± 1.22 postoperatively (P < 0.05). The mean JOA scores improved from 8.50 ± 1.12 preoperatively to 14.50 ± 1.46 at the final follow-up (P < 0.05). The effects were excellent in 8 cases, good in 6 cases, and fair in 2 cases. After partial pedicle excision, the width of the remaining pedicle was 1.70 ± 0.22 mm postoperatively and significantly recovered to 3.38 ± 0.49 mm at the 1-year follow-up. There were no surgery-related complications, such as dural tearing, spinal cord injury, nerve root injury, pedicle fracture, and cervical hematocele or infection. CONCLUSIONS: The posterior transpedicular approach is an effective method for the treatment of myelopathy in select patients and is a supplement to the described surgical approach for PECD.

Radiographic findings and anatomical variations of the caudal cervical area in horses with neck pain and ataxia: case-control study on 116 horses.

BACKGROUND: Abnormalities of the ventral lamina of the sixth cervical vertebra (AVL-C6) are thought to exert abnormal stress on the articular process joints (APJs) of the cervicothoracic junction. The aim of the study was to investigate the association between AVL-C6 and radiographic findings in the caudal cervical area and between clinical signs of neck pain and ataxia and radiographic findings. METHODS: Medical records of horses subjected to cervical radiography were reviewed. Horses were classified into those with neck pain (group C), those with ataxia (group A) and healthy horses (group H). Presence of AVL-C6 and increased size, dysplasia, remodelling, fragmentation and osteochondral fragment at the APJs (C5-T1) were recorded. Univariable logistic regression analysis was performed to identify the associations between explanatory and dependent variables. Variables with P<0.2 were included in the multivariable analysis. RESULTS: One hundred and sixteen horses were included (44 in group C, 29 in group A, 66 in group H); 24 of 116 horses had radiographic AVL-C6. Age, AVL-C6 and overall/C6-C7 increase in size remained in the final models. CONCLUSIONS: The presence of AVL-C6 and moderate/severe increase in size of the caudal cervical APJs increase the odds of showing neck pain and, if severe, ataxia.

A COVID-19 patient with intense burning pain.

A woman in her forties with asthma and COPD was admitted to a general medical floor with respiratory symptoms, body aches, and anosmia. Reverse transcription polymerase chain reaction detected severe acute respiratory syndrome coronavirus-2. Admission labs, including biomarkers of the systemic immunological dysfunction seen in many cases of coronavirus disease 2019 (COVID-19), were within normal ranges. On the second day of admission, she developed neck and back pain that was constant, burning in quality, and exacerbated by light touch and heat. Wearing clothing caused pain and interfered with her sleep. The area was tender to light finger stroke. The patient was given acetaminophen, NSAIDs, and opioids with no relief of pain. However, gabapentin was effective. At follow-up 1 month later, her symptoms were improved and still relieved by gabapentin. Neuropathic pain was seen in over 2% of COVID-19 patients in one observational study. The pain seen in our case was bilateral, involved an area innervated by multiple levels of spinal nerves, and was limited to the back. While it is rare, a significant number of COVID-19 patients are afflicted by neuropathic pain, and our case illustrates that gabapentin may be effective.

A genome-wide association study finds genetic variants associated with neck or shoulder pain in UK Biobank.

BACKGROUND: Common types of musculoskeletal conditions include pain in the neck and shoulder areas. This study seeks to identify the genetic variants associated with neck or shoulder pain based on a genome-wide association approach using 203 309 subjects from the UK Biobank cohort and look for replication evidence from the Generation Scotland: Scottish Family Health Study (GS:SFHS) and TwinsUK. METHODS: A genome-wide association study was performed adjusting for age, sex, BMI and nine population principal components. Significant and independent genetic variants were then sent to GS:SFHS and TwinsUK for replication. RESULTS: We identified three genetic loci that were associated with neck or shoulder pain in the UK Biobank samples. The most significant locus was in an intergenic region in chromosome 17, rs12453010, having P = 1.66 × 10-11. The second most significant locus was located in the FOXP2 gene in chromosome 7 with P = 2.38 × 10-10 for rs34291892. The third locus was located in the LINC01572 gene in chromosome 16 with P = 4.50 × 10-8 for rs62053992. In the replication stage, among four significant and independent genetic variants, rs2049604 in the FOXP2 gene and rs62053992 in the LINC01572 gene were weakly replicated in GS:SFHS (P = 0.0240 and P = 0.0202, respectively). CONCLUSIONS: We have identified three loci associated with neck or shoulder pain in the UK Biobank cohort, two of which were weakly supported in a replication cohort. Further evidence is needed to confirm their roles in neck or shoulder pain.

On the importance of the innervation of the human cervical longitudinal ligaments at vertebral level.

PURPOSE: In our aging society, the prevalence of degenerative spinal diseases rose drastically within the last years. However, up till now, the origin of cervical pain is incompletely understood. While animal and small cadaver studies indicate that a complex system of sensory and nociceptive nerve fibers in the anterior (ALL) and posterior longitudinal ligament (PLL) at the level of the intervertebral disc might be involved, there is a lack of data exploring whether such a network exists and is equally distributed within the cervical vertebrae (VB). We, therefore, aimed to investigate the spatial distribution of the mentioned nerve networks in human tissue. METHODS: We performed macroscopic (Sihler staining, Spalteholz technique, and Plastination) and microscopic (immunohistochemistry for PGP 9.5 and CGRP) studies to characterize spatial differences in sensory and nociceptive innervation patterns. Therefore, 23 human body donors were dissected from level C3-C6. RESULTS: We could show that there is a focal increase in sensory and nociceptive nerve fibers at the level of C4 and C5 for both ALL and PLL, while we observed less nerve fiber density at the level of C3 and C6. An anatomical vicinity between nerve and vessels was observed. CONCLUSION: To our knowledge, these findings for the first time report spatial differences in sensory and nociceptive nerve fibers in the human cervical spine at VB level. The interconnection between nerves and vessels supports the importance of the perivascular plexus. These findings might be of special interest for clinical practice as many patients suffer from pain after cervical spine surgery.

Prevalence of benign osseous lesions of the spine and association with spinal pain in the general population in whole body MRI.

BACKGROUND: Benign osseous lesions of the spine are common but precise population prevalence estimates are lacking. Our study aimed to provide the first population-based prevalence estimates and examine association with back and neck pain. MATERIALS AND METHODS: We used data from the population-based Study of Health in Pomerania (SHIP). Whole-body MRI examinations (1.5 Tesla: T1, T2, and TIRM weightings) were available from 3,259 participants. Readings of the spinal MRI images were conducted according to a standardized protocol by a single reader (JS). The intra-rater reliability was greater than Kappa values of 0.98. Pain measures included the seven-day prevalence of spine pain and neck pain, and average spine pain intensity due to spine pain during the past three months. RESULTS: We found 1,200 (36.8%) participants with at least one osseous lesion (2,080 lesions in total). Osseous lesions were less common in men than in women (35.5% vs 38.9%; P = .06). The prevalence of osseous lesions was highest at L2 in both sexes. The prevalence of osseous lesions increased with age. Up to eight osseous lesions were observed in a single subject. Hemangioma (28%), and lipoma (13%) occurred most often. Sclerosis (1.7%), aneurysmal bone cysts (0.7%), and blastoma (0.3%) were rare. Different osseous lesions occurred more often in combination with each other. The association with back or neck pain was mostly negligible. CONCLUSION: Osseous lesions are common in the general population but of no clinical relevance for spinal pain. The prevalence of osseous lesions varied strongly across different regions of the spine and was also associated with age and gender. Our population-based data offer new insights and assist in judging the relevance of osseous lesions observed on MRIs of patients.

Cervical Discogenic Pain Treatment with Percutaneous Jellified Ethanol: Preliminary Experience.

BACKGROUND: Percutaneous DiscoGel® (Gelscom SAS, France), introduced in 2007 as a promising new minimal invasive technique, showed efficacy and safety in lumbar spine surgery, with limited use and scientific reports with regard to the cervical spine. Since the first publication of its use on the cervical spine (2010), less than 100 cases have been published. We introduce an initial experience with this relatively new procedure. We hypothesized that percutaneous DiscoGel® is a safe and effective option for chronic neck pain of cervical discogenic origin. METHOD: This was a clinical study on 10 patients with chronic discogenic pain operated on for 18 cervical discs with percutaneous DiscoGel®. Inclusion criteria were patients with chronic axial or referred neck pain with MRI showing a cervical disc that is consistent with patient symptoms and failed conservative treatment. Exclusion criteria were clinical myelopathy, motor deficit, severe stenosis or reduced disc height by more than 50%, or previous cervical spine surgery. RESULTS: A total of 10 cases consisting of 6 females and 4 males underwent treatment with percutaneous DiscoGel® for 18 cervical discs. C5/C6 was the most affected level. The mean preoperative VAS score was 8; the postoperative VAS scores at 6 weeks and 3 months were 2.2 and 2.9, respectively. There were no postoperative complications or neurological deficits. CONCLUSION: The present study has the limitation of the small number of cases; however, with the limited number of studies and less than 100 published cases in the literature, this initial work shows that cervical percutaneous DiscoGel® is an effective minimally invasive bridging option between conservative and open surgical treatment for cervical discogenic pain, with a high success rate. The differentiation of pain types (nociceptive, referred, radicular, and trapezius myalgia) that can coexist is crucial for procedure selection and improving treatment outcome.

Rare Occurrence of Incidental Finding of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features in Hürthle Cell Adenoma.

INTRODUCTION: Hürthle cell adenoma is a rare benign lesion of the thyroid gland, however, controversies about its potential malignant behavior still remain. Among thyroid neoplasms, papillary carcinoma is the most common variant with great variety of histological subtypes demonstrating different biological behavior. AIM: To raise the awareness of possible coexistence of these two lesions and discussion about possible therapeutic approaches. CASE REPORT: A 42 year old female patient was examined because of the pain in the thyroid area. Cytological examination suggested Hürthle cell adenoma. Subsequently, right thyroid lobectomy was performed. Intraoperative frozen sections confirmed the diagnosis, yet final histological analysis revealed encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), now reclassified as noninvasive follicular thyroid neoplasm with papillary- like nuclear features (NIFTP) within the adenoma, which was not noticed through scintigraphy, ultrasound, cytological and frozen section analysis. CONCLUSIONS: Problems concerning both diagnostic and therapeutic approach to these lesions are being discussed, since opinions reported in the literature are divided, posing great challenge for the clinician in determining adequate therapeutic procedures.

Cervical Intervertebral Disc Degeneration Contributes to Dizziness: A Clinical and Immunohistochemical Study.

OBJECTIVES: Dizziness often happens in patients with chronic neck pain with only cervical disc degeneration but without cervical radiculopathy or myelopathy. We prospectively selected a series of patients who showed cervical disc degeneration with concomitant chronic neck pain and intractable dizziness who did not respond to conservative treatment to test a new diagnostic method for this dizziness, to analyze the results of anterior cervical discectomy and fusion (ACDF) surgery based on the test, and to explore its pathogenesis. METHODS: Seventy-seven patients who had a transient neck pain and dizziness relief after injection of bupivacaine into a suspected disc were included in the study. In total, 52 underwent ACDF as surgery group, and 25 refused surgery and accepted conservative treatments as conservative group from June, 2015 to October, 2016 with subsequent follow-up to 1 year. The outcomes were visual analogue scale for neck pain, Neck Disability Index, and intensity and frequency of dizziness. During ACDF, the 72 specimens of degenerative cervical discs were collected to determine the innervation in degenerative cervical discs immunohistochemically. RESULTS: After surgery, the patients experienced a significant reduction in neck pain and dizziness. Symptomatic relief in surgery group was obviously better than conservative group at each time point of follow-up (P = 0.001). Ruffini corpuscles and substance P-positive free nerve fibers were obviously increased in the number and deeply ingrown into the inner degenerative cervical discs. CONCLUSIONS: Current clinical and immunohistochemical studies strongly suggest that chronic neck pain and intractable dizziness in this series of patients stem from the degenerative cervical discs.

Impact of Fat Infiltration in Cervical Extensor Muscles on Cervical Lordosis and Neck Pain: A Cross-Sectional Study.

BACKGROUND: Weakness of cervical extensor muscles causes loss of cervical lordosis, which could also cause neck pain. The aim of this study was to investigate the impact of fat infiltration in cervical extensor muscles on cervical lordosis and neck pain. METHODS: Fifty-six patients who suffered from neck pain were included in this study. Fat infiltration in cervical extensor muscles was measured at each level of C2-3 and C6-7 using axial magnetic resonance imaging. The visual analogue scale (VAS), 12-Item Short Form Health Survey (SF-12), and Neck Disability Index (NDI) were used for clinical assessment. RESULTS: The mean fat infiltration was 206.3 mm2 (20.3%) at C2-3 and 240.6 mm2 (19.5%) at C6-7. Fat infiltration in cervical extensor muscles was associated with high VAS scores at both levels (p = 0.047 at C2-3; p = 0.009 at C6-7). At C2-3, there was a negative correlation between fat infiltration of the cervical extensor muscles and cervical lordosis (r = -0.216; p = 0.020). At C6-7, fat infiltration in the cervical extensor muscles was closely related to NDI (p = 0.003) and SF-12 (p > 0.05). However, there was no significant correlation between cervical lordosis and clinical outcomes (VAS, p = 0.112; NDI, p = 0.087; and SF-12, p > 0.05). CONCLUSIONS: These results suggest that fat infiltration in the upper cervical extensor muscles has relevance to the loss of cervical lordosis, whereas fat infiltration in the lower cervical extensor muscles is associated with cervical functional disability.

Immunoglobulin G4-related disease mimicking an epidural spinal cord tumor: case report.

The authors report a case of immunoglobulin G4-related disease (IgG4-RD) presenting as a paraspinal, epidural mass. This disease encompasses a host of autoimmune conditions that were previously thought to be separate entities. It is characterized by fibrosis, mediated by the aberrant proliferation and tissue invasion of IgG4-positive plasma cells, which can occur in any organ. As with other autoimmune conditions, it tends to be responsive to steroids and other immunosuppressants. It can rarely present as a tumefactive lesion of the central nervous system, creating the potential for misdiagnosis (given its similar radiological appearance to malignancy) and mistreatment. In 2015, a panel of experts convened to set forth guidelines for the diagnosis and treatment of IgG4-RD. In the case presented here, the patient initially presented with pain and weakness in the left upper extremity. Initial neuroimages revealed a contrast-enhancing mass extending from C-4 to T-1, invading the epidural spinal canal, encasing the exiting nerve roots, infiltrating the paraspinal musculature, and surrounding the left vertebral artery. A PET scan confirmed the mass was hypermetabolic, but results of fine-needle aspiration and CT-guided biopsy were inconclusive. Open biopsy yielded fibrotic tissue that met the pathological criteria for IgG4-RD: lymphoplasmacytic infiltrate, fibrosis in a storiform pattern, and obliterative phlebitis. The patient was treated with 2 doses of 4 mg of dexamethasone (Decadron) and then 50 mg of prednisone per day. Within 2 weeks, the mass was radiologically shown to have drastically decreased in size. The prednisone dose was decreased to 40 mg per day, and 100 mg of azathioprine per day was added. The patient continued to improve and the mass continued to decrease over the next 6 months. Currently, she has been weaned from all steroids and will be maintained on a daily dose of 100 mg of azathioprine.

Intradural chondroma in the cervical spine: case report.

Chondromas are benign tumors that are rarely located in the spine. The authors present a rare occurrence of a spinal chondroma that developed as an intradural but extramedullary tumor in a 60-year-old woman. The location of the tumor at C4-5 was confirmed by MRI, with hyperintensity on T2-weighted images and isointensity on T1-weighted images. The tumor was completely contained intradurally, with no continuity to any vertebrae. It adhered to the anterior dura, indicative of its likely origin from the dura mater. The tumor was completely resected, with no sign of recurrence after 3 years postoperatively. Although reports of chondromas originating from the dura mater have been previously described, these have all been intracranial tumors. To the best of the authors' knowledge, this is the first report of an intradural chondroma located in the spine. Therefore, chondromas should be considered in the differential diagnosis of intradural spinal tumors.