RESUMEN
INTRODUCTION: Osteochondromas, also known as osteocartilaginous exostosis, are among the most common benign cartilaginous bone tumors, primarily occurring as solitary lesions. While typically found in long bones, spinal involvement is rare, accounting for only a small percentage of benign lesions in this location. Solitary osteochondromas responsible for spinal cord compression are seldom. CASE PRESENTATION: We describe the case of a 34-year-old male with no significant medical history, presenting with progressive symptoms suggestive of spinal cord compression. Imaging studies revealed a bony lesion originating from the left lateral aspect of the posterior arch of the T8 vertebra, causing spinal cord compression and myelopathy. Surgical intervention was necessary to decompress the spinal cord and obtain histological samples, resulting in immediate postoperative improvement in motor function. Pathologic exam concluded to an osteochondroma. DISCUSSION: Osteochondromas primarily affect growing bones and are more commonly observed as solitary lesions, particularly in male patients. Spinal involvement is rare, and neurological symptoms are typically indicative of intracanalar extension of the exostosis, leading to compression of neural elements. Imaging modalities such as MRI are crucial for assessing cartilage thickness and the impact of compression on the spinal cord.
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Osteocondroma , Compresión de la Médula Espinal , Neoplasias de la Columna Vertebral , Vértebras Torácicas , Humanos , Masculino , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/diagnóstico por imagen , Osteocondroma/complicaciones , Osteocondroma/diagnóstico por imagen , Osteocondroma/cirugía , Osteocondroma/patología , Adulto , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/patología , Vértebras Torácicas/cirugía , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/patología , Descompresión QuirúrgicaRESUMEN
We retrospectively investigated the correlation between the spinal cord compression angle and increased signal intensity (ISI) in 118 patients with ossification of the posterior longitudinal ligament (OPLL). Patients were analyzed based on the presence and shape of ISI on magnetic resonance imaging. Various indicators, including the spinal cord compression angle, were measured through imaging examinations. Spearman's correlation and logistic regression were used for analyses. Significant positive correlations were observed between the ISI grade and the spinal cord compression angle, maximum spinal canal occupying rate, cervical range of motion, and segmental range of motion. The spinal cord compression ratio and Japanese Orthopaedic Association (JOA) score were negatively correlated with the ISI grade. Regression analysis revealed that the spinal cord compression angle and JOA scores were independent factors that significantly influenced ISI grade. The odds ratio of ISI was 3.858 (95% confidence interval: 0.974-15.278) when comparing the highest and lowest quartiles of the spinal cord compression angle. Patients with a spinal cord compression angle > 35° had more severe imaging manifestations. Thus, a spinal cord compression angle > 35° could serve as a significant indicator of OPLL severity, and greater attention should be focused on treating patients with larger spinal cord compression angles.
Asunto(s)
Imagen por Resonancia Magnética , Osificación del Ligamento Longitudinal Posterior , Compresión de la Médula Espinal , Humanos , Osificación del Ligamento Longitudinal Posterior/diagnóstico por imagen , Femenino , Masculino , Compresión de la Médula Espinal/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Adulto , Anciano de 80 o más Años , Rango del Movimiento ArticularRESUMEN
Intraosseous occurrence of a spinal AVM is anecdotal, with only four such cases reported previously. This is the first report of a spinal intraosseous AVM in the cervical vertebrae. A 44-year-old male patient presented with a 2-month history of progressive quadriparesis and bladder dysfunction. Magnetic resonance imaging showed multiple flow voids within the C4 and C5 vertebral bodies, and an extradural component causing cord compression. CT showed extensive bony destruction at both levels. The diagnosis of an intraosseous AVM was confirmed with spinal angiography. The AVM was noted to be fed by branches from the ascending cervical arteries and the vertebral artery. The nidus was draining into the vertebral venous plexus and thence into the jugular vein through the marginal sinus. The patient underwent partial embolization of the AVM. Surgical resection was attempted but found to be unfeasible due to torrential bleeding. A 360-degree stabilization along with decompressive laminectomies was performed, resulting in clinical improvement and disease stabilization at one year follow-up. The case and its management dilemmas are discussed in light of a brief literature review.
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Malformaciones Arteriovenosas , Vértebras Cervicales , Embolización Terapéutica , Humanos , Masculino , Adulto , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/cirugía , Malformaciones Arteriovenosas/terapia , Embolización Terapéutica/métodos , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/cirugía , Arteria Vertebral/anomalías , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Resultado del Tratamiento , Imagen por Resonancia Magnética , Laminectomía/métodos , Descompresión Quirúrgica/métodosRESUMEN
BACKGROUND: How to quickly read and interpret intraoperative ultrasound (IOUS) images of patients with degenerative cervical myelopathy (DCM) to obtain meaningful information? Few studies have systematically explored this topic. PURPOSE: To systematically and comprehensively explore the IOUS characteristics of patients with DCM. MATERIALS AND METHODS: This single-center study retrospectively included patients with DCM who underwent French-door laminoplasty (FDL) with IOUS guidance from October 2019 to March 2022. One-way ANOVA and Pearson's /Spearman's correlation analysis were used to analyze the correlations between the cross-sectional area of the spinal cord (SC) and individual characteristics; the relationships between the morphology, echogenicity, pulsation, decompression statuses, compression types of SC, location of the spinal cord central echo complex (SCCEC) and the disease severity (the preoperative Japanese Orthopedic Association score, preJOA score); the difference of the spinal cord pulsation amplitude(SCPA) and the SCCEC forward movement rate (FMR) between the compressed areas(CAs) and the non-compressed areas (NCAs). RESULTS: A total of 38 patients were successfully enrolled (30 males and 8 females), and the mean age was 57.05 ± 10.29 (27-75) years. The cross-sectional area of the SC was negatively correlated with age (r = - 0.441, p = 0.006). The preJOA score was significantly lower in the heterogeneous group than in the homogeneous group (P < 0.05, p = 0.005). The hyperechoic area (HEA) was negatively while the SCCEC FMR was positively correlated with the preJOA score (r = - 0.334, p = 0.020; r = 0.286, p = 0.041). The SCCEC FMR and SCPA in CAs were significantly greater than those in NCAs (p < 0.05, p = 0.007; P < 0.001, P = 0.000). CONCLUSION: The cross-sectional area of the SC decreases with age in adults. More changes in intramedullary echogenicity and less moving forward of the SCCEC often indicate poor SC status, and the SCCEC FMR and SCPA are more pronounced in CAs.
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Vértebras Cervicales , Laminoplastia , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Adulto , Laminoplastia/métodos , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/diagnóstico por imagen , Ultrasonografía , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/diagnóstico por imagenRESUMEN
BACKGROUND: Chronic compressive myelopathy (CCM) is a major cause of spinal cord disorders in the elderly, in which the spinal cord is compressed by bony or soft tissue structures. Although computed tomography myelography (CTM) has been clinically used for the diagnosis of CCM, a method of CTM in rodents remains to be developed. NEW METHOD: A 50⯵l Hamilton syringe attached to a disposable needle was percutaneously inserted into the subarachnoid space (cisterna magna) between the occipital bone and C1 lamina in an anesthetized adult mouse, followed by the injection of contrast medium and CT imaging. RESULTS: CTM clearly visualized the shape of the spinal cord of intact mice and tiptoe-walking Yoshimura (Twy) mice without any health issues. COMPARISON WITH EXISTING METHOD(S): Unlike histology, the current method functions in live mice, directly depicts the compressed spinal cord, and provides clinically related image information. Furthermore, the intrathecal administration of contrast medium through the percutaneous route makes CTM less invasive and takes less time than a conventional intrathecal injection method. CONCLUSIONS: The CTM method used in the present study enables clear visualization of the shape of the dural sac and spinal cord and is useful when conducting experiments on CCM and other spinal diseases in rodents.
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Medios de Contraste , Inyecciones Espinales , Mielografía , Compresión de la Médula Espinal , Tomografía Computarizada por Rayos X , Animales , Mielografía/métodos , Inyecciones Espinales/métodos , Medios de Contraste/administración & dosificación , Compresión de la Médula Espinal/diagnóstico por imagen , Ratones , Tomografía Computarizada por Rayos X/métodos , Masculino , Médula Cervical/diagnóstico por imagen , Modelos Animales de Enfermedad , Vértebras Cervicales/diagnóstico por imagenRESUMEN
PURPOSE: Spinal tuberculosis, if not promptly treated, can lead to kyphotic deformity, causing persistent neurological abnormalities and discomfort. Spinal cord compression can occur due to ossification of the ligamentum flavum (OLF) at the apex of kyphosis. Traditional surgical interventions, including osteotomy and fixation, pose challenges and risks. We present a case of thoracic myelopathy in a patient with post-tuberculosis kyphosis, successfully treated with biportal endoscopic spinal surgery (BESS). METHOD: A 73-year-old female with a history of untreated kyphosis presented with walking difficulties and lower limb pain. Imaging revealed a kyphotic deformity of 120° and OLF-induced cord compression at T8-9. UBE was performed under spinal anesthesia. Using the BESS technique, OLF was successfully removed with minimal damage to the stabilizing structures. RESULTS: The patient exhibited neurological improvement after surgery, walking on the first day without gait instability. Follow-up at 1 year showed no kyphosis progression or recurrence of symptoms. BESS successfully resolved the cord compression lesion with minimal blood loss and damage. CONCLUSION: In spinal tuberculosis-related OLF, conventional open surgery poses challenges. BESS emerges as an excellent alternative, providing effective decompression with reduced instrumentation needs, minimal blood loss, and preservation of surrounding structures. Careful patient selection and surgical planning are crucial for optimal outcomes in endoscopic procedures.
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Descompresión Quirúrgica , Endoscopía , Cifosis , Ligamento Amarillo , Osificación Heterotópica , Tuberculosis de la Columna Vertebral , Humanos , Anciano , Femenino , Cifosis/cirugía , Cifosis/etiología , Cifosis/diagnóstico por imagen , Ligamento Amarillo/cirugía , Ligamento Amarillo/diagnóstico por imagen , Descompresión Quirúrgica/métodos , Tuberculosis de la Columna Vertebral/cirugía , Tuberculosis de la Columna Vertebral/complicaciones , Tuberculosis de la Columna Vertebral/diagnóstico por imagen , Endoscopía/métodos , Osificación Heterotópica/cirugía , Osificación Heterotópica/complicaciones , Osificación Heterotópica/diagnóstico por imagen , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Vértebras Torácicas/cirugía , Vértebras Torácicas/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Multiple myeloma associated with extramedullary plasmacytoma at initial presentation is rare. We describe a case of a man in his 30s who initially presented with symptoms of spinal cord compression. Further imaging revealed a mediastinal tumour, with a biopsy confirming plasmacytoma. Immunofixation revealed IgA lambda paraprotein. Bone marrow biopsy demonstrated atypical T-cell cytotoxic proliferation and trilineage hypoplasia. The patient was diagnosed with extramedullary plasmacytoma with active IgA multiple myeloma. The patient received mediastinal radiation to the tumour, followed by anti-myeloma therapy. This diagnosis is critical as managing a solitary plasmacytoma drastically differs from an extramedullary plasmacytoma with active multiple myeloma.
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Inmunoglobulina A , Neoplasias del Mediastino , Mieloma Múltiple , Plasmacitoma , Compresión de la Médula Espinal , Humanos , Masculino , Mieloma Múltiple/complicaciones , Mieloma Múltiple/diagnóstico , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Plasmacitoma/diagnóstico , Plasmacitoma/complicaciones , Plasmacitoma/diagnóstico por imagen , Neoplasias del Mediastino/complicaciones , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/diagnóstico , Adulto , Imagen por Resonancia Magnética , Diagnóstico DiferencialRESUMEN
OBJECTIVES: To compare magnetic resonance (MR) short T1 inversion recovery (STIR) sequence with MR T2-weighted (T2W) sequence for detecting increased signal intensity (ISI) and assessing outcomes of ISI in cervical spondylotic myelopathy (CSM). METHODS: Data of patients with CSM who showed ISI on MR imaging and had undergone cervical spine surgery were retrospectively reviewed. STIR and T2W images were examined to assess signal intensity ratio (SIR), length and grading of the ISI, maximal spinal cord compression, canal narrowing ratio, and ligamentum flavum hypertrophy. The patients were divided into good and poor groups based on their outcomes. χ2 tests and variance analysis were used to assess intergroup differences. Univariate and multivariate logistic regression analyses were performed to identify risk factors for poor outcomes, and receiver operating characteristic curves were plotted to detect prognostic effects. RESULTS: SIR and ISI lengths were significantly different between the STIR and T2 images. In the univariate logistic regression analysis, age, diabetes, SIRT2, SIRSTIR, and ISISTIR grading were significant factors. Accordingly, in the multivariate logistic regression analysis, age, diabetes, SIRT2, and SIRSTIR were included in the model. Among patients with diabetes, we observed a significant difference between SIRT2 and SIRSTIR. CONCLUSIONS: The STIR sequence demonstrated superior capability to the T2W sequence in detecting ISI; however, there was no obvious difference in predicted outcomes. STIR sequence has a better prognostic value than T2W sequence in patients with diabetes who have CSM. ISI grading based on the STIR sequence may be a clinically valuable indicator.
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Vértebras Cervicales , Imagen por Resonancia Magnética , Espondilosis , Humanos , Masculino , Femenino , Persona de Mediana Edad , Espondilosis/cirugía , Espondilosis/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Anciano , Estudios Retrospectivos , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/etiología , Adulto , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/diagnóstico por imagenRESUMEN
Hodgkin's lymphoma revealed by a medullary compression with a double primary vertebral localisation is extremely rare. We report the case of a boy in middle childhood who was presented with slow progression of medullary compression syndrome over 9 months, ultimately leading to paraplegia with loss of sphincter tone. The spinal MRI showed two tumour processes at T9 and L1 with epidural extension. An anatomical-pathological examination of the biopsy of the tumour mass, along with immunohistochemical analysis, confirmed the diagnosis of a lymphocyte-rich classic Hodgkin's lymphoma, stage IV according to the Ann Arbor classification. The therapeutic strategy was based on chemotherapy. This study aims to report a unique clinical presentation of Hodgkin's lymphoma in a paediatric patient and underscores the diagnostic challenges encountered in such an uncommon scenario.
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Enfermedad de Hodgkin , Imagen por Resonancia Magnética , Compresión de la Médula Espinal , Humanos , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/diagnóstico , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Masculino , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/diagnóstico , Neoplasias de la Médula Espinal/complicaciones , Vértebras Torácicas/diagnóstico por imagen , Vértebras Lumbares , Paraplejía/etiologíaRESUMEN
Objective: To investigate the imaging characteristics of cervical kyphosis and spinal cord compression in cervical spondylotic myelopathy (CSM) with cervical kyphosis and the influence on effectiveness. Methods: The clinical data of 36 patients with single-segment CSM with cervical kyphosis who were admitted between January 2020 and December 2022 and met the selection criteria were retrospectively analyzed. The patients were divided into 3 groups according to the positional relationship between the kyphosis focal on cervical spine X-ray film and the spinal cord compression point on MRI: the same group (group A, 20 cases, both points were in the same position), the adjacent group (group B, 10 cases, both points were located adjacent to each other), and the separated group (group C, 6 cases, both points were located >1 vertebra away from each other). There was no significant difference between groups ( P>0.05) in baseline data such as gender, age, body mass index, lesion segment, disease duration, and preoperative C 2-7 angle, C 2-7 sagittal vertical axis (C 2-7 SVA), C 7 slope (C 7S), kyphotic Cobb angle, fusion segment height, and Japanese Orthopedic Association (JOA) score. The patients underwent single-segment anterior cervical discectomy with fusion (ACDF). The occurrence of postoperative complications was recorded; preoperatively and at last follow-up, the patients' neurological function was evaluated using the JOA score, and the sagittal parameters (C 2-7 angle, C 2-7 SVA, C 7S, kyphotic Cobb angle, and height of the fused segments) were measured on cervical spine X-ray films and MRI and the correction rate of the cervical kyphosis was calculated; the correlation between changes in cervical sagittal parameters before and after operation and the JOA score improvement rate was analyzed using Pearson correlation analysis. Results: In 36 patients, only 1 case of dysphagia occurred in group A, and the dysphagia symptoms disappeared at 3 days after operation, and the remaining patients had no surgery-related complications during the hospitalization. All patients were followed up 12-42 months, with a mean of 20.1 months; the difference in follow-up time between the groups was not significant ( P>0.05). At last follow-up, all the imaging indicators and JOA scores of patients in the 3 groups were significantly improved when compared with preoperative ones ( P<0.05). The correction rate of cervical kyphosis in group A was significantly better than that in group C, and the improvement rate of JOA score was significantly better than that in groups B and C, all showing significant differences ( P<0.05), and there was no significant difference between the other groups ( P>0.05). The correlation analysis showed that the improvement rate of JOA score was negatively correlated with C 2-7 angle and kyphotic Cobb angle at last follow-up ( r=-0.424, P=0.010; r=-0.573, P<0.001), and positively correlated with the C 7S and correction rate of cervical kyphosis at last follow-up ( r=0.336, P=0.045; r=0.587, P<0.001), and no correlation with the remaining indicators ( P>0.05). Conclusion: There are three main positional relationships between the cervical kyphosis focal and the spinal cord compression point on imaging, and they have different impacts on the effectiveness and sagittal parameters after ACDF, and those with the same position cervical kyphosis focal and spinal cord compression point have the best improvement in effectiveness and sagittal parameters.
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Vértebras Cervicales , Cifosis , Imagen por Resonancia Magnética , Compresión de la Médula Espinal , Espondilosis , Humanos , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Cifosis/cirugía , Cifosis/diagnóstico por imagen , Cifosis/etiología , Espondilosis/cirugía , Espondilosis/diagnóstico por imagen , Espondilosis/complicaciones , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Fusión Vertebral/métodos , Resultado del Tratamiento , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/etiología , Descompresión Quirúrgica/métodos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana EdadRESUMEN
Degenerative Cervical Myelopathy (DCM) is the functional derangement of the spinal cord resulting from vertebral column spondylotic degeneration. Typical neurological symptoms of DCM include gait imbalance, hand/arm numbness, and upper extremity dexterity loss. Greater spinal cord compression is believed to lead to a higher rate of neurological deterioration, although clinical experience suggests a more complex mechanism involving spinal canal diameter (SCD). In this study, we utilized machine learning clustering to understand the relationship between SCD and different patterns of cord compression (i.e. compression at one disc level, two disc levels, etc.) to identify patient groups at risk of neurological deterioration. 124 MRI scans from 51 non-operative DCM patients were assessed through manual scoring of cord compression and SCD measurements. Dimensionality reduction techniques and k-means clustering established patient groups that were then defined with their unique risk criteria. We found that the compression pattern is unimportant at SCD extremes (≤14.5 mm or > 15.75 mm). Otherwise, severe spinal cord compression at two disc levels increases deterioration likelihood. Notably, if SCD is normal and cord compression is not severe at multiple levels, deterioration likelihood is relatively reduced, even if the spinal cord is experiencing compression. We elucidated five patient groups with their associated risks of deterioration, according to both SCD range and cord compression pattern. Overall, SCD and focal cord compression alone do not reliably predict an increased risk of neurological deterioration. Instead, the specific combination of narrow SCD with multi-level focal cord compression increases the likelihood of neurological deterioration in mild DCM patients.
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Vértebras Cervicales , Imagen por Resonancia Magnética , Compresión de la Médula Espinal , Humanos , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/etiología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Vértebras Cervicales/diagnóstico por imagen , Médula Cervical/diagnóstico por imagen , Espondilosis/diagnóstico por imagen , Espondilosis/complicaciones , Progresión de la Enfermedad , Aprendizaje Automático , AdultoRESUMEN
PURPOSE: To report the surgical outcome of synovial osteochondromatosis, a rare tumor of the cervical spine, in a 6-year-old boy. METHODS: A 6-year-old boy presented with muscle weakness in the right deltoid (2) and biceps (4) during a manual muscle test. Magnetic resonance imaging showed a 3 × 2 × 1.5 cm mass within the spinal canal at the C4-6 level, compressing the cervical spinal cord from the right side. Computed tomography revealed hyperintense areas within the tumor and ballooning of the right C4-5 and C5-6 facet joints. RESULTS: After a biopsy confirmed the absence of malignancy, a gross total resection was performed. The pathological diagnosis of synovial osteochondromatosis was established. Postoperatively, muscle weakness improved fully in the manual muscle test, and there were no neurological findings after 3 months. However, the patient is under careful follow-up owing to the detection of a regrowth site within the right C4-5 and C5-6 intervertebral foramen 2 years postoperatively. CONCLUSIONS: Synovial osteochondromatosis of the cervical spine in children is rare, and this is the first report of its regrowth after surgery. Synovial osteochondromatosis should be included in the differential diagnosis of pediatric cervical spine tumors.
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Vértebras Cervicales , Condromatosis Sinovial , Laminectomía , Humanos , Masculino , Niño , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Laminectomía/métodos , Condromatosis Sinovial/cirugía , Condromatosis Sinovial/diagnóstico por imagen , Parálisis/etiología , Parálisis/cirugía , Resultado del Tratamiento , Recuperación de la Función , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Spinal cord stimulation (SCS) is an efficacious treatment for various refractory chronic pain syndromes. Serious complications including spinal cord compression (SCC) are rare with 19 previous reports which are mainly attributed to fibrotic scar tissue formation at the distal end of the leads at the location of the contacts. We report a case of SCC following SCS implantation at the lead entry location secondary to a delayed progression of spinal canal stenosis. CASE PRESENTATION: A patient in her early 70s underwent SCS implantation with adequate therapeutic benefit for approximately 2 years before citing complaints of increasing lower back pain and lower extremity radicular pain. Lumbar spine X-rays excluded lead migration as a causative factor. An MRI of the lumbar spine obtained 30 months following SCS implantation demonstrated a marked interval progression of central canal stenosis secondary to facet and ligamentous hypertrophy manifesting in compression of the spinal cord at the lead entry location. An L1-L2 decompressive laminectomy with hardware removal resulted in the resolution of her symptoms. A literature search conducted with the PubMed database identified previously published cases of SCC following SCS implantation which highlighted the rarity of this complication. CONCLUSION: Our case report urges physicians of SCS patients, noting a loss of therapeutic benefit with their device, to investigate new pathologies including SCC. Furthermore, our case highlights clinical symptoms and surgical treatments of SCC. Paddle leads are more commonly implicated in published cases of SCC than percutaneous leads. Lastly, MRI conditionality is critical to identifying cases of SCC.
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Estimulación de la Médula Espinal , Estenosis Espinal , Humanos , Femenino , Estenosis Espinal/terapia , Estenosis Espinal/cirugía , Estenosis Espinal/etiología , Estenosis Espinal/diagnóstico por imagen , Estimulación de la Médula Espinal/métodos , Anciano , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/terapia , Factores de Tiempo , Remoción de Dispositivos , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: To our knowledge, there is no previous report in the literature of non-traumatic neglected complete cervical spine dislocation characterized by anterior spondyloptosis of C4, extreme head drop, and irreducible cervicothoracic kyphosis. CASE PRESENTATION: We report the case of a 33-year-old Caucasian man with a 17-year history of severe immune polymyositis and regular physiotherapy who presented with severe non-reducible kyphosis of the cervicothoracic junction and progressive tetraparesia for several weeks after a physiotherapy session. Radiographs, computed tomography, and magnetic resonance imaging revealed a complete dislocation at the C4-C5 level, with C4 spondyloptosis, kyphotic angulation, spinal cord compression, and severe myelopathy. Due to recent worsening of neurological symptoms, an invasive treatment strategy was indicated. The patient's neurological status and spinal deformity greatly complicated the anesthetic and surgical management, which was planned after extensive multidisciplinary discussion and relied on close collaboration between the orthopedic surgeon and the anesthetist. Regarding anesthesia, difficult airway access was expected due to severe cervical angulation, limited mouth opening, and thyromental distance, with high risk of difficult ventilation and intubation. Patient management was further complicated by a theoretical risk of neurogenic shock, motor and sensory deterioration, instability due to position changes during surgery, and postoperative respiratory failure. Regarding surgery, a multistage approach was carefully planned. After a failed attempt at closed reduction, a three-stage surgical procedure was performed to reduce displacement and stabilize the spine, resulting in correct spinal realignment and fixation. Progressive complete neurological recovery was observed. CONCLUSION: This case illustrates the successful management of a critical situation based on a multidisciplinary collaboration involving radiologists, anesthesiologists, and spine surgeons.
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Cifosis , Compresión de la Médula Espinal , Traumatismos Vertebrales , Masculino , Humanos , Adulto , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Vértebras Cervicales/lesiones , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/cirugía , Traumatismos Vertebrales/complicaciones , Radiografía , Cifosis/diagnóstico por imagen , Cifosis/etiología , Cifosis/cirugíaRESUMEN
STUDY DESIGN: A retrospective, single-center study. OBJECTIVE: The aim of this study is to evaluate the efficacy and safety of a newly developed extensive dome-like laminoplasty using en bloc resection of the C2 inner lamina in patients with severe cord compression behind the C2 body. SUMMARY OF BACKGROUND DATA: A surgery for severe cord compression behind C2 body is challenging for spinal surgeons. To date, there has been no established solution for severe cord compression behind the C2 body. MATERIALS AND METHODS: Patients with severe cord compression behind the C2 body who underwent posterior surgery consecutively were enrolled. Extensive dome-like laminoplasty that was newly developed was performed to remove en bloc removal of the C2 inner lamina were performed. Preoperative and postoperative canal diameters behind the C2 and mean removed area of the C2 inner lamina were measured using MRI and CT scan. Clinical and radiographic parameters were assessed preoperative and postoperative periods. In addition, perioperative complications were analyzed. RESULTS: A total of 36 patients underwent extensive dome-like laminoplasty and their diagnoses were ossification of the posterior longitudinal ligament (OPLL, 66.7%) and congenital stenosis with spondylosis (33.3%). The mean canal diameter behind the C2 increased from 9.85 (2.28) mm preoperatively to 19.91 (3.93) mm at the last follow-up ( P <0.001). Clinically, neck and arm visual analog scale, Japanese Orthopaedic Association score, and neck disability index significantly improved at postoperative 1 month ( P <0.05), and the scores were maintained until the last follow-up. No meaningful radiographic changes occurred after the surgeries. During the procedures, there were no particular complications, but one patient showed deteriorated myelopathic symptoms and underwent additional C1-C2 decompressive surgery. CONCLUSIONS: After extensive dome-like laminoplasty, surgical outcomes are satisfactory, and complications are rare. This technique may be a viable option for patients with severe cord compression behind the C2 body. LEVEL OF EVIDENCE: Level IV.
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Laminoplastia , Compresión de la Médula Espinal , Humanos , Laminoplastia/métodos , Masculino , Femenino , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/diagnóstico por imagen , Persona de Mediana Edad , Resultado del Tratamiento , Anciano , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Adulto , Imagen por Resonancia Magnética , Estudios RetrospectivosRESUMEN
PURPOSE: To observe the growth and resolution of decompression gas bubbles in the spinal cord of live rats in real time using MRI. METHODS: We constructed an MRI-compatible pressure chamber system to visualize gas bubble dynamics in deep tissues in real time. The system pressurizes and depressurizes rodents inside an MRI scanner and monitors their respiratory rate, heart rate, and body temperature while providing gaseous anesthesia under pressure during the experiments. RESULTS: We observed the formation of decompression gas bubbles in the spinal cord of rats after compression to 7.1 bar absolute and rapid decompression inside the MRI scanner while maintaining continuous gaseous anesthesia and vital monitoring. CONCLUSION: We have shown the direct observation of decompression gas bubble formation in real time by MRI in live, anesthetized rats.
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Imagen por Resonancia Magnética , Animales , Ratas , Imagen por Resonancia Magnética/métodos , Ratas Sprague-Dawley , Gases , Sistemas de Computación , Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/diagnóstico por imagen , Diseño de Equipo , MasculinoRESUMEN
BACKGROUND: Angioleiomyomas are benign mesenchymal tumors usually located in the limbs, with anecdotal reports in the spine. We present an atypical case of an epidural spine angioleiomyoma presenting with compressive myelopathy symptoms. The diagnosis was suggested based on MRI findings, and subsequently confirmed histopathologically. RESULTS: This is the first known occurrence of pure spinal epidural angioleiomyoma as a source of compressive myelopathy. The imaging presentation, especially the 'dark reticular sign' on MRI, was crucial in suggesting the diagnosis despite the atypical location CONCLUSION: This report serves to raise awareness among clinicians and radiologists about including angioleiomyoma in differential diagnoses for spinal epidural lesions with indicative MRI features. The favorable outcome after surgical intervention underscores the necessity of swift and accurate diagnosis followed by appropriate treatment for such uncommon spinal tumors.
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Angiomioma , Imagen por Resonancia Magnética , Compresión de la Médula Espinal , Humanos , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/cirugía , Angiomioma/diagnóstico por imagen , Angiomioma/cirugía , Angiomioma/patología , Angiomioma/complicaciones , Neoplasias Epidurales/diagnóstico por imagen , Neoplasias Epidurales/cirugía , Neoplasias Epidurales/complicaciones , Neoplasias Epidurales/patología , Masculino , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Diagnóstico DiferencialRESUMEN
BACKGROUND: Capillary hemangiomas are rare vascular lesions that rarely affect the central nervous system. When they present within the spinal canal, they are typically confined intradurally, with intramedullary extension rare. We present a rare case of spinal intramedullary capillary hemangioma, with a systematic review of the literature. METHODS: Medical records and imaging data were retrospectively reviewed using the health record software EPIC (Verona, Wisconsin, USA) and the radiology management software system RIS/PACS (Radiology Information System/Picture Archiving and Communication System; QREADS). The report was written in accordance with the CARE (case reports) guidelines. We also performed a systematic review of the literature on all cases of intramedullary spinal capillary hemangiomas in accordance with PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. RESULTS: We report a case of a 54-year-old man who presented with progressive paraplegia and sensory deficits in the lower extremities. Spinal magnetic resonance imaging showed an intramedullary enhancing lesion centered at T11 with associated spinal cord compression. He underwent thoracic laminectomy and gross total resection of the lesion without complications and subsequent improvement on his neurological examination. Histological examination showed findings consistent with a capillary hemangioma. The literature review also documented 21 studies with a combined total of 38 cases of intramedullary spinal capillary hemangioma. CONCLUSIONS: Purely intramedullary capillary hemangiomas are unusual spinal lesions with only a few cases reported in the literature. These should be considered in the differential diagnosis of intramedullary tumors. Surgical management remains the first line of treatment for symptomatic patients.