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INTRODUCTION: Low back pain is one of the most common cause for outpatient visits. Though few studies have shown the vital role of paraspinal muscles in lumbar spine pathology, literature is scarce regarding the influence of the paraspinal muscles in disc degeneration. We aimed to analyse the correlation between paraspinal muscles and disc degeneration. METHODS: This is a Level III Prospective Cohort Study done in MRI of lumbosacral spine in 504 patients at 2520 levels from L1-2 to L5-S1. The parameters assessed were age, Pfirrmann grade for disc degeneration and paraspinal muscle (Multifidus and Erector Spinae) mass assessed by the gross cross sectional area of the muscle.The values and their correlation was analyzed using SPSS software. RESULTS: The study included a total of 504 patients (231 males and 273 females) with a mean age of 52.00 ± 15.00 (22-80) years. The mean GCSA in cm2 of the paraspinal muscles at L1-L2, L2-L3,L3-L4,L4-L5,L5-S1 were 16.177 ± 2.72, 17.275 ± 2.16, 16.900 ± 3.07, 16.800 ± 2.63, 13.426 ± 2.42 respectively. We found that the age of the patient is directly proportional to the disc degeneration and inversely proportional to GCSA of paraspinal muscle. There was a significant negative correlation between disc degeneration and paraspinal muscle mass. CONCLUSION: We found that the paraspinal muscle mass reduces and Pfirrman's Grade increases as age advances. Also patients with disc degeneration tend to have wasting of paraspinal muscles and vice versa. Hence, strengthening the paraspinal muscles should be emphasised to prevent back pain and to stall the degeneration cascade.
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Epithelioid sarcoma of the spine has been rarely reported in the literature. Its diagnosis is challenging due to nonspecific findings. We report a case of 42-year-old gentleman with back pain. Magnetic resonance imaging (MRI) revealed lesion in the L4 vertebral body extending into the spinal canal with pre and paravertebral involvement. He underwent posterior spinal decompression and instrumentation with biopsy. Histopathological examination was nonspecific. Considering clinical and radiological features, antitubercular treatment was initiated. The patient developed acute onset weakness of both lower extremities 1 month post-surgery. Repeat MRI and positron emission tomography (PET) computed tomography revealed an increase in the extent of lesion which required revision decompression. Histopathological examination showed cells with epithelioid appearance, positive for Vimentin, and epitheloid membrane antigen in immunohistochemistry. Radiotherapy was planned but the patient expired due to multiorgan dysfunction. Epithelioid sarcomas are rare soft-tissue neoplasms with poor prognosis. They can mimic infection and a high degree of suspicion is required in these cases to diagnose and treat them early.
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BACKGROUND: Capillary hemangiomas are benign vascular lesions commonly seen in subcutaneous tissues. The most common site of origin is from the vertebral body, and only a few cases of isolated lesions in thoracic epidural space, especially after trauma, have been reported in the literature. CASE DESCRIPTION: We report a case of 63-year-old male with progressive bilateral lower limb weakness and exaggerated lower limb deep tendon reflexes without bowel and bladder involvement. His history revealed T7 fracture with paraparesis which was treated surgically, and implants were removed a year later. MRI showed an epidural lesion from T6-T8 extending into the right T7-8 foramen which showed hypointensity on T1, hyperintensity on T2, and homogenous enhancement in contrast images with severe cord compression. Laminectomy was done and the lesion was removed en bloc. Histopathological examination revealed it to be capillary hemangioma. The neurology came back to normal after 3 months. CONCLUSION: Although capillary hemangiomas are rare lesions, it has to be considered in the differential diagnosis of epidural space-occupying lesions which require early surgical removal to prevent a progressive and permanent neurological deficit.
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INTRODUCTION: Melorheostosis is a rare condition affecting the bones and has only been occasionally reported. We herein report a case of melorheostosis affecting left femur and tibia which was diagnosed based on clinical and radiological features and managed with bisphosphonates. CASE REPORT: A 28-year-old female patient presented with complaints of pain over left knee and thigh for the past 3 months. To evaluate the cause of pain X-ray and magnetic resonance imaging were done, which revealed characteristic candle dripping wax appearance suggestive of melorheostosis. After arriving at the diagnosis patient was started on nonsteroidal anti-inflammatory drugs and pamidronate which provided symptomatic betterment patient has now been followed up for past 1 year and is symptom free. CONCLUSION: Melorheostosis is an uncommon cause of a common symptom. Positive clinical and imaging features helped us to arrive at the diagnosis. Proper work up would help in early diagnosis and management. More evidence is needed to illustrate the effectiveness of medical or surgical treatments for patients with this rare diagnosis.
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OBJECTIVE: The pathomechanism and factors influencing hypertrophy of the Ligamentum flavum in the lumbar spine still requires a confident specificity. We aimed to analyse the association between various factors and Ligamentum Flavum Thickness (LFT) and also to investigate the major contributor for Ligamentum Flavum Hypertrophy (LFH) at various levels in the lumbar spine. PATIENTS AND METHODS: The following were evaluated at L1-L2,L2-L3,L3-L4,L4-L5 and L5-S1 levels in MRI of 1070 lumbar disc levels of 214 subjects: Pfirrmann's grade of the disc, anterior and posterior disc height, disc volume, facet tropism and LFT. LFT > 0.4 cm was considered as hypertrophy.Correlation between LFT and other parameters was done and values with p < 0.05 was considered statistically significant. RESULTS: 112 male and 102 female were included. There was an increase in the anterior disc height (0.98 cm to 1.50 cm), posterior disc height (0.84 cm to 0.96 cm), disc volume (7.17cm3 to 14.6cm3), facetal angle and LFT on both sides from L1-2 to L5-S1 levels. Highest frequency of LFT was seen at L4-5.Pfirrmann's grade of the disc and anterior disc height had a statistically significant positive correlation with LFT at L1-L2,L2-L3,L3-L4,L4-L5 levels whereas facet tropism was strongly associated with LFT at L5-S1 level. CONCLUSION: Higher Pfirrmann's grade and decreased anterior disc height can lead to ligamentum flavum hypertrophy at L1-L2, L2-L3,L3-L4,L4-L5 levels.Whereas at L5-S1 level, it is the presence of facet tropism which can cause LFH. Hence, patients with the presence of above mentioned factors at those respective levels have higher preponderance to develop Lumbar canal stenosis.