Radiological Analysis of Cerebrospinal Fluid Dynamics at the Craniovertebral Junction Using Time-Spatial Labeling Inversion Pulse Magnetic Resonance Imaging in Patients with Cervical Spinal Canal Stenosis.

OBJECTIVE: Spondylotic changes in the cervical spine cause degeneration, leading to cervical spinal canal stenosis. This stenotic change can affect cerebrospinal fluid (CSF) dynamics by compressing the dural sac and reducing space in the subarachnoid space. We examined CSF dynamics at the craniovertebral junction (CVJ) using time-spatial labeling inversion pulse magnetic resonance imaging (Time-SLIP MRI) in patients with cervical spinal canal stenosis. METHODS: The maximum longitudinal movement of the CSF at the CVJ was measured as length of motion (LOM) in the Time-SLIP MRI of 56 patients. The sum of ventral and dorsal LOM was defined as the total LOM. Patients were classified into 3 groups depending on their spinal sagittal magnetic resonance imaging findings: control (n = 27, Kang classification grades 0 and 1), stenosis (n = 14, Kang classification grade 2), and severe stenosis (n = 15, Kang classification grade 3). RESULTS: Time-SLIP MRI revealed pulsatile movement of the CSF at the CVJ. The mean total, ventral, and dorsal LOM was 14.2 ± 9, 8.1 ± 5.7, and 3.8 ± 2.9 mm, respectively. The ventral LOM was significantly larger than the dorsal LOM. The total LOM was significantly smaller in the severe stenosis group (6.1 ± 3.4 mm) than in the control (16.0 ± 8.4 mm) or stenosis (11 ± 5.4 mm) groups (P < 0.001, Kruskal-Wallis H-test). In 5 patients, postoperative total LOM was improved after adequate decompression surgery. CONCLUSIONS: This study demonstrates that CSF dynamics at the CVJ are influenced by cervical spinal canal stenosis. Time-SLIP MRI is useful for evaluating CSF dynamics at the CVJ in patients with spinal canal stenosis.

Transient spinal cord dysfunction after surgery for intraspinal tumors: A case report.

RATIONALE: Limb dysfunction is not uncommon clinically after intramural tumor surgery. However, there are no relevant literature reports on the recovery of unilateral motor function caused by spinal cord dysfunction after short-term observation and treatment. The report of such cases is of great value for improving the cognition of postoperative complications of meningioma reducing misdiagnosis and providing reference for clinical treatment. PATIENT CONCERNS: A 73-year-old female patient with numbness and weakness in both lower limbs accompanied by unstable walking for 2 months. Combined with imaging data and postoperative pathological diagnosis, it was diagnosed as thoracic spinal meningioma. The patient experienced transient unilateral limb dysfunction after surgery. DIAGNOSES: Magnetic resonance imaging and its enhanced magnetic resonance imaging suggest a space occupying lesion on the left side of the spinal canal at the level of the thoracic 3 to 4 vertebral body, possibly a meningioma. The postoperative pathology was grade I meningioma. INTERVENTION: Administer 10 mL of dexamethasone, 1 g of methylprednisolone, and 250 mL of mannitol for treatment. OUTCOMES: After 3 hours, the patient's muscle strength gradually recovered, and after 12 hours, it was better than the preoperative level. CONCLUSION: Spinal cord dysfunction may occur after surgery for intraspinal meningioma in the upper thoracic spine. Unlike spinal cord dysfunction caused by spinal cord injury, this dysfunction is short-term and transient. The use of hormones and diuretics is a feasible solution that can quickly restore patient limb function.

Cranial subdural migrating to lumbar subdural space in a toddler.

Migrated spinal subdural haematoma (sSDH) is a significantly uncommon finding. This case involves a paediatric patient representing after cranial trauma with new abnormal gait and leg pain who was found to have a migrated sSDH. Literature review for reported cases of pathogenesis theories, causes and management was performed and summarised in this report. The authors concluded that new abnormal gait and leg pain in a paediatric patient with previous cranial trauma is an indication for spinal MRI if migrated subdural haematoma is suspected. Non-surgical management is generally tolerated, and steroids can be trialled for radiculopathy if clinically indicated.

Unilateral Approaches for Posterior Spinal Canal Decompression in Cervical Spondylotic Myelopathy-An Evaluation of Conceptual Feasibility.

BACKGROUND: Patients with cervical spondylotic myelopathy (CSM) can be treated with posterior approaches for spinal canal decompression. OBJECTIVE: We compared the patients' outcome after 2 different unilateral and a bilateral posterior approach for decompression to elucidate feasibility and potential procedure-related differences. METHODS: Medical records of 98 patients with CSM undergoing posterior decompression between 2012 and 2018 were assessed. Patients were divided into 3 groups: (1) unilateral interlaminar fenestration with over-the-top "undercutting" (laminotomy) for compression limited to a ligamentum flavum hypertrophy, (2) unilateral hemilaminectomy for lateralized compression with a combination of ligamentous hypertrophy and osseus stenosis, and (3) laminectomy/laminoplasty for circular osseous-ligamentous spinal canal narrowing. RESULTS: The mean age was 73 years (m:f = 1.4:1), and most frequent symptoms (mean duration: 15 months) were ataxia (69%) and sensory changes (57%). Main location of stenoses (median Naganawa Score = 3; mean anteroposterior spinal canal diameter = 7.7 ± 2.2 mm) was C3 to C6. Thirty-one percent of the patients were assigned for a laminotomy procedure, 20% for a hemilaminectomy, and 49% for a laminectomy/laminoplasty. There were no significant differences of patients' characteristics, blood loss, and operation time between the 3 groups. Independent from the mode of surgery, the spinal canal was significantly widened (median Naganawa Score = 0; mean anteroposterior diameter = 11.4 ± 3.6 mm) and myelopathy (mJOA Score) improved ( P < .001); a higher body mass index was significantly correlated with a worse mJOA improvement (r = 0.293/ P = .003). Quality of life (Short-Form 36v2 Health Survey/Neck Disability Index) and reduction of the neck pain level were similar in the 3 groups at last follow-up (mean: 28 months). CONCLUSION: To minimize patients' periprocedural burden in CSM with dorsal compression, individual tailoring of the posterior approach according to the underlying compressive pathology achieves sufficient decompression and comparable long-term results.

Spinal leptomeningeal hemangioblastomatosis occurring without craniospinal surgery in von Hippel-Lindau disease.

Hemangioblastomatosis represents an unusual and malignant leptomeningeal dissemination of hemangioblastoma (HB). It has been reported in patients with sporadic HB or von Hippel-Lindau (VHL) disease. Hemangioblastomatosis had been reported following resection of a primary HB lesion in all cases except one patient with a sporadic HB. We present a patient with VHL with several HBs at the brainstem, cerebellum, pituitary stalk and retina who developed spinal hemangioblastomatosis without previous craniospinal surgery. A whole spine MRI showed the spinal dissemination from the primary lesions. The patient received craniospinal radiotherapy due to the extensive spinal leptomeningeal dissemination and multiple HBs. MRI performed 12 months after the radiotherapy showed stability of the lesions.

Primary Benign Tumors of the Spinal Canal.

Benign tumors that grow in the spinal canal are heterogeneous neoplasms with low incidence; from these, meningiomas and nerve sheath tumors (neurofibromas and schwannomas) account for 60%-70% of all primary spinal tumors. Benign spinal canal tumors provoke nonspecific clinical manifestations, mostly related to the affected level of the spinal cord. These tumors present a challenge for the patient and healthcare professionals, for they are often difficult to diagnose and the high frequency of posttreatment complications. In this review, we describe the epidemiology, risk factors, clinical features, diagnosis, histopathology, molecular biology, and treatment of extramedullary benign meningiomas, osteoid osteomas, osteoblastomas, aneurysmal bone cysts, osteochondromas, neurofibromas, giant cell tumors of the bone, eosinophilic granulomas, hemangiomas, lipomas, and schwannomas located in the spine, as well as possible future targets that could lead to an improvement in their management.

Diagnosis and radiation therapy of an extensive myxoma in the retropharyngeal region infiltrating the cranial cervical vertebral canal in a dog.

An 8-year-old, intact Rottweiler-female dog presented due to an acute onset of lethargy, abnormal gait, and wheezing. Physical examination revealed stridor, cervical pain, and ambulatory tetraparesis. Magnetic resonance imaging-examination displayed a lobulated, fluid-filled mass extending from the sphenoid bone to C5, infiltrating the cranial vertebral canal causing extradural compression of the spinal cord and narrowing of the pharynx. An emergency debulking-surgery around the pharynx was performed. Histopathological findings were consistent with a myxoma. The remaining tumor was irradiated resulting in stable disease 6 months later. The dog died 18 months later due to aspiration pneumonia without clinical signs of neurologic or respiratory compromise.

Comparison between the coronal diameters of the cervical spinal canal and spinal cord measured using computed tomography and magnetic resonance imaging in Korean patients.

BACKGROUND: If the proportion of the spinal cord in the epidural space can be determined under C-arm fluoroscopy during cervical epidural block, a safe entry point for the epidural needle can be established. The aim of this study was the measurement of the cord to canal transverse diameter ratio of each cervical spines. METHODS: We retrospectively evaluated the imaging data of 100 patients who underwent both cervical computed tomography (CT) and cervical magnetic resonance imaging (MRI) at our hospital. We measured the diameters of the spinal canal and spinal cord from the 3rd cervical vertebra to the 1st thoracic vertebra (T1) at each level by using the patients' cervical CT and MRI images. The spinal cord and spinal canal diameters were measured in the transverse plane of the cervical MRI and CT images, respectively. RESULTS: The spinal cord to spinal canal diameter ratio was the highest at the 4th and 5th cervical vertebrae (0.64 ± 0.07) and the lowest at T1 (0.55 ± 0.06, 99% CI [0.535, 0.565]. CONCLUSIONS: Our findings suggest that the cord to canal transverse diameter ratio could be used as a reference to reduce direct spinal cord injuries during cervical epidural block under C-arm fluoroscopy. In the C-arm fluoroscopic image, if an imaginary line connecting the left and right innermost lines of the pedicles of T1 is drawn and if the needle is inserted into the outer one-fifth of the left and right sides, the risk of puncturing the spinal cord would be relatively reduced.

A Rare Case of Cysticercosis Involving the Whole Spinal Canal.

BACKGROUND: Cysticercosis is the commonest parasitic disease to affect the central nervous system (CNS). However, cysticercosis affecting the spine is extremely rare. We reported a rare case of cysticercosis involving the whole spinal canal in China. CASE PRESENTATION: A rare case of cysticercosis involving the entire spinal cord, in a 52-year-old Chinese man, was detected in 2021. Epidemiological investigation, clinical and etiological examination was performed. CONCLUSION: Since spinal cysticercosis is a rare but potentially life-threatening disease, clinicians should always consider the differential diagnosis of space-occupying lesions.

Femoral head to lower lumbar neural foramen distance as a novel radiographic parameter to predict postoperative stretch neuropraxia.

OBJECTIVE: Lumbosacral fractional curves in adult spinal deformity (ASD) patients often have sharp coronal curves resulting in significant pain and imbalance. Postoperative stretch neuropraxia after fractional curve correction can lead to discomfort and unsatisfactory outcomes. The goal of this study was to use radiographic measures to increase understanding of the relationship between postoperative stretch neuropraxia and fractional curve correction. METHODS: In 62 ASD patients treated from 2015 to 2018, radiographic review was performed, including measurement of the distance between the lower lumbar neural foramen (L4 and L5) in the concavity and convexity of the lumbosacral fractional curve and the ipsilateral femoral heads (FHs; L4-FH and L5-FH) in pre- and postoperative anteroposterior spine radiographs. The largest absolute preoperative to postoperative change in distance between the lower lumbar neural foramen and the ipsilateral FH (ΔL4/L5-FH) was used for analysis. Chi-square analyses, independent and paired t-tests, and logistic regression were performed to study the relationship between L4/L5-FH and stretch neuropraxia for categorical and continuous variables, respectively. RESULTS: Of the 62 patients, 13 (21.0%) had postoperative stretch neuropraxia. Patients without postoperative stretch neuropraxia had an average ΔL4-FH distance of 16.2 mm compared to patients with stretch neuropraxia, who had an average ΔL4-FH distance of 31.5 mm (p < 0.01). Patients without postoperative neuropraxia had an average ΔL5-FH distance of 11.1 mm compared to those with stretch neuropraxia, who had an average ΔL5-FH distance of 23.0 mm (p < 0.01). Chi-square analysis showed that patients had a 4.78-fold risk of developing stretch neuropraxia with ΔL4-FH > 20 mm (95% CI 1.3-17.3) and a 5.17-fold risk of developing stretch neuropraxia with ΔL5-FH > 15 mm (95% CI 1.4-18.7). Logistic regression analysis indicated that the odds of developing stretch neuropraxia were 15:1 with a ΔL4-FH > 20 mm (95% CI 3-78) and 21:1 with a ΔL5-FH > 15 mm (95% CI 4-113). CONCLUSIONS: The novel ΔL4/L5-FH distances are strongly associated with postoperative stretch neuropraxia in ASD patients. A ΔL4-FH > 20 mm and ΔL5-FH > 15 mm significantly increase the odds for patients to develop postoperative stretch neuropraxia.

Hypertrophy of the ligamentum flavum in lumbar spinal canal stenosis is associated with abnormal accumulation of specific lipids.

Ligamentum flavum hypertrophy (HLF) is the most important component of lumbar spinal canal stenosis (LSCS). Analysis of hypertrophied ligamentum flavum (HLF) samples from patients with LSCS can be an important que. The current study analyzed the surgical samples of HLF samples in patients with LCSC using quantitative and qualitative high performance-liquid chromatography and mass spectrometry. We collected ligamentum flavum (LF) tissue from twelve patients with LSCS and from four patients with lumbar disk herniation (LDH). We defined LF from LSCS patients as HLF and that from LDH patients as non-hypertrophied ligamentum flavum (NHLF). Total lipids were extracted from the LF samples and evaluated for quantity and quality using liquid chromatography and mass spectrometry. The total lipid amount of the HLF group was 3.6 times higher than that of the NHLF group. Phosphatidylcholines (PCs), ceramides (Cers), O-acyl-ω-hydroxy fatty acids (OAHFAs), and triglycerides (TGs) in the HLF group were more than 32 times higher than those of the NHLF group. PC(26:0)+H+, PC(25:0)+H+, and PC(23:0)+H+ increased in all patients in the HLF group compared to the NHLF group. The thickness of the LF correlated significantly with PC(26:0)+H+ in HLF. We identified the enriched specific PCs, Cers, OAHFAs, and TGs in HLF.

The effects of cages implantation on surgical and adjacent segmental intervertebral foramina.

OBJECTION: The overarching goal of our research was to compare the clinical and radiological outcomes with different sizes of cages implantation in anterior cervical discectomy and fusion (ACDF), and to evaluate the effects on surgical and adjacent segmental intervertebral foramina. METHODS: The clinical data of 61 patients were analyzed retrospectively. The radiological data included the surgical intervertebral disk space height before (H0) and after surgery (H), the preoperative mean height of adjacent segments (Hm), the area and height of the surgical and adjacent segment foramen, the surgical segmental Cobb angle (α1), and C2-7Cobb angle (α2). The calculation of clinical data was conducted by Japanese Orthopaedic Association Scores (JOA), the recovery rate of JOA scores and visual analog scales (VAS). In accordance with the different ranges of distraction (H/Hm), patients were classified into three groups: group A (H/Hm<1.20, n=13), group B (1.20≤H/Hm≤1.80, n=37), and group C (H/Hm>1.80, n=11). RESULTS: After the operation and at the final follow-up, our data has demonstrated that the area and height of surgical segmental foramen all increased by comparing those of preoperation in three groups (all P<0.05). However, except for a decrease in group C (all P<0.05), the adjacent segmental foramina showed no significant changes (all P>0.05). The area and height of the surgical segment foramen and the distraction degree were positively correlated (0

Pedigree analysis of lumbar developmental spinal stenosis: Determination of potential inheritance patterns.

Lumbar developmental spinal stenosis (DSS) refers to multilevel pre-existing narrowed spinal canals, which predispose to neural compromise. The objective of this study is to identify any inheritance pattern of DSS by utilizing pedigree charts. This was a case series of 13 families with a total of 80 subjects having magnetic resonance imaging (MRI) from L1 to S1. Cases (subjects with DSS) or controls (subjects without DSS) were identified by measuring their anteroposterior (AP) vertebral canal diameters. Multilevel model analyses were also performed to evaluate whether there is substantial clustering of observations within the families, and the effect of multilevel DSS. The intraclass correlation coefficient (ICC) and Akaike information criteria (AIC) were compared between models. Correlations between subject demographics and AP vertebral canal diameter were statistically insignificant at all levels. Only vertebral canal cross-sectional area, and axial and sagittal vertebral canal diameter were found to be statistically different between cases and controls at all levels (all p < .05). Both males and females were affected by DSS and there was no skipping of generation, which highly suggested DSS followed an autosomal dominant inheritance pattern. After accounting for multilevel DSS, there was a drop of more than 10 in AIC and some variances were also explained within families. This is the first study that suggests multilevel lumbar DSS to have an autosomal dominant inheritance pattern. Within families with a background of DSS, subjects had a smaller canal size, contributed by shortened axial and sagittal AP vertebral canal diameter, and smaller canal cross-sectional area.

Comparison of the anatomical morphology of cervical vertebrae between humans and macaques: related to a spinal cord injury model.

Non-human primates are most suitable for generating cervical experimental models, and it is necessary to study the anatomy of the cervical spine in non-human primates when generating the models. The purpose of this study was to provide the anatomical parameters of the cervical spine and spinal cord in long-tailed macaques (Macaca fascicularis) as a basis for cervical spine-related experimental studies. Cervical spine specimens from 8 male adult subjects were scanned by micro-computed tomography, and an additional 10 live male subjects were scanned by magnetic resonance imaging. The measurements and parameters from them were compared to those of 12 male adult human subjects. Additionally, 10 live male subjects were scanned by magnetic resonance imaging, and the width and depth of the spinal cord and spinal canal and the thickness of the anterior and posterior cerebrospinal fluid were measured and compared to the relevant parameters of 10 male adult human subjects. The tendency of cervical parameters to change with segmental changes was similar between species. The vertebral body, spinal canal, and spinal cord were significantly flatter in the human subjects than in the long-tailed macaques. The cerebrospinal fluid space in the long-tailed macaques was smaller than that in the human subjects. The anatomical features of the cervical vertebrae of long-tailed macaques provide a reference for establishing a preclinical model of cervical spinal cord injury.

The effects of age, pathology, and fusion on cervical neural foramen area.

Cervical radiculopathy is a relatively common neurological disorder, often resulting from mechanical compression of the nerve root within the neural foramen. Anterior cervical discectomy and fusion (ACDF) is a common treatment for radicular symptoms that do not resolve after conservative treatment. One mechanism by which ACDF is believed to resolve symptoms is by replacing degenerated disc tissue with bone graft to increase the neural foramen area, however in vivo evidence demonstrating this is lacking. The aim of this study was to evaluate the effects of age, pathology, and fusion on bony neural foramen area. Participants included 30 young adult controls (<35 years old), 23 middle-aged controls (36 to 60 years old), and 36 cervical arthrodesis patients tested before and after ACDF surgery. Participants' cervical spines were imaged in the neutral, full flexion, and full extension positions while seated within a biplane radiography system. A validated model-based tracking technique determined three-dimensional vertebral position and orientation and automated software identified the neural foramen area in each head position. The neural foramen area decreased throughout the entire sub-axial cervical spine with age and pathology, however, no changes in neural foramen area were observed due solely to replacing degenerated disc tissue with bone graft. The neural foramen area was not associated with disc height in young adult controls, but moderate to strong associations were observed in middle-aged controls. The results provide evidence to inform the debate regarding localized versus systemic spinal degeneration and provide novel insight into the mechanism of pain relief after ACDF.