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1.
Rinsho Shinkeigaku ; 60(9): 603-608, 2020 Sep 29.
Artigo em Japonês | MEDLINE | ID: mdl-32779595

RESUMO

We report a 77-year-old man who presented with numbness and weakness of the feet bilaterally, that had progressed over 13 years. He was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) on the basis of nerve conduction studies and a sural nerve biopsy; however, he was inadequately treated and his weakness had progressed. At 76 years of age, he developed spasticity in the legs as well as bladder and rectal incontinences. Gd-enhanced MRI revealed severe compression of the cervical cord by massively enlarged nerve roots. A cervical laminectomy was performed to decompress the cervical cord. A fascicular biopsy of the C5 dorsal root showed a prominent lymphocyte infiltration and edema. Repeated methylprednisolone pulse therapy and IVIg ameliorated the weakness. We concluded that the main cause of nerve root hypertrophy in this patient was active inflammation.


Assuntos
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/etiologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/terapia , Compressão da Medula Espinal/etiologia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/terapia , Raízes Nervosas Espinhais/patologia , Idoso , Vértebras Cervicais , Edema , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Laminectomia , Linfócitos/patologia , Masculino , Metilprednisolona/administração & dosagem , Pulsoterapia , Compressão da Medula Espinal/terapia , Resultado do Tratamento
3.
Spine (Phila Pa 1976) ; 45(15): E903-E908, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675600

RESUMO

STUDY DESIGN: Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens, which has not previously been reported. OBJECTIVE: Our aim was to explore the possible topographic correlation of the C5 nerve root with regards to its course and regional relation to C6 Chassaignac tubercle. SUMMARY OF BACKGROUND DATA: C5 palsy is reported amongst the most frequent postoperative complications of cervical spinal procedures. We hypothesized that etiologic mechanisms proposed thus far in the current literature, although with some plausible explanation, still cannot explain why the C5 nerve root and not any other level suffer a postoperative palsy. METHODS: Six fresh cadavers had extensive layer by layer dissection performed by two surgeons (one of whom has experience as an anatomy demonstrator and dissector). Roots of brachial plexus were exposed in relation to cervical transverse processes. Photographs were taken at each stage of the exposure. RESULTS: We observed a close relation of the path of the C5 nerve root with the C6 tubercle bilaterally. Moreover, we noted a steeper descent of C5 in comparison with the other adjacent roots. CONCLUSION: Steeper angle of the C5 nerve root and close proximity to C6 Chassaignac tubercle may play a role in predisposing it to neuropraxia. Detailed anatomical photographs on fresh unprocessed cadaveric specimens are novel. Peculiar anatomical features and recent experimental evidence discussed do highlight a postganglionic extraforaminal etiology corresponding well to the demographic meta-analysis data on clinical features of postoperative C5 palsy. Exploring an alternative unified "neurophysiologic stress and critical tipping point" etiological model that encompasses current theories and correlates known metanalyses observations, we believe further studies would be prudent to ascertain/refute these findings. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Paralisia/etiologia , Raízes Nervosas Espinhais/lesões , Raízes Nervosas Espinhais/cirurgia , Cadáver , Vértebras Cervicais/patologia , Descompressão Cirúrgica/métodos , Dissecação/efeitos adversos , Feminino , Humanos , Masculino , Paralisia/patologia , Complicações Pós-Operatórias/etiologia , Raízes Nervosas Espinhais/patologia
4.
J Clin Neurosci ; 77: 98-105, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32417129

RESUMO

Neurofibromatosis type 1 (NF1) manifests itself in many ways in the spine. This study aims to report the types of spinal lesions, clinical and demographic data in a large cohort from a complex NF1 centre. The characteristics of those with spinal neurofibromatosis, where neurofibromas are present on every spinal nerve root, were sought for comparison with the wider group of NF1 patients. This is a retrospective review of MDT minutes of 303 patients from a UK NF1 centre and the largest reported series of NF1 patients based on radiological data. Prevalence of each symptom and lesion was calculated and statistically significant associations were established. The most reported findings were cutaneous lesions (44.9%) and neurological deficit (27.4%). 28.4% had dural ectasia, 52.5% had some form of spinal deformity. 57.8% had spinal nerve root tumours, the most common of which were at C2. The most progressive lesions were spinal nerve root tumours (29.1%). The only statistically significant association found was between dural ectasia and spinal deformity (P < 0.003), where dural ectasia is associated with a 32.6% increase in spinal deformity incidence. This is the largest descriptive study of spinal lesions in NF1. Spinal tumours and spinal deformity are prevalent in NF1. The predilection of spinal tumours for flexible spinal regions suggests that repetitive movement might be an important factor in pathogenesis. Physicians and patients should be alert to the observation that although many spinal neurofibromatosis patients display no neurological deficit, they often have significant lesions which require monitoring and sometimes surgery.


Assuntos
Neurofibromatose 1/etiologia , Neurofibromatose 1/patologia , Raízes Nervosas Espinhais/patologia , Coluna Vertebral/patologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neurofibroma/patologia , Neurofibromatoses , Neurofibromatose 1/complicações , Neurofibromatose 1/epidemiologia , Estudos Retrospectivos , Neoplasias da Medula Espinal/patologia , Curvaturas da Coluna Vertebral , Reino Unido/epidemiologia
5.
J Clin Neurosci ; 77: 106-109, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32387257

RESUMO

The symptoms of lumbar radiculopathy, in particular foraminal stenosis, often exacerbated when the patient is upright. However, it is difficult to detect the compression of nerve roots while the patient is upright using conventional MRI. In this study, we analyzed the compression of lumbar nerve roots using dynamic digital tomosynthesis radiculography (DTRG) in patients diagnosed with lumbar radiculopathy. And we determined the relationship between leg pain and nerve compression while the patients are either prone or upright. We evaluated 30 patients with unilateral leg pain diagnosed as lumbar radiculopathy by physical examination and MRI. The patients were divided in two groups, one with foraminal stenosis (17 patients) and the other with canal stenosis (13 patients), based on MRI findings. All patients underwent DTRG to determine the diameter of their nerve roots in the foramen while prone and upright. Pain while prone or upright was assessed using a 100-point visual analogue scale (VAS) questionnaire. The VAS for leg pain while upright was significantly higher in the foraminal stenosis group (58 ± 24.7) than it was in the canal stenosis group (19.6 ± 13.2; p = 0.0002)). The nerve root diameter while prone or upright was significantly smaller in the foraminal stenosis group (1.2 ± 0.2 mm) than it was in the canal stenosis group (0.2 ± 0.1 mm; p < 0.0001). DTRG has the potential to visualize nerve compression while the patient is upright to reveal the relevance of foraminal stenosis to clinical findings. DTRG is useful for diagnosis of lumbar foraminal stenosis.


Assuntos
Constrição Patológica/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Medição da Dor , Radiografia/métodos , Estenose Espinal/diagnóstico por imagem , Adulto , Idoso , Constrição Patológica/diagnóstico , Constrição Patológica/patologia , Feminino , Humanos , Vértebras Lombares , Região Lombossacral/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Postura , Radiculopatia/diagnóstico por imagem , Radiculopatia/patologia , Raízes Nervosas Espinhais/patologia , Estenose Espinal/diagnóstico , Estenose Espinal/patologia
6.
Clin Nucl Med ; 45(6): e285-e287, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32332304

RESUMO

Primary central nervous system lymphoma is an extranodal lymphoma originating in the brain, spinal cord, and leptomeninges, which rarely spreads outside the nervous system. Neurolymphomatosis is the term used to describe lymphomatous involvement of the cranial nerves (except optic nerve) and peripheral nerve roots or plexus. We report a case of a 23-year-old man presented with progressive weakness of all 4 limbs. F-FDG PET/CT revealed FDG-avid thickening along the multiple cranial nerve roots, spinal nerve roots, and brain parenchymal lesion. Core biopsy from the peripheral nerve root demonstrated the lymphomatous involvement.


Assuntos
Neoplasias do Sistema Nervoso Central/patologia , Nervos Cranianos/patologia , Linfoma/patologia , Neurolinfomatose/patologia , Raízes Nervosas Espinhais/patologia , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Nervos Cranianos/diagnóstico por imagem , Difusão , Humanos , Linfoma/diagnóstico por imagem , Masculino , Neurolinfomatose/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Raízes Nervosas Espinhais/diagnóstico por imagem , Adulto Jovem
7.
J Clin Neurosci ; 73: 259-263, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32007377

RESUMO

The anomalous anatomical arrangement of the cervical spinal nerve roots within the spinal canal can complicate the surgical treatment of several pathologies. This work aimed to reveal intraspinal anatomical anomalies of the extradural and also intradural cervical spinal nerve roots courses. The anatomical study was realised in 43 cadavers with a mean age of 53.7 (32 men and 11 women). After opening the spinal canal and also the dural sac the intradural and extradural anomalies of the cervical spinal nerve roots (bilaterally) were explored and documented. We found completely 49 cases (56.98%) of intraspinal cervical nerve root anomalies. Extradural anomalies were found in 11 cases (12.79%) including atypical spacing, two roots exiting through one neuroforamen, extradural communications, aberrant root. Intradural anomalies observed in 28 cases (32.56%) comprised: communications between the dorsal roots and ventral roots separately or together and the multiple communications. Other anomalies (10 cases, 11.63%) included various types of atypical spacing of the roots and their asymmetry. All the results are differentiated according to the plexus type (pre-, postfixed, normotyped). This study describes intraspinal (extradural and intradural) anatomical anomalies of the cervical spinal nerve root courses. Knowledge of these variabilities should help to prevent the failure of several medical procedures.


Assuntos
Pescoço/patologia , Raízes Nervosas Espinhais/patologia , Adulto , Cadáver , Espaço Epidural/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espaço Subdural/patologia
8.
World Neurosurg ; 136: e393-e397, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931248

RESUMO

OBJECTIVE: During surgery, shoulder traction is often used for better fluoroscopic imaging of the lower cervical spine. Traction on the C5 root has been implicated as a potential cause of C5 palsy after cervical spine surgery. Using magnetic resonance imaging, this study was undertaken to determine the impact of upper extremity traction on the C5 root orientation. METHODS: In this study, 5 subjects underwent coronal magnetic resonance imaging of the cervical spine and left brachial plexus. Using a wrist restraint, sequential traction on the left arm with 10, 20, and 30 lb. was applied. Measurements of the angle between the spinal axis and C5 nerve root and the angle between the C5 nerve root and the upper trunk of the brachial plexus were obtained. The measurements were taken by a trained neuroradiologist and analyzed for significance. RESULTS: The angle between the C5 nerve root and the vertical spinal axis remained within 3 and 4 degrees of the mean and was not found to be associated with increased traction weight (P = 0.753). The angle between the C5 root and the upper trunk increased with increasing weight and was found to be statistically significant (P = 0.003). CONCLUSIONS: While the cause of C5 palsy is likely multifactorial, this study provides evidence that, in the awake volunteer, upper extremity traction leads to C5 root and upper trunk tension. These results suggest that shoulder traction in the anesthetized patient could lead to tension of the C5 nerve root and subsequent injury and palsy.


Assuntos
Cuidados Intraoperatórios/efeitos adversos , Paralisia/etiologia , Tração/efeitos adversos , Adulto , Idoso , Plexo Braquial/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Feminino , Fluoroscopia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paralisia/patologia , Raízes Nervosas Espinhais/patologia
9.
Pain Pract ; 20(1): 34-43, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31325409

RESUMO

BACKGROUND: Lumbar adhesive arachnoiditis is a debilitating neuropathic condition and is difficult to diagnose owing to lack of definitive diagnostic criteria. By focusing on the intrathecal mobility of nerve roots, we assessed whether useful diagnostic criteria could be established using MRI. METHODS: Seventeen patients with a high risk for lumbar adhesive arachnoiditis and 18 no-risk patients with chronic low back pain and/or leg pain participated in this study. The patients underwent MRI in both the supine and prone positions. Eleven axial T2-weighted images between the L2 and L5/S levels were obtained, and the proportion of the low-intensity area in the dorsal half to the total low-intensity area in the dural sac was calculated for each axial view. RESULTS: At some lumbar levels, the low-intensity area in the dorsal half of the dural sac was relatively larger in patients with a high risk for lumbar adhesive arachnoiditis than in the no-risk patients. In the no-risk group, the proportion of the low-intensity area in the dorsal half in the supine position was significantly higher than that in the prone position at all lumbar levels. However, in the high-risk group, at some levels, the proportions were not significantly different in the dorsal half of the dural sac between the supine and prone positions. CONCLUSION: In patients with a known risk for lumbar adhesive arachnoiditis, nerve roots lose their potential to migrate in the dural sac in the gravitational force direction on MRI.


Assuntos
Aracnoidite/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Raízes Nervosas Espinhais/diagnóstico por imagem , Idoso , Aracnoidite/patologia , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Decúbito Ventral , Raízes Nervosas Espinhais/patologia
10.
Br J Neurosurg ; 34(1): 72-75, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31668095

RESUMO

Purpose: The anomalous anatomical arrangement of the thoracic spinal nerve roots within the spinal canal can complicate the surgical treatment of several pathologies. The aim of this work was to reveal intraspinal anatomical variations of the thoracic spinal nerve roots.Methods: Anatomical study on 43 cadavers with a mean age of 53.7. After opening the spinal canal and dural sac, intradural and extradural anomalies of the thoracic spinal nerve roots were documented. Extradural communicating branches were excised, histologically processed and examined for the presence of nervous tissue.Results: We found 14 cases (32.6%) of intraspinal thoracic nerve root variations: intradural in 8 cases (18.6%), intradural communicating branches in 3 cases (6.97%), extradural anatomical variations occurred 6 cases (13.95%), 2 cases (4.65%) had extradural communicating branches between the nerve roots, 1 case had simultaneous occurrence of intradural and extradural communications (0.23%). All the results are differentiated according to the plexus type. In macroscopic extradural thoracic communicating branch had no nervous tissue on microscopy.Conclusions: This study describes intraspinal anatomical variations of thoracic spinal nerve roots. Knowledge of these variables should help prevent the failure of several medical procedures.


Assuntos
Raízes Nervosas Espinhais/anormalidades , Raízes Nervosas Espinhais/patologia , Vértebras Torácicas/anormalidades , Vértebras Torácicas/patologia , Adulto , Idoso , Cadáver , Dura-Máter/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Canal Vertebral/anormalidades , Canal Vertebral/anatomia & histologia , Canal Vertebral/patologia , Raízes Nervosas Espinhais/anatomia & histologia , Vértebras Torácicas/anatomia & histologia
11.
Spine (Phila Pa 1976) ; 45(7): 444-451, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31651686

RESUMO

STUDY DESIGN: Retrospective case series. OBJECTIVE: Anterior sacral meningocele (ASM) is a rare disorder. We reviewed 11 cases of congenital ASM and classified them into three types based on the anatomy and relationship between the cyst and sacral nerve roots. SUMMARY OF BACKGROUND DATA: The cohort with ASM is relatively large; the classification is novel and has not been previously reported. METHODS: Eleven consecutive patients with ASM who underwent surgery between February 2014 and January 2019 were retrospectively analyzed. They included four males and seven females. The dorsal transsacral approach was adopted in all cases. The follow-up time was at least 3 months. RESULTS: We attempted to classify ASM into three types. Of the 11 cases, six were caudal type, two were paraneural type, and three were nerve-root type. The meningocele was ligated after exploring no nerve involvement, in Type I and II. For Type III, the herniating sac and involved nerve roots were ligated when the nerve roots were indicated as nonfunctional on neurophysiological monitoring; otherwise, the sacral nerve roots were protected and imbricated on the residual sac like a hand-in-glove, and sutured to reconstruct the nerves sleeve. Eight cases were accompanied by tethered cord syndrome (TCS); spinal cord detethering was done with one-stage operation. Ten patients' presenting symptoms improved at 3 to 6 months' follow-up; notably, constipation significantly improved. Only one case accompanied by an epidermoid cyst had a second laparoscopic surgery by a general surgeon. CONCLUSION: Aim of surgical treatment is to obliterate the communication between the subarachnoid space and herniated sac, detether the spinal cord, and resect the congenital tumor. The new classification helps to recognize the relationship between the meningocele and sacral nerve roots, and subsequently adopt different surgical strategies. We consider the dorsal transsacral approach relatively feasible, safe, and with lower complication. LEVEL OF EVIDENCE: 4.


Assuntos
Encefalocele/classificação , Encefalocele/cirurgia , Meningocele/classificação , Meningocele/cirurgia , Sacro/cirurgia , Adolescente , Adulto , Estudos de Coortes , Encefalocele/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Meningocele/diagnóstico , Estudos Retrospectivos , Raízes Nervosas Espinhais/patologia , Raízes Nervosas Espinhais/cirurgia , Resultado do Tratamento , Adulto Jovem
12.
Spine (Phila Pa 1976) ; 45(11): E608-E615, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31770316

RESUMO

STUDY DESIGN: Anatomic study in nine fresh-frozen cadavers. OBJECTIVE: To confirm the anatomical feasibility of transferring the extradural ventral roots (VRs) and dorsal roots (DRs) of contralateral C7 nerves to those of the ipsilateral C7 nerves respectively through a cervical posterior approach. SUMMARY OF BACKGROUND DATA: The contralateral C7 nerve root transfer technique makes breakthrough for treating spastic limb paralysis. However, its limitations include large surgical trauma and limited indications. METHODS: Nine fresh-frozen cadavers (four females and five males) were placed prone, and the feasibility of exposing the bilateral extradural C7 nerve roots, separation of the extradural C7 VR and DR, and transfer of the VR and DR of the contralateral C7 to those of the ipsilateral C7 on the dural mater were assessed. The pertinent distances and the myelography results of each specimen were analyzed. The acetylcholinesterase (AChE) and antineurofilament 200 (NF200) double immunofluorescent staining were preformed to determine the nerve fiber properties. RESULTS: A cervical posterior midline approach was made and the laminectomy was performed to expose the bilateral extradural C7 nerve roots. After the extradural C7 VR and DR are separated, the VR and DR of the contralateral C7 have sufficient lengths to be transferred to those of the ipsilateral C7 on the dural mater. The myelography results showed that the spinal cord is not compressed after the nerve anastomosis. The AChE and NF200 double immunofluorescent staining showed the distal ends of the contralateral C7 VRs were mostly motor nerve fibers, and the distal ends of the contralateral C7 DRs were mostly sensory nerve fibers. CONCLUSION: Extradural contralateral C7 nerve root transfer in a cervical posterior approach for treating spastic limb paralysis is anatomically feasible. LEVEL OF EVIDENCE: 5.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Espasticidade Muscular/cirurgia , Paralisia/cirurgia , Raízes Nervosas Espinhais/cirurgia , Adulto , Idoso , Cadáver , Vértebras Cervicais/patologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/patologia , Paralisia/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos da Medula Espinal/patologia , Traumatismos da Medula Espinal/cirurgia , Raízes Nervosas Espinhais/patologia
13.
Jpn J Radiol ; 38(3): 222-230, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31865529

RESUMO

PURPOSE: This study aimed to investigate the relationship between the fractional anisotropy (FA) values of compressed nerves derived in diffusion tensor imaging (DTI) and the corresponding clinical symptoms for quantitative and clinical evaluation in patients with lumbosacral radiculopathy. METHODS: Thirty-six patients and ten volunteers participated in the study and measured with DTI. The resultant FA values for L5-S1 lumbar nerve roots were calculated at three sub-regions. Additionally, the DTI relevant tractography was also performed on L4-S1 nerve roots. Clinical symptoms were performed by Japanese Orthopedic Association (JOA) scoring for each patient and volunteer. RESULTS: The FA values of the nerves at the symptomatic side were significantly lower than those at the asymptomatic side (p < 0.001). Diffusion tensor tractography distinctly showed abnormalities in the symptomatic nerve tracts. There was a significant correlation between JOA scores and the FA values of the compressed nerves at middle and distal sub-regions (p < 0.005). CONCLUSION: The clinical symptoms associated robustly with the DTI derived FA values of the compressed nerves in patients with lumbosacral radiculopathy. Therefore, the FA values can be a potential clinical tool to evaluate the nerve roots in lumbosacral radiculopathy quantitatively.


Assuntos
Imagem de Tensor de Difusão/métodos , Radiculopatia/diagnóstico por imagem , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Avaliação como Assunto , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/inervação , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Radiculopatia/patologia
14.
Int J Neurosci ; 130(4): 343-347, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31675909

RESUMO

Objective: Anterior funiculus lesion is uncommon in subacute combined degeneration of the spinal cord with few data available. Aim of the study was to describe a case with the rare manifestation and summarize existing literatures.Methods: We report a case of a 42-year-old woman with anterior and lateral funiculus lesions on cervicothoracic spine magnetic resonance imaging, who presented with unsteady gait, sensory level and weakness of lower limbs. Besides, we reviewed and analyzed literatures about subacute combined degeneration of the spinal cord with anterior funiculus lesions published during the past two decades.Results: The diagnosis of subacute combined degeneration of the spinal cord was considered due to her presence of low serum vitamin B12 levels, pernicious anemia and gastric carcinoid.Conclusion: Physicians should consider subacute combined degeneration of the spinal cord as a possible differential diagnosis when faced with atypical lesions distributed in the anterior funiculus.


Assuntos
Raízes Nervosas Espinhais/patologia , Degeneração Combinada Subaguda/patologia , Adulto , Feminino , Humanos , Raízes Nervosas Espinhais/diagnóstico por imagem
15.
Medicine (Baltimore) ; 98(42): e17341, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626091

RESUMO

RATIONALE: Schwannomas grow slowly, originating from the Schwann cells of the nerve sheath. Schwannomas of cranial origin have the highest incidence, followed by intraspinal schwannomas. However, paravertebral schwannoma is rare, and to our knowledge, giant paravertebral schwannomas near the lumbar nerve roots with bone destruction are extremely rare. PATIENT CONCERNS: A 47-year-old Chinese woman complained of lower back soreness and a sensation of a bulging lumbar disc with no obvious cause for the past 3 years. DIAGNOSIS: Lumbar magnetic resonance imaging showed a large mass with uneven density, 17 × 12 × 15 cm in size, located to the right of the 4th lumbar with obvious bony destruction. Histopathology and immunohistochemistry confirmed that this mass was a benign schwannoma. INTERVENTIONS: Complete resection of the tumor (measuring about 17 × 12 × 15 cm in size) and vertebral reconstruction using internal fixation were performed. OUTCOMES: The patient was discharged without complications after surgery. The 3-year follow-up revealed that the patient recovered well with no evidence of recurrence. LESSONS: Here, we emphasize the importance of careful radiological examination and reflect on the difficulty of tumor resection. Furthermore, understanding the treatment and diagnosis of lumbar paravertebral schwannoma is critical for plastic surgeons and radiologists when encountering similar cases.


Assuntos
Vértebras Lombares/patologia , Neurilemoma/patologia , Neoplasias da Coluna Vertebral/patologia , Raízes Nervosas Espinhais/patologia , Feminino , Humanos , Dor Lombar/etiologia , Vértebras Lombares/virologia , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/cirurgia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(42): e17422, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626098

RESUMO

Symptoms of intervertebral foraminal stenosis are caused by compression of nerve root exiting the intervertebral foramen. Many attempts to measure the size of the neuromuscular exit have been made; however, only a few studies to compare the area differences between foramens by computed tomography (CT) were done. In this retrospective comparative study, we used the region of interest (ROI) in CT to measure and compare the area of intervertebral foramen between the healthy control group and the patient group.Eighty-one patients who underwent CT of the lumbar spine between May 2014 and December 2017 were enrolled. Using the medical imaging program, the foraminal area between L5 and S1 vertebrae was measured on the sagittal, coronal, and axial planes using ROI. Four groups were established for comparison: those diagnosed with foraminal stenosis by a radiologist and those who were not, those diagnosed with foraminal stenosis by orthopedic surgeons and those who were not. These groups were further divided into subcategories depending on whether the area was operated on for foraminal stenosis. Interobserver and intraobserver agreements were assessed.The mean age of patients was 56.5 years (range 17-84). The foraminal area of the surgical group on sagittal plane was significantly narrower than the control group (P = .005). However, the difference between the 2 groups on axial and coronal planes was not statistically significant (P > .1). Foraminal area <80 mm on sagittal images was a statistically significant risk factor for clinical symptom (P = .028) and that <65 mm was a statistically significant risk factor in predicting operability (P = .01). Interobserver and intraobserver agreements were fair to good on axial and coronal planes (about 0.7), whereas the agreements were excellent on sagittal plane (>0.9).In this study, we proved that measuring the intervertebral foraminal area using the ROI in CT in the lumbar spine is useful for diagnosing L5-S1 foraminal stenosis, especially on sagittal plane. Furthermore, not only does it provide aid in diagnosis, but it also helps predicting the operability of foraminal stenosis.


Assuntos
Vértebras Lombares/patologia , Estenose Espinal/diagnóstico por imagem , Estudos de Casos e Controles , Tratamento Conservador/estatística & dados numéricos , Constrição Patológica , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/patologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Fusão Vertebral/estatística & dados numéricos , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/patologia , Estenose Espinal/terapia , Tomografia Computadorizada por Raios X
18.
Free Radic Biol Med ; 143: 454-470, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31472247

RESUMO

Brachial plexus avulsion (BPA) occurs when the spinal nerve roots are pulled away from the surface of the spinal cord and disconnects neuronal cell body from its distal downstream axon, which induces massive motoneuron death, motor axon degeneration and de-innervation of targeted muscles, thereby resulting in permanent paralysis of motor functions in the upper limb. Avulsion injury triggers oxidative stress and intense local neuroinflammation at the lesioned site, leading to the death of most motoneurons. Berberine (BBR), a natural isoquinoline alkaloid derived from medicinal herbs of Berberis and Coptis species, has been reported to possess neuro-protective, anti-inflammatory and anti-oxidative effects in various animal models of central nervous system (CNS)-related disorders. In this study, we aimed to investigate the effect of BBR on motoneuron survival and axonal regeneration following spinal root avulsion plus re-implantation in rats. Our results indicated BBR significantly accelerated motor function recovery in the forelimb as revealed by the increased Terzis grooming test score, facilitated motor axon regeneration as evidenced by the elevated number of Fluoro-Gold-labeled and P75-positive regenerative motoneurons. The survival of motoneurons was notably promoted by BBR administration presented with boosted ChAT-immunopositive and neutral red-stained neurons. BBR treatment efficiently alleviated muscle atrophy, attenuated functional motor endplates loss in biceps and prevented the reduction of motor axons in the musculocutaneous nerve. Additionally, BBR treatment markedly mitigated the avulsion-induced neuroinflammation via inhibiting microglial and astroglial reactivity, up-regulated the expression of antioxidative indicator Cu/Zn SOD, and down-regulated the levels of nNOS, 3-NT, lipid peroxidation and NF-κB, as well as promoted SIRT1, PI3K and Akt activation. Collectively, BBR might be a promising therapy to assist re-implantation surgery for the treatment of BPA.


Assuntos
Axônios/fisiologia , Berberina/farmacologia , Neurônios Motores/citologia , Regeneração Nervosa/efeitos dos fármacos , Reimplante/métodos , Traumatismos da Medula Espinal/prevenção & controle , Raízes Nervosas Espinhais/cirurgia , Animais , Feminino , Neurônios Motores/efeitos dos fármacos , Neurônios Motores/metabolismo , Fármacos Neuroprotetores/farmacologia , Ratos , Ratos Sprague-Dawley , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/patologia , Raízes Nervosas Espinhais/lesões , Raízes Nervosas Espinhais/patologia , Nervos Espinhais/transplante
19.
Sci Rep ; 9(1): 11468, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391542

RESUMO

Lumbosacral nerve root avulsion leads to widespread death of neurons in the anterior horn area of the injured spinal cord, which results in dysfunction in the lower extremities. Heat shock protein 27 (Hsp27) has been found to play cytoprotective roles under adverse conditions. However, the role of Hsp27 in neurons after lumbosacral nerve root avulsion is unknown. The aim of the present study was to investigate the effects and mechanism of action of Hsp27 on neurons after lumbosacral nerve root avulsion. It was found that Hsp27 expression was elevated in the anterior horn area of the injured spinal cord and the up-regulation of Hsp27 protected neurons against apoptosis after lumbosacral nerve root avulsion. In addition, Hsp27 plays an anti-apoptotic role by suppressing oxidative stress reactions. These findings indicated that Hsp27 may play a key role in resistance to lumbosacral nerve root avulsion-induced neuron apoptosis and may prove to be a potential strategy for improving prognosis after lumbosacral nerve root avulsion.


Assuntos
Células do Corno Anterior/patologia , Proteínas de Choque Térmico HSP27/metabolismo , Proteínas de Choque Térmico/metabolismo , Chaperonas Moleculares/metabolismo , Radiculopatia/patologia , Raízes Nervosas Espinhais/lesões , Animais , Apoptose , Hipóxia Celular , Linhagem Celular Tumoral , Meios de Cultura Livres de Soro , Modelos Animais de Doenças , Técnicas de Silenciamento de Genes , Proteínas de Choque Térmico HSP27/genética , Proteínas de Choque Térmico/genética , Humanos , Região Lombossacral , Masculino , Chaperonas Moleculares/genética , Estresse Oxidativo , Cultura Primária de Células , RNA Interferente Pequeno/metabolismo , Radiculopatia/etiologia , Ratos , Raízes Nervosas Espinhais/citologia , Raízes Nervosas Espinhais/patologia , Regulação para Cima
20.
Neuroradiology ; 61(10): 1203-1208, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31396663

RESUMO

We herein present three cases of a rare type of spinal AVF, an intradural radicular AVF, which mimicked a dural AVF. A 65-year-old male presented with congestive myelopathy. On angiography, right vertebral angiogram (VAG) showed a suspected dural AVF; however, left VAG showed the same intradural dilated vein fed by the anterior spinal artery (ASA). Intraoperative and histological results suggested that a single AVF was located on the right C1 nerve root fed by the right C1 radicular artery and branch of the anterior spinal artery. Two additional patients with a radicular AVF at the C3 or C5 level were presented. Intradural radicular AVFs and dural AVFs have very similar appearances; however, there is a difference that makes the risk of the endovascular treatment of radicular AVFs markedly higher because of blood supply from the ASA. In our case, the AVF was completely occluded by direct surgery without major complications.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Dura-Máter/irrigação sanguínea , Dura-Máter/diagnóstico por imagem , Raízes Nervosas Espinhais/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Angiografia , Malformações Vasculares do Sistema Nervoso Central/patologia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Diagnóstico Diferencial , Dura-Máter/patologia , Dura-Máter/cirurgia , Humanos , Masculino , Raízes Nervosas Espinhais/irrigação sanguínea , Raízes Nervosas Espinhais/patologia , Raízes Nervosas Espinhais/cirurgia
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