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PubMed2004

Multiple neurenteric cysts in the posterior fossa and cervical spinal canal--case report.

A 46-year-old woman presented with multiple neurenteric cysts in the posterior fossa and spinal canal. Neuroimaging demonstrated neurenteric cysts in the interspace between the left cerebellar hemisphere and vermis, the lateral side of the right cerebellar hemisphere, and the ventral side of the spinal cord at the C-2 and C-4 levels. Total resection of the paravermian cyst and partial removal of the spinal cyst at the C-4 level were performed. Histological examination showed the cyst wall consisted of single or multiple layers of columnar epithelial cells with secretory granules, with mucin secretion verified by periodic acid-Schiff staining. Immunohistochemical staining showed the walls were positive for the cytokeratin, epithelial membrane antigen, and carcinoembryonic antigen, and negative for glial fibrillary acidic protein and S-100 protein. These findings confirmed the endodermal origin. The diagnosis was neurenteric cyst. The paravermian cyst disappeared, but the spinal cyst at the C-4 level recurred 8 months later. Reoperation became necessary 16 months later. The other two cysts also showed enlargement at 6 or 15 months. Total removal of neurenteric cyst is recommended if possible.

Carcinoembryonic Antigen↗
PubMed2002

[Chondroma of the lumbar spinal canal: a case report].

Chondroma is a benign cartilaginous tumor and fairly rare in the spine. A case of chondroma in the lumbar spine is presented. A male at age 66 was suffered from progressive low back pain associated with hypesthesia in his right leg. Radiographic examination showed an extradural mass in the dorsal part of spinal canal at L 5 level. No osteolytic change was noted by CT scan. MRI showed iso-intensity with marginal enhancement on T 1-weighted images and heterogeneous intensity on T 2-weighted image. The mass was totally removed by laminectomy and pathohistologically diagnosed as chondroma. Postoperative course was uneventful and the symptoms disappeared completely. One of the origin of chondroma is thought to be metaplasia of the connective tissue in contact with spine. This is why no pathological change was found in bone adjacent to the tumor. Careful preoperative diagnosis and total removal of the tumor is important since malignant transformation may happen in chondroma.

Aged↗
PubMed2005

Lipoma with dumb-bell extradural extension through the intervertebral foramen into the spinal canal. Case report.

The authors present the case of a 60-year-old woman with a neck lipoma that developed dumb-bell extradural extension, causing radiculopathy. To the best of the authors' knowledge, this is the first report of a lipoma originating in the neck with dumb-bell extradural extension through the intervertebral foramen and into the spinal canal. The lipoma was first excised from the foramen via a posterior approach to allow decompression of the nerve roots. The remaining lipomatous tissue was then resected via an anterior approach to avoid the region around the vertebral artery.

Cervical Vertebrae↗
PubMed1976

Subarachnoid block and enlargement of the spinal canal in hypertrophic neuritis.

A case of Dejerine-Sottas hypertrophic neuritis is reported. The patient, a 45-year-old male, suffered from chronic hypertrophic polyneuropathy, abnormal pupils, fasciculations, tremor, back pain, impotence, sphincter disorders, cramps, and lightning pains in the lower extremities. Besides extensive subarachnoid block, there was X-ray evidence of enlargement of the bony spinal canal with scalloping of the lumbar vertebrae. Surgical exploration showed these abnormalities to be due to extreme hypertrophy of the cauda equina. Histologic findings in peripheral nerve and lumbar root biopsies were typical of hypertrophic neuropathy of the onion bulb type. Vertebral changes secondary to hypertrophied nerve roots appear not to have been described before in hypertrophic neuritis; however, knowledge of their possible occurrence may be of practical importance in the management of similar future cases. A simple way of visualizing enlarged peripheral nerves is briefly described.

Cauda Equina↗
PubMed1983

Computed tomography of bone fragments in the spinal canal. An experimental study.

The detectability of bone fragments of differing size and structure, placed epidurally in the spinal canal at different levels from T XI to L II, was studied in three vertebral preparations using three different CT scanners, Philips Tomoscan 310, General Electric 8800 and Siemens Somatom 2. The thickness of the bone fragment was the most decisive factor. Cortical bone fragments could be detected down to a thickness of 0.6 mm and spongy bone fragments down to 1.2 mm. No difference in detectability between the different CT scanners was found.

Diagnosis, Differential↗
PubMed1995

Reversible anterior cord syndrome due to penetration of the spinal canal by pedicular screws.

The use of transpedicular screws in patients with disturbed posterior column anatomy is sometimes hazardous. We report a patient with a burst fracture at T7 who developed an anterior cord syndrome immediately after posterior instrumentation. Diagnosis of the anterior cord syndrome was ascertained by an emergency computerised tomogram which showed a misplaced screw compressing the cord from the anterolateral aspect of the spinal canal. Extraction of this screw and revision of the instrumentation resulted in speedy and complete resolution of the neurological deficit. The patient was mobilised within the first postoperative week and was able to work by the fourth postoperative month. The application of smooth contoured screws and blunt surgical instruments was found to be helpful because they are less likely to produce a cutting injury of neural tissue. We must further stress that transpedicular screws for the upper thoracic segments are to be employed very cautiously, if ever, to avoid severe neurological complications.

Adult↗
PubMed1976

[Possibilities of cervical fusion surgery in the spinal canal with intervertebral disk degeneration, Therapeutic and case-report contribution].

This is a report of a patient with pains in the shoulders and arms, atrophies of the small muscles of the hands, and paraspasms of the legs. After having suffered from the disease for eight to nine years, the patient was diagnosed as having cervical myelopathy. Measurements of the bony cervical vertebral column, which were made on a lateral roentgenogram, showed extreme narrowness of the spinal canal, the measured values obtained being below the lower limit. In addition, the cervical canal was narrowed at three levels by the formation of projections on degenerate disks. This suggested the most effective surgical treatment: Vetral clearance of disks, removal of prominences, and fusion of the three levels through the use of four bone dowels. Subsidence of pains in the shoulders and arms, improvements of paresis of the hands, and considerable improvement of paraspams of the legs were observed postoperatively. This particular case shows that surgical intervention may be considered a possible method of therapy even in the case of narrowness of the cervical canal, a condition that was aggravated here by a number of degenerate disks. In such situations it is possible for the cervical canal to be considerably relieved by clearing the disks, removing the projections and crests, and making use of the special technique of fusion or joining together so that improvement will be possible even in those cases where the disease has already arrived at a progressive state.

Cervical Vertebrae↗
PubMed1993

The distribution of medication along the spinal canal after chronic intrathecal administration.

Chronic intrathecal drug infusion for the treatment of neurological diseases, such as spasticity and chronic pain, has become an accepted method of therapy in recent years. Concurrent pharmacokinetic studies have shown that the cisternal cerebrospinal fluid (CSF) drug level is considerably lower than the lumbar CSF level during continuous infusion into the lumbar subarachnoid space. One factor that makes analysis of this decline in drug level difficult to quantify is that it is only feasible to sample CSF at the two extremes of the spinal subarachnoid space. Using a radionuclide technique, we have examined the distribution along the spinal canal of a hydrophilic compound, indium-111 diethylenetriamine pentaacetic acid, that was delivered over 72 hours into the lumbar subarachnoid space in five patients with implanted drug pumps. Over a 20-cm distance of the thoracic cord, radionuclide counts decreased gradually so that the indium-111 diethylenetriamine pentaacetic acid concentration surrounding the cord at the T2 vertebral level was 43% of that at the T12 level in four patients. Therefore, it appears that even with a hydrophilic compound, which minimizes spinal cord capillary losses, there is still a considerable reduction of CSF drug concentration along the spinal canal. The clinical implication of this gradual decline in drug level is that for intrathecal infusion of relatively hydrophilic compounds there may not be any advantage in placing the catheter tip at more rostral locations, such as at the midthoracic or cervical cord.

Analgesia, Epidural↗
PubMed1994

Distinction between degenerative and isthmic spondylolisthesis on sagittal MR images: importance of increased anteroposterior diameter of the spinal canal ("wide canal sign").

OBJECTIVE: The purpose of this study was to determine whether a visually apparent increase in the anteroposterior diameter of the spinal canal ("wide canal sign") can be used reliably to differentiate degenerative from isthmic spondylolisthesis on midline sagittal MR images. We hypothesized that the wide canal sign would be present only in isthmic spondylolisthesis, where the vertebral ring is disrupted by defects in the pars interarticularis. MATERIALS AND METHODS: The midline sagittal MR images of 100 control subjects without spondylolysis or spondylolisthesis were analyzed to establish the normal range of sagittal canal diameters at the various lumbar levels. Midline sagittal MR images of the lumbar spine were reviewed in 53 patients in whom either isthmic (n = 35) or degenerative (n = 18) spondylolisthesis was confirmed with conventional radiography and/or CT. For each spinal level, the sagittal canal ratio, defined as the maximum anteroposterior diameter of the canal at that level divided by the diameter of the canal at L1, was calculated. From our analysis of the control subjects, a normal sagittal canal ratio was determined to be less than 1.25. A sagittal canal ratio of 1.25 or greater at the level of a spondylolisthesis was considered to represent an abnormally increased sagittal canal diameter (wide canal sign), indicating the presence of bilateral pars interarticularis defects. Using this sign alone, two neuroradiologists who had no knowledge of the true diagnosis classified the type of spondylolisthesis in a randomized subgroup of 34 age-matched adults (all more than 40 years old and with grade I isthmic or degenerative spondylolisthesis). RESULTS: In the 100 subjects without spondylolisthesis and in the 18 patients with degenerative spondylolisthesis, the sagittal canal ratio did not exceed 1.25 (mean values, 0.93-0.99) at any level of the lumbar spine. Conversely, the sagittal canal ratio at the level of isthmic spondylolisthesis exceeded 1.25 (mean value, 1.56) in 34 of 35 patients. In patients more than 40 years old, in whom degenerative spondylolisthesis is prevalent and misdiagnosis of isthmic spondylolisthesis is potentially more likely, both neuroradiologists were 100% accurate in correctly assigning the type of spondylolisthesis when using the wide canal sign alone. CONCLUSION: The wide canal sign on midline sagittal MR images (corresponding to an sagittal canal ratio > or = 1.25) is a reliable predictor of the presence of defects of the pars interarticularis at the level of a spondylolisthesis. This sign could be useful for distinguishing degenerative from isthmic spondylolisthesis when degenerative sclerosis in the pars interarticularis mimics spondylolysis, when direct axial imaging of the pars interarticularis has not been done, or when imaging is technically inadequate.

Adult↗
PubMed1994

Injuries of the lower cervical spine associated with widening of the spinal canal.

In this paper, we present 17 cases with injury of the lower cervical spine associated with widening of the spinal canal. This was due to bilateral fracture of the pedicles of the neural arch, where the body of the injured vertebra is displaced anteriorly, while the posterior elements of the vertebra remain in situ. Eleven patients were male and six female, between 32 and 53 years of age. Ten of them were involved in a road traffic accident, while seven had a fall on the head. We distinguished two types of injury: Type I with anterior displacement of the injured vertebra (12 cases) and Type II with impaction of the injured vertebral body on the vertebra below (five cases). Thirteen patients were without neurological complications, two had root lesions, while two had tetraplegia from a point higher than the injury level. This was due to an extensive anterior displacement of the injured vertebra and of the whole spine above, associated with dislocation of the vertebra above the injury and damage to the spinal cord. The cases with anterior displacement of the injured vertebra are unstable and need spinal fusion after prior reduction, while the rest can be treated non-operatively with head traction followed by bracing until stable intervertebral union is achieved.

Accidental Falls↗
PubMedDate not supplied

[Complex indications in surgery of the lumbar spinal canal].

Opinions on the treatment of disc herniation are very controversial and the results reported vary, very much indeed. Most often, one decided--and still decides--to excise the disc herniation in conjunction with hemilaminotomy or flavectomy; this method having been carried out from 1974 to 1983 on 598 patients, at the department of Orthopaedic Surgery, Balgrist, of the University of Zurich. A follow-up of over 400 patients has proved to be very informative: whereas very good or good clinical results can be reported in 73.6% of such cases with disc herniation, alone, these not having undergone operation before, similar results were only found in 27.2% of those who had also been suffering from additional causes of lumbalgia like a relatively narrow spinal canal, spondylolisthesis, spondylolysis or nearthrosis for instance. This finding is of paramount importance when attempting to improve the overall results. It is very necessary to separate the complex cases from the "simple" disc herniation ones. At the same time, those patients suffering from lumbalgia due not only to a herniated disc but also to other additional causes arising from alterations to the lumbar spinal canal must be judged and treated differentially. The present follow-up permits conclusions and considerations correspondingly.

Adolescent↗
PubMed1982

[Changes of posterior osseous elements in narrowing of antero-posterior diameters of the lumbar spinal canal].

Narrowing of the antero-posterior diameters of the foramen and its influence to the posterior osseous elements were studied on 585 dry vertebral bones of 117 human lumber specimens. 1. Narrowing of the antero-posterior diameter of the foramen progresses even after reaching adult age and continues thereafter. Close correlations were found between the antero-posterior diameters and the transverse diameters and between the antero-posterior diameters and the area. 2. Narrowing of the antero-posterior diameters of the foramen was due to hypertrophy of the inside of the L3 to L5 lamina, but it is also due to shortening of the pedicle or compression of the posterior elements of L1 and L2 level. 3. Together with narrowing of the antero-posterior diameters of the foramen due to developmental stenosis and due to advanced age, the articular facets move on toward the sagittal plane keeping 90 degree angle between the laminae, and medial edges of the superior articular facets approach to the mid-line and add the depth of the lateral recesses, but the antero-posterior diameters of the lateral recesses do not correlate with narrowing of the antero-posterior diameters of the foramen. 4. Changes of the posterior osseous elements related to the narrowing of the antero-posterior diameters of the foramen are significant at the lower lumbar vertebrae of the male. It is therefore concluded that developmental inclination, muscular activity and advanced age were factors influencing the spinal canal stenosis.

Adult↗
PubMed2000

Reference values for radiological evaluation of cervical vertebral body shape and spinal canal.

BACKGROUND: Defining normal values is essential for reliable evaluation of growth disturbances. Previous studies of the cervical spine have mainly focused on the sagittal canal diameter and interpedicular distances. Values for vertebral body height and depth have been published only in adult men and cadavers. OBJECTIVES: To define normal values for vertebral body height (H)/vertebral body depth (D) ratio (H/D ratio) and sagittal canal diameter (S)/ vertebral body depth ratio (S/D ratio) in C2-7. MATERIALS AND METHODS: Lateral cervical spine radiographs were available from 441 children and 192 adults. Subjects' ages varied from newborn to 39 years. Vertebral body height and depth and sagittal canal diameter were measured and ratios were calculated. This was a cross-sectional and retrospective study. RESULTS: Vertebral bodies grow relatively more in height than in depth, most actively at puberty. At all levels, the H/D ratio remains below 1, indicating that vertebral body depth is greater than height. The SD ratio is quite stable until 7-8 years of age and then it starts to decline slowly. CONCLUSIONS: When estimating platyspondyly, the age of the patient must be taken into consideration because vertebral body height is lower in children. Growth of the spinal canal declines after 7-8 years of age.

Adolescent↗