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A 61-year-old male with right facial pain and hearing loss was found to have a cerebellopontine angle epidermoid tumor that extended downward through the foramen magnum into the upper cervical spinal canal. The tumor was removed except for a small fragment of its capsule adherent to the brainstem. Only three such tumors with caudal extension have been reported.
A total of 197 men and women with history of previous back pain were radiographed and clinically examined. Measurements related to the shape and size of the spinal canal were subsequently made from the lumbar radiographs. Interarticular distance and the ratio between interarticular and interpedicular distances were significantly less in women with restriction of lumbar extension, sidebending, and rotation: not in men. Anteroposterior (AP) foraminal distances and pedicular lengths were less in men with restricted extension and sidebending, although not in women. Midsagittal diameters were not significantly less in those with restricted mobility. The radiographic differences between men and women with restricted back mobility arise partly from the sexual differences in interarticular and AP foraminal distance, the former being less in women, the latter in men. This suggests a different pathogenetic factor in the two sexes.
This study aims to demonstrate predictive factors for post traumatic syringomyelia (PTS), and in particular to correlate the role of insufficiency of reduction of a spinal fracture with the occurrence of syringomyelia. One hundred and twenty-eight spinal cord injured patients (SCI) were studied during the years 1992 and 1993. Among them, 75 underwent a complete and reliable evaluation including: review of the initial vertebral lesion, and of the surgery report, and a radiological study of the lesion site with standard X-rays, a CT scan, and an MRI. The CT Scan included slices in sagittal reconstructions and in the axial plane at the site of injury with the calculation of a percentage of canal stenosis in the two planes of the space. An MRI was carried out with T1 and T2 weighted images, including sagittal entire cord images in addition to sagittal and axial slices centred on the site of injury. A syrinx was diagnosed in 28% of the patients. The occurrence of a syrinx is significantly correlated with spinal canal stenosis in the sagittal plane (delta D) with a P < 0.001 and in the axial plane (delta S) (P < 0.05). This present study demonstrates the major role of the insufficiency of reduction of the vertebral lesion in the genesis of a syrinx. The quality of the initial treatment of the vertebral injury is the first step in the prevention of a syrinx. The treatment of a syrinx, besides techniques of drainage, must also take into account the spinal realignment.
A case of melanocytic schwannoma, a rare form of schwannian neoplasm, in the thoracolumbar spinal canal of a 52-year-old man is presented. Histopathologically, the tumor was composed of irregularly interlacing spindle-shaped cells showing cystic degeneration, with occasional pigmented tumor cells. The tumor cells showed a low degree of nuclear pleomorphism without any mitotic figures. These histological features were considered to be consistent with a benign schwannian tumor showing pigmentation. Most of the pigments were considered to be melanin histochemically and immunohistochemically. According to the pathological features of the present tumor and those described previously in the literature, the neoplastic Schwann cells were assumed to have melanogenetic capacity, and the concept of the common neural crest origin of Schwann cells and melanocytes appeared to be demonstrated in the present tumor.
Diastematomyelia is a congenital anomaly wherein the distal spinal canal is bisected by a longitudinally oriented septum made up of fibrous tissue, cartilage, or bone. The main lesion is expressed by characteristic gait disturbances and dysfunction of the anal and vesical sphincters resulting from damage to the cord or cauda equina. Symptoms almost invariably begin during childhood. By the time symptoms appear, the damage is largely irreversible. In rare instances, the neuropathic expression of diastematomyelia is delayed until adult life. Only a dozen such cases have been reported. Described herein is the case of a patient in whom the typical symptoms appeared at 28 years of age. Decompression laminectomy and resection of the septum relieved the symptoms completely and permanently. The pathogenesis of nerve damage in diastematomyelia is thought to be different in patients with adult-onset disease than in children. This could explain why surgical treatment has a better prognosis in adults.
STUDY DESIGN: This is a retrospective study of a consecutive series of patients undergoing spinal decompression or disc enucleation with preservation of the ligamentum flavum. MacNab criteria and Prolo scoring was used to assess them pre- and after surgery. OBJECTIVES: The aim of the study was to assess the incidence of perioperative complications and long-term clinical outcome of the procedure. SUMMARY OF THE BACKGROUND DATA: One previous study has shown this technique to be effective in reducing the rate of perioperative complications and recurrences in patients undergoing microscopic disc enucleation. However, this study does not comment on the long-term clinical results or the use of the technique in a wider range of spinal procedures. METHODS: Between 1991 and 1999, we operated on 214 patients for peripheral lumbar radiculopathy. MacNab criteria and Prolo scoring was used for their pre- and postoperative assessment. Postoperative assessment was with the help of a postal questionnaire. In addition, clinical notes were studied to look for any further procedures or operative complications. RESULTS: All 214 patients returned the postoperative questionnaires. There were 104 males and 110 females. The mean follow-up was 5.97 years. Thirty-eight patients had an associated fusion or Graf ligament stabilization. Two hundred ninety-six levels were operated in all. There were four instances of dural tear and one of nerve root injury. Five patients underwent revision. There was a statistically significant improvement in the MacNab criteria (P < 0.001) and Prolo score (P < 0.001) after surgery. CONCLUSIONS: We recommend a ligamentum flavum preserving approach because it decreases the rate of perioperative complications while giving comparable long-term results.
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The authors report a patient in whom rebleeding after operation for a left temporal arteriovenous malformation resulted in the dislocation of multiple hemostatic clips. Several clips, including a Yasargil aneurysm clip, were detected incidentally in the lumbar spinal canal. No clinical signs or symptoms were noted. Retrospectively, passage of the aneurysm clip through the aqueduct could be detected on computerized tomography scans performed to evaluate a series of epileptic seizures.
B-scan ultrasonic measurements of lumbar spinal canal diameter were examined as predictors of industrial back pain complaints and extended work loss. Baseline data were collected on 3,020 Washington State aircraft manufacturing workers, and over a mean 3.7-year follow-up period 352 subjects reported industrial back pain complaints. Mean canal measurements of subjects with industrial back pain complaints were smaller at all spinal levels than in subjects without complaints. The mean differences between the groups, however, were extremely small (0.07 mm to 0.51 mm), and not all levels were statistically significant. The relative risk for an L5-S1 measurement 2 standard deviations below the mean was 1.4, yet the measurement explained less than 1% of the uncertainty in predicting complaints. No association was found between canal measurements and claims with extended work loss of greater than one month. The imprecision of the measurements and poor predictive ability indicate that B-scan ultrasonography, as used in this study, is of dubious screening value.
A 13-year-old girl suffered a single gunshot wound to the abdomen that resulted in multiple small bowel perforations and an incomplete neurologic injury involving her lower extremities. Physical exam failed to locate an exit wound. Radiographs revealed the bullet within the spinal canal at the thoracolumbar junction. It was subsequently removed on a non-urgent basis.
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