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Embolization of a dural arteriovenous fistula of the ventral cervical spinal canal in a nine-year-old boy.

A 9-year-old patient presented with an acute left hemiparesis secondary to an intradural hemorrhage of the cervical spinal cord. Angiography revealed a dural arteriovenous (AV) fistula with multiple venous aneurysms fed by a radicular branch of the right vertebral artery. This AV fistula did not contribute blood flow to the cervical segment of the spinal cord, which was tested by an intra-arterial injection of methohexital. Interruption of the fistula was possible by transluminal embolization with polyvinyl alcohol and silk. At a 6-month follow-up, the patient was neurologically intact, and angiography demonstrated no AV fistula. This case illustrates an unusual presentation of a dural AV fistula. Dural AV fistulas are rare in the cervical region and extremely unusual in patients less than 20 years of age. The lesion proved to be amenable to transluminal embolization alone, without the need for surgery, with a dramatic resolution of the neurological deficit.

Acute Disease↗

[Proposition of an anatomic and functional reserve into the spinal canal, as an interference factor on the mechanical degenerative low back pain and sciatica physiopathology].

OBJECTIVE: To test the hypothesis of an anatomic and functional reserve in the spinal canal that explains the radiological changes in lumbar spine of asymptomatic individuals, the differences in modalities of clinical presentation and the discrepancies in the prevalence of mechanical and degenerative low back pain and sciaticas. CASES AND METHODS: Two groups of 27 persons were submitted to computed axial tomography. In one group, the patients presented low back pain and/or sciaticas. The other formed by matched controls, showed no signs or symptoms. The bony canal area, dural sac area, interfacets distance and lateral recesses depth were quantitative assessed. RESULTS: The asymptomatics ones had larger bony canals than the acute and chronic patients, due to statistical significant differences. The ranges responsible for these differences and whose averages had higher figures in the asymptomatics ones in relation to the chronic patients, were the bony canal areas at L3-L4, L4-L5, the dural sac area and lateral recesses depth at L4-L5; in relation to acute ones: the bony canal areas at L3-L4, L4-L5, L5-S1, dural sac area at L4-L5, L5-S1, and sagittal diameter L5-S1 and lateral recesses depth at L4-L5. CONCLUSIONS: The radiological changes in asymptomatic ones, the lack of symptoms in the control group, the presence of chronic and acute features and the discrepancies in the prevalence of low back pain were attributed to the existence of an anatomic and functional reserve. This reserve would be determined by the presence of a "safety factor" which would have differential distribution in asymptomatics, acute and chronic. It would be the element able to influence the presence or absence of low back pain in persons with radiological changes.

Analysis of Variance↗

Stenosis of the lumbar spinal canal in vertebral ankylosing hyperostosis.

Certain morphologic features frequently observed in radiography or computed tomography (CT) scan in patients with hyperostosis led us to study the association between a narrowed spinal canal and vertebral hyperostosis. Twenty-eight items were selected and studied by three different investigators (two rheumatologists and one radiologist) in radiographs and CT scans of 100 patients with acquired stenosis of the lumbar canal, with or without hyperostosis (46 and 54 cases, respectively). The most distinctive points that we suggest can be used as diagnostic criteria of the hyperostotic narrowed lumbar canal are anterior or posterior lateral marginal somatic osseous proliferations, proliferations of the nonarticular aspects of the posterior apophyses, and ossifications of the posterior articular capsule and of the ligaments (yellow ligament, posterior longitudinal ligament, and the supraspinal ligament). Four of these six criteria should be present to establish the diagnosis of hyperostotic lumbar stenosis. The appearance of lumbar hyperostosis on X-ray or CT scans differs from that of simple degenerative changes due to arthrosis, and the hyperostosis can be held responsible for dural compression.

Aged↗

Percutaneous access to the anterior spinal canal through a cervical disk.

We describe a CT-guided percutaneous technique for aspiration of an anterior intraspinal fluid collection through a cervical disk. The approach is identical to that of cervical diskography or percutaneous cervical diskectomy, with intentional placement of the needle tip in the spinal canal. This procedure had no adverse effects and avoided an open operation to exclude spinal cord compression.

Adult↗

Thoracolumbar burst fractures: correlation between post-traumatic spinal canal stenosis and initial neurological deficit.

Forty five patients (27 males and 18 females) aged 18 to 62 years, with thoracolumbar burst fracture treated between 1980 to 1994 were studied retrospectively. The purpose of the study was the identification of the existing correlation between the posttraumatic spinal canal stenosis and the initial neurological deficit. The presence of Dall and Stauffer type II fracture statistically constitutes an important factor, with negative involvement, in the diagnosis of the initial neurological status. In thoracolumbar spine, there is an inversely proportional relation with statistical importance between the level of injury and the post-traumatic spinal stenosis-as the burst fracture is sited higher, smaller canal encroachments by fragments will produce the same neurological deficit.

Adolescent↗