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[Osteoconduction in porous hydroxyapatite ceramics grafted into the defect of the lamina in experimental expansive open-door laminoplasty in the spinal canal].

We have investigated the osteoconduction in porous hydroxyapatite ceramics grafted into the defect of the lamina of dogs in expansive open-door laminoplasty. Porous Hydroxyapatite block (HAB) was sintered at 900 degrees C with size of 4 x 7 x 19 mm, a mean pore diameter of 90 microns and a void volume of 70%. The operation was performed in 29 dogs. The animals were sacrificed at three or at six months after the operation (the three-month group and the six-month group). After the grafted HABs with adjacent vertebrae were removed, the stability of the grafted HABs was manually evaluated. The HAB was firmly fixed to the laminae in 14 of 20 cases. It seemed that the stability of the HAB was poor in those cases in which the HAB had not been tightly sutured. To investigate osteoconduction, serial sections of the laminar bones including the HAB were prepared without decalcification and were examined histologically. New bone formation in the pores of the HAB was found in all cases. However, the osteoconduction rate was higher in the six-month group than in the three-month group (p < 0.01). And the osteoconduction rate was higher in those cases in which the HAB was firmly fixed to the laminae than in those with a loosely fixed HAB. Bone ingrowth in the HAB was frequently observed in the zone adjacent to the bone, more so than in other zones. Osteoconduction appeared to occur at the contact surface and to extend towards the center of the HAB.

Animals↗

Primary intradural pontocerebellar chordoma metastasizing in the subarachnoid spinal canal.

Chordomas that are entirely extraosseous and intradural are rare. Additionally subarachnoid spinal implantation from such a cranial, intradural chordoma has never been reported before. The authors present a case of a widespread primary intradural chordoma in the basal cisterns of a 48-year-old woman which shows seeding of neoplastic cells to the spinal leptomeninges. It is concluded that also in cases of intradural and intracranial chordomas a tumor staging should include the search for spinal subarachnoid metastases.

Biopsy↗

Somatosensory and motor evoked potentials in patients with tumours in the spinal canal.

Motor and sensory evoked potentials were recorded in 27 patients with expanding spinal tumour. The patients were divided into 2 groups: I. tumours at the level of the spinal cord and II. at the level of the cauda equina. On the basis of the localization of the tumour, midline and lateral subgroups were distinguished. The latencies of motor evoked potentials were prolonged in most of the patients, even those without paresis, in both groups. The motor evoked potentials detected subclinical motor lesions in 7 patients. All patients but one manifested sensory deficits, which could not be shown with the somatosensory evoked potentials. Significantly more prolonged cortical motor latencies were found in most of the patients with a laterally located tumour on the tumour side than contralaterally, whereas in somatosensory evoked potentials this difference was not apparent. On the basis of these observations, we concluded that motor evoked potentials, 1. could more reliably detect the neural deficit than somatosensory evoked potentials; 2. could show the side where the tumour was located; 3. proved useful in the detection of subclinical motor lesions. The general conclusion may be drawn that this electrophysiological method can provide useful information for the surgeon.

Adult↗

MR assessment of the normal position of the spinal cord in the spinal canal.

PURPOSE: To investigate intradural geometry, which strongly influences the effects of epidural spinal cord stimulation. METHODS: Axial MR images with turbo spin-echo were made of 26 healthy subjects at C-4 through C-6, T-5 and T-6, and T-11 and T-12, at T-11 and T-12 both in the supine and the prone position. Measurements were made of the dorsomedial and the ventromedial cerebrospinal fluid layer and the anteroposterior and transverse sizes of both the spinal cord and the dural sac. The samples of all variables were analyzed statistically. The distance between spinal and vertebral midline was also determined. RESULTS: The dorsal cerebrospinal fluid layer was 1.5 to 4.0 mm at C-4 through C-6 and 4.0 to 8.5 mm at T-5 and T-6. At T-11 it was 2.0 to 6.0 mm in the supine position and was increased by approximately 2.2 mm in the prone position. At T-12 these values were 1.5 to 4.5 mm and approximately 3.4 mm, respectively. Differences between the spinal and vertebral midline up to 1.5 to 2.0 mm occurred in approximately 40% of the images. CONCLUSIONS: Because there are variations of the dorsal cerebrospinal fluid layer among subjects by more than a factor of 2, and significant variations of the mediolateral position of the spinal cord, information on these parameters in patients will be essential for the optimal application of epidural spinal cord stimulation.

Adult↗

Hemangiopericytomas of the spinal canal. Report of four cases and review of literature.

The Authors report four cases of spinal hemangiopericytomas. The diagnosis has been ascertained by electron microscopy. Despite the malignant nature, the association of surgery and radiotherapy is interesting in that it prolongs the survival rate. Clinical, neuroradiological, microscopic and ultrastructural features of intraspinal hemangiopericytomas are evaluated in the light of the review of the relevant literature.

Adult↗

Dimensions of the spinal canal in individuals symptomatic and non-symptomatic for sciatica: a CT study.

Measurements obtained in 50 spinal CT studies of patients referred for suspected lumbo-sacral nerve root compression, were compared to those of a group of 30 individuals asymptomatic in this respect, who had been referred for abdominal pathology. Transverse ligamentous interfacet and transverse dural dimensions were significantly reduced in the sciatica group, with usually normal interpedicular and sagittal dimensions ruling out idiopathic developmental stenosis. The borderline value for ligamentous interfacet distance (ILD) at L4-5 appeared to be 11 mm.

Humans↗

Unusual appearance of an en plaque meningioma of the cervical spinal canal. A case report and literature review.

STUDY DESIGN: A case report of a patient with cervical spinal cord and nerve root compression caused by a meningioma en plaque together with calcification of the posterior longitudinal ligament is presented,with a review of the literature. OBJECTIVE: To present the diagnosis of a calcified dural meningioma en plaque, with extradural extension into the ligamentum flavum, in a woman with cervical myelopathy and neuropathy. SUMMARY OF BACKGROUND DATA: This case demonstrates that the cervical spine can be involved in dural meningioma en plaque with calcifications, in a manner mimicking ossification of the ligamentum flavum, which has never been previously reported. METHODS: A patient presenting with cervical cord and nerve root compression caused by ossification of the posterior longitudinal ligament and a concurrent calcified dural meningioma en plaque was treated surgically and has made a gradual recovery. Imaging studies,surgical findings, and histopathologic evaluation were analyzed to support the diagnosis. RESULTS: At surgery, ossification of the posterior longitudinal ligament was noted, along with a calcified lesion involving the posterior cervical dura and the adjacent ligamentum flavum. A calcified meningioma was diagnosed by histopathologic examination of the dural-based lesion. CONCLUSION: Although previously not described, the diagnosis of calcified dural meningioma en plaque should be considered in all patients presenting with spinal cord and/or nerve root compression,even at cervical levels. Although ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum are more common etiologies of partially circumferential spinal calcification, dural-based meningiomas with extension into the surrounding ligaments demand early recognition because they can be associated with a poorer prognosis.

Cervical Vertebrae↗