摘要:

Study Design.The outcome of two patients with Larsen’s syndrome after spinal surgery was evaluated after follow-up for 9 and 16 years.Objective.To report on a new phenomenon of anteroposterior dissociation of the vertebrae in Larsen’s syndrome. To demonstrate that it can be visualized before surgery with imaging and also seen intraoperatively. To show that the neurologic recovery after surgery is sustained and to review the technical reasons for the difficulties in achieving a surgical fusion. The critical role of CT scanning will be illustrated.Summary of Background Data.The results of preoperative and postoperative radiologic investigations and intraoperative findings are presented to support this new phenomenon.Methods.Two patients underwent multiple spinal surgeries because of a deteriorating myelopathic clinical status. Intraoperatively, anteroposterior dissociation was documented in both patients. There was great difficulty in obtaining a surgical fusion, and an unusually long circumferential fusion was eventually necessary to obtain stability. Prolonged halo-vest immobilization was essential.Results.Neurologic recovery was sustained over time, and the spinal deformity did not deteriorate.Conclusion.Awareness of this phenomenon is essential to the management of spinal deformities in Larsen’s syndrome when presenting with myelopathy. Special features in the radiologic workup should be sought after so as to plan staged surgical procedures. Conventional principles of planning of fusion levels are inadequate. Early treatment is advocated, as the neurologic compromise is reversible.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.Marginal resection of a paraspinal tumor in the thoracic vertebra was performed.Objective.To document a very rare pathology for a paraspinal tumor.Summary of Background Data.Primary leiomyosarcoma of the spine or paravertebral space is extremely rare. A case of a patient who was operated on for a mass in the spinal canal and whose pathology was reported to be leiomyosarcoma is presented.Methods.Marginal resection of the paravertebral mass was performed.Results.The pathology of the tumor was reported as leiomyosarcoma.Conclusion.Leiomyosarcomas may develop at any site where smooth muscle cells are present. However, primary leiomyosarcoma of the spine or paravertebral space is extremely rare. Leiomyosarcoma, although rare, should be kept in mind as one of the possible diagnoses when a patient with a paraspinal tumor is presented.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.This report describes a case of successful surgical excision of an intrathoracic paraspinal desmoid tumor with an intraspinous extension causing scoliosis and paralysis in a 12-year-old girl.Objectives.The purpose of this report is to illustrate the potential spectrum of disease of a desmoid tumor and to make physicians aware of the rare possibility of an intraspinal extension of a paraspinal desmoid tumor.Summary of Background Data.Surgical excision of desmoid tumors in the pediatric population is the standard of care for initial treatment. There have been no clinical reports in the spine literature of a desmoid tumor causing scoliosis or of a desmoid tumor with an intraspinous extension causing paralysis.Methods.The tumor was decompressed from a posterior approach followed by an anterior resection and an anterior spinal fusion. Two weeks later a posterior spinal fusion was performed to correct the spinal deformity. The patient also received radiation therapy after surgery for 5 weeks.Results.The patient tolerated the procedure well, has been free of recurrence for 9 years, and is currently doing well.Conclusion.This case report should help expand the understanding of the spectrum of this uncommon tumor.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.Retrospective study of seven cases of ossification of ligamentum flavum from two urban hospitals in a Chinese population.Objectives.To inspect the epidemiology, clinical presentation, pathology, and treatment outcome in these Chinese patients with ossification of ligamentum flavum.Summary of Background Data.Ossification of ligamentum flavum involving the lower thoracic region is relatively common in the Japanese population. It is usually presented with myelopathy of progressive nature.Materials and Methods.Five patients were male and two were female. The mean age was 52 years (range 41–73 years). Diagnosis was made by CT scan, MRI, and subsequent histology. Six patients have been treated by laminectomy and one by laminoplasty. The average follow-up duration is 34 months (range 26–44 months). The outcome is evaluated by Japanese Orthopaedics Association (JOA) score.Results.The average time of presentation from the onset of symptoms was 9 months (range 3–12 months). Most of the patients presented with lower limb numbness and gait disturbance. One case was presented after a minor trauma. Mean JOA score was 4.8 (range 2–7, of 11). The lower thoracic level was the most frequently involved region. One case was associated with ossification of the posterior longitudinal ligament. Two patients had transient postoperative neurologic deterioration, which improved subsequently. Mean percentage of recovery after surgery in terms of JOA score is 65% (25–100%), with a mean final JOA score of 7.8.Conclusion.Ossification of ligamentum flavum is an uncommon cause of myelopathy in the Chinese population. It can present acutely after minor trauma. Posterior decompression, especially withen blocdissection of laminae, gives satisfactory results.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case of an osteoid osteoma at the lower thoracic spine with scoliosis is reported.Objectives.To suggest that myolysis of the erector spinae muscles reflected by signal abnormalities on magnetic resonance images causes back pain, protective muscle contraction, and scoliosis.Summary of Background Data.Osteoid osteomas of the spine are frequently accompanied by scoliosis. The proposed mechanism of the scoliosis has been explained as a postural adaptation of the spine through predominant muscle spasm on the concave side.Methods.The history of the patient and radiologic, magnetic resonance imaging, and histologic findings of the peritumoral area were reviewed.Results.Magnetic resonance images showed signal abnormalities on muscles surrounding the tumor, and use of gadopentetate dimeglumine resulted in an enhancement. The microscopic examination of the erector spinae muscles that demonstrated high intensities on T2-weighted images showed derangement or destruction of the muscle fibers and replacement of the muscle fibers with fat tissue and infiltrating inflammatory cells.Conclusion.These findings were interpreted as those of myolysis. The suggested mechanism of the induction of scoliosis by the present osteoid osteoma is that the unaffected iliocostalis and quadratus lumborum muscles on the tumor side predominantly contracted over those on the opposite side to decrease the tension of the erector spinae muscles involved in myolysis, thereby producing a functional scoliosis.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This review article discusses new magnetic resonance techniques for imaging collagen containing structures such as intervertebral discs, tendons, and ligaments. The semisolid collagen in tendons and ligaments is not normally demonstrable with magnetic resonance imaging but may be visualized with magic angle imaging and other techniques. This allows these structures to be studied with methods used for other tissues and organs. The ordered nature of collagen provides a directional signature for the tissues that may be of diagnostic value. Solute transport in these avascular or partially avascular structures can be observed with gadolinium chelates. The time scale of this process is much slower than for other tissues of the body. Solid state imaging techniques applied in applied in material sciences may provide other new approaches to diagnosis of disease in these structures.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A prospective randomized clinical study with a 5-year follow-up.Objectives.To analyze the long-term effect of supplementary transpedicular screw fixation on reoperation rate and functional outcome.Summary of Background Data.Within the past few years the benefit of supplemental pedicle screw fixation has been questioned as a standard procedure in lumbar spinal fusion surgery. The long-term effect of supplemental pedicle screw fixation is still unknown.Methods.From 1992 through 1994 a total of 129 patients with severe chronic low back pain were randomly selected for either supplemental pedicle screw fixation (instrumented) or no pedicle screw instrumentation (noninstrumented) posterolateral spinal fusion. The Dallas Pain Questionnaire, Low Back Pain Rating Scale, and a questionnaire concerning work status assessed the outcome.Results.A 5-year follow-up of 93% showed that the instrumented group had a 25% reoperation rate (removal of instrumentation with and without second fusion) compared with a reoperation rate of 14% in the noninstrumented group (fusion and decompression) (P< 0.03). A total of 51% were capable of working after 5 years compared with 40% before surgery. There was no difference in work capacity between the two groups at any point of observation. Overall, there was no significant difference between the instrumented and noninstrumented groups in regard to functional outcome as measured by both the Dallas Pain Questionnaire and Low Back Pain Rating Scale. When analyzing diagnostic subgroups at the 5-year follow-up, patients with isthmic spondylolisthesis had a significantly better outcome by use of a posterolateral fusion without supplemental instrumentation compared with an instrumented fusion (P< 0.03). However, patients with primary degenerative instability improved significantly more when instrumentation supported the posterolateral spinal fusions (P< 0.02). To the question “was it worth it?” 67% answered “yes” in the instrumented group whereas 70% did so in the noninstrumented groups (not significant).Conclusion.The long-term functional outcome of posterolateral spinal fusion improved significantly for boththose with and without pedicle screw instrumentation, with a global 70% satisfaction reported by the patients. Patients with isthmic spondylolisthesis Grades 1 and 2 with noninstrumented fusion had superior long-term outcomes after posterolateral spinal fusion in comparison with an instrumented fusion. In contrast, patients diagnosed as having primary degenerative instability improved significantly when the posterolateral fusion was supported by instrumentation. In actuality, pedicle screw instrumentation increased reoperation rate compared with noninstrumented posterolateral fusion.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID