Korean Journal of Spine最新文献

Guillain-Barré syndrome (GBS) is an inflammatory demyelinating polyneuropathy characterized by areflexic paralysis. Most cases of GBS are preceded by an infection, however, posttraumatic GBS has also recently been reported. We report a case of posttraumatic GBS immediately following a traffic accident. We think this case is of clinical significance for practitioners because of the rare cause of a sudden flaccid paralysis following trauma.

Objective: The space available for the spinal cord (SAC) is a measure of spinal cord functional reserve and may vary in different societies. The objective of this study is to measure normal SAC at each subaxial cervical disc level of asymptomatic adult Nigerians and to compare obtained values with published studies worldwide.

Methods: This is a prospective, cross-sectional study using magnetic resonance imaging facility at Memfys Hospital Enugu, from 2012 to 2013. Disc level measurement of midsagittal spinal canal and cord of randomly selected 102 consenting asymptomatic adults, 21 to 50 years. Literature search of related studies worldwide was used to compare with the current study. Analysis was done using inferential and descriptive statistics.

Results: Average SAC values were 4.9±1.4 mm (C3/4), 4.5±1.2 mm (C4/5), 4.6±1.4 mm (C5/6), and 4.9±1.2 mm (C6/7). In 21-30 years group, SAC was 5.4±0.6 mm(C3/4), 4.9±0.6 mm(C4/5), 4.9±0.6 mm(C5/6), and 5.1±0.5 mm(C6/7). In 31-40 years group, SAC was 5.4±0.5 mm(C3/4), 4.6±0.5 mm (C4/5), 4.9±0.6 mm (C5/6), and 5.3±0.6 mm (C6/7); but among 41-50 years group, SAC was 3.8±0.6 mm (C3/4), 3.9±0.6 mm (C4/5), 3.6±0.6 mm (C5/6), and 4.3±0.6 mm (C6/7). In females SAC was 4.9±1.3 mm(C3/4), 4.5±1.2 mm(C4/5), 4.6±1.2 mm(C5/6), and 4.8±1.1 mm (C6/7). In males, SAC was 4.9±1.4 mm(C3/4), 4.6±1.2 mm(C4/5), 4.5±1.5 mm(C5/6), and 5.1±1.3 mm(C6/7). From analysis of variance, impact of age on SAC was 0.118 (p=0.001) while gender had 0.078 (p=0.223). SAC at each level has positive correlation of 0.6 to 0.7 with adjacent levels (p<0.0001). Comparing this result with studies worldwide, our population has lower SAC values than others.

Conclusion: C4/5 and C5/6 are narrowest subaxial cervical spine levels and probably explain preponderance of C4/5 and C5/6 cord injury. There may be higher incidence of congenital canal stenosis predisposing to worse outcome following cervical spine injury or degenerative diseases in this study population. This is different from European series but similar to Japanese.

Intraspinal synovial cysts are rare but they are being documented with increasing frequency due to improvements in radiological imaging. However, hemorrhage into synovial cysts is uncommon, and affected patients may present with acute onset radiculopathy. This type of hemorrhage is known to result from rupture of fragile neoangiogenic vessels in the cyst wall, due to a traumatic event or anticoagulant therapy. Here, the authors present a rare case of hemorrhagic lumbar synovial cyst caused by spinal instability after microscopic discectomy. To the best of the authors' knowledge, this is the first report of hemorrhagic lumbar synovial cyst caused by spinal instability following microscopic discectomy in the absence of a traumatic event or anticoagulant therapy. We discuss the pathophysiological mechanism of this uncommon entity and provide a review of the literature.

We report a case of a 45-year-old man with a complaint of both leg weakness and hypoesthesia. Radiological evaluation revealed an osteolytic lesion of the ninth thoracic vertebra. The patient underwent posterior corpectomy with total excision of the tumor, mesh cage insertion with posterior screw fixation and subsequent radiotherapy. Histology confirmed the diagnosis of Langerhans cell histiocytosis (LCH). This case report presents the diagnostic work-up, histopathological evaluation, and the treatment procedures of rare LCH in the thoracic spine.

Angiolipomas are composed of mature adipose tissue and blood vessels. Spinal angiolipomas are rare benign tumors with a good prognosis, and most symptoms are due to progressive compression of the spinal cord and root. The treatment of choice is total resection without any additional therapy. We report a case of an epidural angiolipoma on the lumbar spine in a 69-year-old man with weakness of the lower extremities. Lumbar magnetic resonance images revealed a well-enhanced epidural mass. He underwent laminectomy, and the tumor was completely removed. Pathologic examination confirmed the tumor was an angiolipoma. The patient's symptoms gradually improved postoperatively.

Objective: Serum C-reactive protein (CRP) concentrations and white blood cell (WBC) count are commonly used to identify postoperative wound infections. We investigated whether changes in serum CRP levels and WBC counts actually differed between patients undergoing revision spinal fusion surgery and those undergoing a primary fusion.

Methods: Patients who underwent posterolateral fusion (PLF) surgery at Pusan National University Yangsan Hospital between October 2013 and April 2015 were considered for this study. Sixty-seven patients with primary lumbar PLF (pPLF) and 21 with revision PLF (rPLF) were enrolled. A retrospective assessment of preoperative and postoperative CRP levels and WBC count was undertaken. Also, we gathered peak CRP day, and CRP normalization days. Comorbidity data were also obtained to evaluate any effects on the course of CRP and WBC count postoperatively.

Results: CRP levels peaked at 3 days after surgery. The maximum CRP values recorded for each group: 4.17 (standard deviation [SD], 4.18) mg/dL and 4.88 (SD, 3.03) mg/dL for pPLF and rPLF. This difference was not statistically significant (p=0.24). A rapid fall in CRP within 5-9 days was observed for both groups.

Conclusion: Out of our expectation, changes in CRP levels after spinal fusion surgery follow the same course regardless of whether it is a revision operation or not. Because of this result, both the primary PLF surgery and revision PLF surgery should be monitored using CRP in the similar way and the antibiotic administration should be determined.

Objective: Cervical pedicle screw (CPS) placement is very challenging due to high risk of neurovascular complications. We devised a new technique (medial funnel technique) to improve the accuracy and feasibility of CPS placement.

Methods: We reviewed 28 consecutive patients undergoing CPS instrumentation using the medial funnel technique. Their mean age was 51.4 years (range, 30-81 years). Preoperative diagnosis included degenerative disease (n=5), trauma (n=22), and infection (n=1). Screw perforations were graded with the following criteria: grade 0 having no perforation, grade 1 having <25%, grade 2 having 25%-50% and grade 3 having >50% of screw diameter. Grades 0 and 1 were considered as correct position. The degree of perforation was determined by 2 junior neurosurgeons and 1 senior neurosurgeon.

Results: A total of 88 CPSs were inserted. The rate of correct placement was 94.3%; grade 0, 54 screws; grade 1, 29 screws; grade 2, 4 screws; and grade 3, 1 screw. No neurovascular complications or failure of instrumentation occurred. In perforated screws (34 screws), lateral perforations were 4 and medial perforations were 30.

Conclusion: We performed CPS insertion using medial funnel technique and achieved 94.3% (83 of 88) of correct placement. And it can decrease lateral perforation.

Capillary hemangiomas are common benign vascular tumors on skin and soft tissues, but developing as an intradural and extramedullary (IDEM) tumor in spine is extremely rare. In this report, we present IDEM tumor compressing thoracic cord in T2-3 level with extensive arachnoiditis below the tumor level in a 60-year-old man. The lesion was removed and histological diagnosis was capillary hemangioma. Prompt diagnosis and resection are important to avoid neurological deterioration from acute hemorrhagic condition. Simultaneous arachnoiditis may be originated from old subarachnoid hemorrhage associated tumor before diagnosis, and we suggest it as a helpful diagnostic feature to suspect vascular tumors such as capillary hemangioma.

Gout is an inflammatory arthritis characterized by deposition of monosodium urate crystals in joints. Though gout frequently involves the big toe or other extremities, it rarely occurs in the spinal canal. A 35-year-old man presented with left L5 radiculopathy. He had leg pain for 8 months and received several epidural steroid injections. Magnetic resonance imaging revealed a 1.7×1.1-cm ovoid contrast-enhancing mass, causing pressure erosion of the left L5 pedicle. Microscopic laminotomy was performed at the left L5 lamina. White chalky materials, identified at the left lateral recess of the spinal canal, were removed in a piecemeal manner. The histopathologic diagnosis was tophaceous gout. Although the patient's radiating pain did not resolve postoperatively, it was dramatically relieved with uric acid-lowering medications. If a mass effect is suspected, surgical removal of gouty tophi might aid in symptom release and definite diagnosis. Medical treatment after rheumatology consultation is crucial.

Objective: Modic changes are signal intensity changes in adjacent vertebral bone marrow on magnetic resonance imaging. Few studies have investigated these changes with regard to the cervical spine. In this study, we investigated the associations between cervical degenerative disease and Modic changes.

Methods: We conducted a retrospective collection of radiological data in patients with neck pain at Pusan National University Yangsan Hospital from January 2010 to December 2014. A total of 169 patients were included in this study. Disc herniation grade, disc space height and global cervical lordosis (C2-C7 Cobb angle) were measured and analyzed. If Modic changes were present, we recorded the Modic change type based on the literature, vertebral level, age, sex, and surgical requirement.

Results: Sixty-six patients exhibited Modic changes in the cervical spine. Out of these 66 patients, Modic change type II (56 patients, 84.8%) and C5-6 vertebral level (23 patients, 34.8%) were the most predominant categories. Patients with Modic change showed worse outcomes in regard to disc herniation grade, disc space height and global cervical lordosis than patients without (p<0.01). Among 169 patients, 18 patients had undergone anterior cervical discectomy with fusion (ACDF). Patients with Modic changes (10 of 66 patients, 15.1%) had a greater probability of undergoing ACDF than those without (8 of 103 patients, 7.8%; p<0.01).

Conclusion: Modic changes refer cervical degenerative changes, and incidence of ACDF is higher when the Modic changes are occurred.