Pub Date : 2023-10-24DOI: 10.21129/nerve.2023.00465
Jin Young Kim, Byeong Ho Oh, Kyung Soo Min, Mou Seop Lee, Jong Beom Lee
Objective Atlanto-axial fusion surgery for instability is a recognized method. However, the complex anatomical structures of the atlas and axis make freehand C1 screw placement technically challenging. This study investigated the accuracy and safety of C1 screw placement without fluoroscopic or other guidance. Methods A retrospective analysis of radiological data was performed on patients who underwent C1 instrumentation between April 2019 and January 2023, with all procedures performed by a spine surgeon with 4 years of experience. Computed tomography was used to evaluate cortical breaches during C1 screw placement. Breach severity was categorized based on the percentage of screw diameter beyond the cortical edge. Morphometric measurements of 30 healthy individuals and 22 patients who underwent surgery were obtained from preoperative CT scans of the bilateral pedicles at the C1 level. Coronal, axial, and sagittal CT reconstructions were examined to ascertain the distance from the screw entry point to the midpoint of the C1 posterior tubercle, diameter of the central canal of the atlas, screw convergence angle, height of the C1 posterior arch at the screw entry point, and width of the canal. Results The surgeon placed 43 C1 screws in 22 consecutive patients. Seven (16%) breaches were identified, all of which were medial C1 screws. The breaches were classified as grades I, III, and IV in 4 (57%), 2 (29%), and 1 (14%) cases, respectively. No clinical complications arose owing to the breaches. Conclusion The freehand technique for C1 screw placement without guidance yielded accurate and safe results. However, a preoperative morphometric assessment and careful familiarization with the unique anatomy are imperative for improving screw placement precision. Key words: Axis, cervical vertebrae; Bone screws; Cervical vertebrae; Spinal fusion
{"title":"Anatomical Evaluation of the Atlas and Analysis of Accuracy for Freehand C1 Screw Placement","authors":"Jin Young Kim, Byeong Ho Oh, Kyung Soo Min, Mou Seop Lee, Jong Beom Lee","doi":"10.21129/nerve.2023.00465","DOIUrl":"https://doi.org/10.21129/nerve.2023.00465","url":null,"abstract":"Objective Atlanto-axial fusion surgery for instability is a recognized method. However, the complex anatomical structures of the atlas and axis make freehand C1 screw placement technically challenging. This study investigated the accuracy and safety of C1 screw placement without fluoroscopic or other guidance. Methods A retrospective analysis of radiological data was performed on patients who underwent C1 instrumentation between April 2019 and January 2023, with all procedures performed by a spine surgeon with 4 years of experience. Computed tomography was used to evaluate cortical breaches during C1 screw placement. Breach severity was categorized based on the percentage of screw diameter beyond the cortical edge. Morphometric measurements of 30 healthy individuals and 22 patients who underwent surgery were obtained from preoperative CT scans of the bilateral pedicles at the C1 level. Coronal, axial, and sagittal CT reconstructions were examined to ascertain the distance from the screw entry point to the midpoint of the C1 posterior tubercle, diameter of the central canal of the atlas, screw convergence angle, height of the C1 posterior arch at the screw entry point, and width of the canal. Results The surgeon placed 43 C1 screws in 22 consecutive patients. Seven (16%) breaches were identified, all of which were medial C1 screws. The breaches were classified as grades I, III, and IV in 4 (57%), 2 (29%), and 1 (14%) cases, respectively. No clinical complications arose owing to the breaches. Conclusion The freehand technique for C1 screw placement without guidance yielded accurate and safe results. However, a preoperative morphometric assessment and careful familiarization with the unique anatomy are imperative for improving screw placement precision. Key words: Axis, cervical vertebrae; Bone screws; Cervical vertebrae; Spinal fusion","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"55 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135266354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-24DOI: 10.21129/nerve.2023.00423
Seung Jun Jeong, Sung Jin Kim
Objective Cervical selective nerve root block (SNRB) is an effective procedure that has long been performed for patients with radiating pain or paresthesia. However, there are several delicate structures around the cervical nerve root, damage to which could lead to irreversible neurovascular injury. Therefore, cervical SNRB requires a high skill level and extensive experience to execute it safely. To overcome these disadvantages, we used biplane computed tomography (CT)-guided fluoroscopy and a needle guidance program to achieve symptom improvement in a safer and shorter procedure. This study aimed to investigate the new method and report on its excellent clinical effects. Methods A total of 57 patients who experienced radiating pain due to cervical spinal stenosis resulting from a herniated disc were enrolled. From September 2020 to September 2021 subjects underwent a biplane CT-guided fluoroscopic nerve block at an outpatient clinic. All procedures were performed by biplane CT-guided fluoroscopy. We analyzed treatment effects with a numerical rating scale (NRS) at 2 and 4 weeks after the procedure. Logistic regression was performed to reveal the significance of changes in NRS after the injection. Results Pain improved in 56 of 57 patients (98%) after 2 and 4 weeks of follow-up compared to pre-injection pain. At the 2-week follow-up, the mean reduction based on NRS scores was 3.226 (2.782-3.674, 0; 95% confidence interval [CI], p < 0.001) indicating a 48% decrease in pain scores compared with the initial NRS. The mean reduction in NRS 4 weeks after the procedure was 3.544 (3.090-3.998, 0; 95% CI, p < 0.001) indicating a 52% reduction compared with the initial NRS. The average duration of the procedure was 4 minutes. Conclusion We demonstrate a clinically effective, safe, and accurate method using a biplane CT-guided fluoroscopy and needle guide program. This new method can be an easy and relatively uncomplicated alternative to treatment for patients with cervical radiculopathy and provides safe and accurate targeting, making it easy for inexperienced surgeons. Key words: Fluoroscopy; Nerve block; Radiculopathy
目的颈椎选择性神经根阻滞(SNRB)是治疗放射性疼痛或感觉异常的有效方法。然而，颈神经根周围有几个脆弱的结构，其损伤可能导致不可逆的神经血管损伤。因此，颈椎SNRB需要高水平的技术和丰富的经验才能安全实施。为了克服这些缺点，我们使用双翼计算机断层扫描(CT)引导下的透视检查和针引导程序，以更安全和更短的程序实现症状改善。本研究旨在探讨新方法，并报道其良好的临床效果。方法选取57例因椎间盘突出导致的颈椎管狭窄引起放射性疼痛的患者。从2020年9月到2021年9月，受试者在门诊接受了双翼ct引导下的透视神经阻滞。所有手术均在双翼ct引导下进行。我们在手术后2周和4周用数值评定量表(NRS)分析治疗效果。Logistic回归分析注射后NRS变化的意义。结果与注射前疼痛相比，57例患者中56例(98%)在随访2周和4周后疼痛得到改善。在2周的随访中，基于NRS评分的平均下降为3.226 (2.782-3.674,0;95%可信区间[CI]， p < 0.001)表明与初始NRS相比，疼痛评分降低了48%。术后4周NRS平均降低3.544 (3.090-3.998,0;95% CI, p < 0.001)表明与初始NRS相比降低了52%。手术的平均时间为4分钟。结论我们展示了一种临床有效、安全、准确的方法，使用双翼ct引导的透视和针导程序。这种新方法对于颈椎神经根病患者来说是一种简单且相对简单的替代治疗方法，并且提供了安全准确的靶向治疗，使缺乏经验的外科医生更容易使用。关键词:透视;神经阻滞;神经根病
{"title":"A New, Effective, Safe, and Accurate Method of Cervical Selective Nerve Root Block","authors":"Seung Jun Jeong, Sung Jin Kim","doi":"10.21129/nerve.2023.00423","DOIUrl":"https://doi.org/10.21129/nerve.2023.00423","url":null,"abstract":"Objective Cervical selective nerve root block (SNRB) is an effective procedure that has long been performed for patients with radiating pain or paresthesia. However, there are several delicate structures around the cervical nerve root, damage to which could lead to irreversible neurovascular injury. Therefore, cervical SNRB requires a high skill level and extensive experience to execute it safely. To overcome these disadvantages, we used biplane computed tomography (CT)-guided fluoroscopy and a needle guidance program to achieve symptom improvement in a safer and shorter procedure. This study aimed to investigate the new method and report on its excellent clinical effects. Methods A total of 57 patients who experienced radiating pain due to cervical spinal stenosis resulting from a herniated disc were enrolled. From September 2020 to September 2021 subjects underwent a biplane CT-guided fluoroscopic nerve block at an outpatient clinic. All procedures were performed by biplane CT-guided fluoroscopy. We analyzed treatment effects with a numerical rating scale (NRS) at 2 and 4 weeks after the procedure. Logistic regression was performed to reveal the significance of changes in NRS after the injection. Results Pain improved in 56 of 57 patients (98%) after 2 and 4 weeks of follow-up compared to pre-injection pain. At the 2-week follow-up, the mean reduction based on NRS scores was 3.226 (2.782-3.674, 0; 95% confidence interval [CI], p < 0.001) indicating a 48% decrease in pain scores compared with the initial NRS. The mean reduction in NRS 4 weeks after the procedure was 3.544 (3.090-3.998, 0; 95% CI, p < 0.001) indicating a 52% reduction compared with the initial NRS. The average duration of the procedure was 4 minutes. Conclusion We demonstrate a clinically effective, safe, and accurate method using a biplane CT-guided fluoroscopy and needle guide program. This new method can be an easy and relatively uncomplicated alternative to treatment for patients with cervical radiculopathy and provides safe and accurate targeting, making it easy for inexperienced surgeons. Key words: Fluoroscopy; Nerve block; Radiculopathy","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135266208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-24DOI: 10.21129/nerve.2023.00472
Dong Wook Kim, Byeong Ho Oh, Kyung Soo Min, Mou Seop Lee, Jong Beom Lee
Objective Surgery is increasingly being performed in elderly patients owing to the aging society and the desire for an improved quality of life. We aimed to examine the perioperative complications of spinal surgery in such patients. Methods This study analyzed the surgical details and perioperative complications in 36 patients aged >85 years who underwent spinal surgery at a single tertiary medical center based on a review of a prospective database. Pre-existing medical illnesses were evaluated using the American Society of Anesthesiologists (ASA) physical status class, and age and surgical parameters were analyzed as factors potentially predictive of complications. Ambulatory function was rated on a 4-point Likert scale. Results During the study, 36 patients (mean age, 87 years) with a mean the ASA class of 2.31 ± 0.47 were enrolled. The mean number of levels treated was 2.06 ± 1.35, and 66% underwent minimally invasive surgery. The mean operative time was 144 ± 70.4 min. Ambulatory function improved significantly by 0.72 ± 0.97 points and visual analog scale scores by 1.88 ± 0.76 points. Twenty complications (19 of which were temporary, and one was permanent) occurred. Patient age, operation time, the ASA class, number of treated patients, and minimally invasive surgery were not significantly associated with complications. Conclusion Spine surgery in patients 85 and older can be accomplished safely if careful attention is paid to preoperative patient selection. Key words: Aged; Delirium; Neurosurgical procedures; Spine
{"title":"Complications Following Spinal Surgery in Patients Aged 85 Years and Older","authors":"Dong Wook Kim, Byeong Ho Oh, Kyung Soo Min, Mou Seop Lee, Jong Beom Lee","doi":"10.21129/nerve.2023.00472","DOIUrl":"https://doi.org/10.21129/nerve.2023.00472","url":null,"abstract":"Objective Surgery is increasingly being performed in elderly patients owing to the aging society and the desire for an improved quality of life. We aimed to examine the perioperative complications of spinal surgery in such patients. Methods This study analyzed the surgical details and perioperative complications in 36 patients aged >85 years who underwent spinal surgery at a single tertiary medical center based on a review of a prospective database. Pre-existing medical illnesses were evaluated using the American Society of Anesthesiologists (ASA) physical status class, and age and surgical parameters were analyzed as factors potentially predictive of complications. Ambulatory function was rated on a 4-point Likert scale. Results During the study, 36 patients (mean age, 87 years) with a mean the ASA class of 2.31 ± 0.47 were enrolled. The mean number of levels treated was 2.06 ± 1.35, and 66% underwent minimally invasive surgery. The mean operative time was 144 ± 70.4 min. Ambulatory function improved significantly by 0.72 ± 0.97 points and visual analog scale scores by 1.88 ± 0.76 points. Twenty complications (19 of which were temporary, and one was permanent) occurred. Patient age, operation time, the ASA class, number of treated patients, and minimally invasive surgery were not significantly associated with complications. Conclusion Spine surgery in patients 85 and older can be accomplished safely if careful attention is paid to preoperative patient selection. Key words: Aged; Delirium; Neurosurgical procedures; Spine","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"60 11-12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135266071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-24DOI: 10.21129/nerve.2023.00444
Jae Woong Kim, Jong-Hwan Hong, Moon-Soo Han, Jung-Kil Lee
Objective Thoracic myelopathy caused by the ossification of the ligamentum flavum (OLF) is commonly treated with surgical decompression. This study aimed to compare the clinical and radiological outcomes of surgical decompression without posterior screw fixation (decompressive laminectomy [DL] group) and with posterior screw fixation (laminectomy with screw fixation [LSF] group) for thoracic myelopathy due to OLF with disc degeneration. Methods A retrospective review of 35 patients (DL group, n = 19; LSF group, n = 16) was conducted. Clinical variables (Japanese Orthopaedic Association scores) and radiological variables (including sagittal vertical axis, pelvic tilt, thoracic kyphosis, sacral slope, lumbar lordosis (LL), segmental Cobbâs angle, dynamic Cobbâs angle, and dynamic thoracolumbar junction [dTLJ] at the operated level) were measured preoperatively and 1 year postoperatively. Results Both groups exhibited significant improvements in clinical characteristics postoperatively. LL significantly increased at 1 year postoperatively in both groups. Other sagittal alignment parameters did not change significantly. The dTLJ did not differ significantly between the groups preoperatively; however, the dTLJ of the DL group was larger than that of the LSF group at 1 year postoperatively. There was no significant difference between the groupsâ dynamic Cobbâs angles or risk of complications. Conclusion Decompression surgery for OLF resulted in clinical improvement regardless of whether posterior fixation was performed. Decompression without posterior fixation could allow thoracolumbar motion preservation and might be an effective approach for thoracic OLF with disc degeneration. Key words: Intervertebral disc degeneration; Laminectomy; Ligamentum flavum; Ossification; heterotopic; Pedicle screws; Range of motion
{"title":"Outcome of Decompressive Laminectomy with or without Posterior Screw Fixation for Thoracic Ossification of the Ligamentum Flavum with Disc Degeneration","authors":"Jae Woong Kim, Jong-Hwan Hong, Moon-Soo Han, Jung-Kil Lee","doi":"10.21129/nerve.2023.00444","DOIUrl":"https://doi.org/10.21129/nerve.2023.00444","url":null,"abstract":"Objective Thoracic myelopathy caused by the ossification of the ligamentum flavum (OLF) is commonly treated with surgical decompression. This study aimed to compare the clinical and radiological outcomes of surgical decompression without posterior screw fixation (decompressive laminectomy [DL] group) and with posterior screw fixation (laminectomy with screw fixation [LSF] group) for thoracic myelopathy due to OLF with disc degeneration. Methods A retrospective review of 35 patients (DL group, n = 19; LSF group, n = 16) was conducted. Clinical variables (Japanese Orthopaedic Association scores) and radiological variables (including sagittal vertical axis, pelvic tilt, thoracic kyphosis, sacral slope, lumbar lordosis (LL), segmental Cobbâs angle, dynamic Cobbâs angle, and dynamic thoracolumbar junction [dTLJ] at the operated level) were measured preoperatively and 1 year postoperatively. Results Both groups exhibited significant improvements in clinical characteristics postoperatively. LL significantly increased at 1 year postoperatively in both groups. Other sagittal alignment parameters did not change significantly. The dTLJ did not differ significantly between the groups preoperatively; however, the dTLJ of the DL group was larger than that of the LSF group at 1 year postoperatively. There was no significant difference between the groupsâ dynamic Cobbâs angles or risk of complications. Conclusion Decompression surgery for OLF resulted in clinical improvement regardless of whether posterior fixation was performed. Decompression without posterior fixation could allow thoracolumbar motion preservation and might be an effective approach for thoracic OLF with disc degeneration. Key words: Intervertebral disc degeneration; Laminectomy; Ligamentum flavum; Ossification; heterotopic; Pedicle screws; Range of motion","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"6 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135266075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-20DOI: 10.21129/nerve.2023.00360
Soo Hyun Lee, Min Sung Bock, Seung Hun Sheen, Inbo Han, Seil Sohn
Spinal angiolipoma (SAL) is a rare benign tumor, accounting for 0.14% to 1.2% of all spinal tumors and approximately 3% of epidural spinal tumors. SAL is composed of mature adipocytes and abnormal blood vessels. Its gradual growth can cause spinal cord and root compression. No additional treatment is required after total surgical resection, and its prognosis is good. We report the c case of an 81-year-old man who had thigh pain and numbness in both feet, along with gait disturbance. High signal intensity was observed on T2- and T1-weighted magnetic resonance imaging. Contrast enhancement showed a highly contrasting epidural mass with spinal cord compression, spreading to the left neural foramen. The tumor was totally removed by laminectomy and facetectomy. After surgery, the patientâs symptoms gradually improved, and a pathological examination concluded that the tumor was an angiolipoma. SAL is an uncommon benign tumor, for which total surgical excision is the treatment of choice. Key words: Angiolipoma; Epidural neoplasms; Epidural space; Spinal neoplasms Angiolipoma; Epidural neoplasms; Epidural space; Spinal neoplasms
{"title":"Thoracic Spinal Angiolipoma: A Case Report and Literature Review","authors":"Soo Hyun Lee, Min Sung Bock, Seung Hun Sheen, Inbo Han, Seil Sohn","doi":"10.21129/nerve.2023.00360","DOIUrl":"https://doi.org/10.21129/nerve.2023.00360","url":null,"abstract":"Spinal angiolipoma (SAL) is a rare benign tumor, accounting for 0.14% to 1.2% of all spinal tumors and approximately 3% of epidural spinal tumors. SAL is composed of mature adipocytes and abnormal blood vessels. Its gradual growth can cause spinal cord and root compression. No additional treatment is required after total surgical resection, and its prognosis is good. We report the c case of an 81-year-old man who had thigh pain and numbness in both feet, along with gait disturbance. High signal intensity was observed on T2- and T1-weighted magnetic resonance imaging. Contrast enhancement showed a highly contrasting epidural mass with spinal cord compression, spreading to the left neural foramen. The tumor was totally removed by laminectomy and facetectomy. After surgery, the patientâs symptoms gradually improved, and a pathological examination concluded that the tumor was an angiolipoma. SAL is an uncommon benign tumor, for which total surgical excision is the treatment of choice. Key words: Angiolipoma; Epidural neoplasms; Epidural space; Spinal neoplasms Angiolipoma; Epidural neoplasms; Epidural space; Spinal neoplasms","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135616841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.21129/nerve.2023.00353
Sun-Jun Jeong, Jong-Hyeok Park, Sun-Young Jun
Intraspinal teratoma is a rare subtype of spinal cord tumors, accounting for only 0.2% to 0.5% of cases. These tumors consist of a mixture of two or more germ cell layers, including the ectoderm, endoderm, and mesoderm. They often contain epithelial tissues, fatty tissues, and follicles derived from these three layers, which can be visualized on magnetic resonance imaging (MRI) in most cases. However, in our patient, a 35-year-old woman with an intradural oval intramedullary teratoma at the L4 level, the tumor exhibited features similar to those of a schwannoma. On MRI, the tumor appeared as a 2-cm mass attached to the end of the spinal cord, with intermediate signal intensity on T2-weighted images and iso-intensity without enhancement on T1-weighted images. L4 laminoplasty with tumor removal was performed under intraoperative monitoring. The tumor was found to be firm with a cyst containing mucoid and fatty tissue posteriorly. Near-total resection was achieved, although the tumor margin was indistinct. A literature review revealed spinal cord tethering and the presence of fatty tissue without MRI enhancement as characteristic findings of teratomas and dermoid cysts. Key words: Dermoid cysts; Spine; Spinal cord neoplasms; Teratoma
{"title":"Adult Intramedullary Mature Teratoma of the Spinal Cord: An Unusual Case with a Review of the Literature","authors":"Sun-Jun Jeong, Jong-Hyeok Park, Sun-Young Jun","doi":"10.21129/nerve.2023.00353","DOIUrl":"https://doi.org/10.21129/nerve.2023.00353","url":null,"abstract":"Intraspinal teratoma is a rare subtype of spinal cord tumors, accounting for only 0.2% to 0.5% of cases. These tumors consist of a mixture of two or more germ cell layers, including the ectoderm, endoderm, and mesoderm. They often contain epithelial tissues, fatty tissues, and follicles derived from these three layers, which can be visualized on magnetic resonance imaging (MRI) in most cases. However, in our patient, a 35-year-old woman with an intradural oval intramedullary teratoma at the L4 level, the tumor exhibited features similar to those of a schwannoma. On MRI, the tumor appeared as a 2-cm mass attached to the end of the spinal cord, with intermediate signal intensity on T2-weighted images and iso-intensity without enhancement on T1-weighted images. L4 laminoplasty with tumor removal was performed under intraoperative monitoring. The tumor was found to be firm with a cyst containing mucoid and fatty tissue posteriorly. Near-total resection was achieved, although the tumor margin was indistinct. A literature review revealed spinal cord tethering and the presence of fatty tissue without MRI enhancement as characteristic findings of teratomas and dermoid cysts. Key words: Dermoid cysts; Spine; Spinal cord neoplasms; Teratoma","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"161 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135730952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.21129/nerve.2023.00374
Dae Hyun Lim, Ju-Yeon Pyo, Yeong Ha Jeong, Byung Ho Jin, Kwang-Ryeol Kim
This case report describes a 64-year-old female patient who presented to the emergency department with lower back pain, bilateral leg pain, and numbness. Magnetic resonance imaging revealed a mass-like lesion at the L2 level, which was surgically removed and was found to be a cellular schwannoma upon histopathological examination. The patient exhibited immediate postoperative improvement and was referred for rehabilitation. This case highlights the importance of considering cellular schwannoma as a possible diagnosis in patients with intradural extramedullary tumors causing compressive symptoms. Key words: Nerve sheath neoplasms; Neurilemmoma; Spinal cord neoplasms
{"title":"Spinal Cellular Schwannoma: A Case Report of Acute Post-Traumatic Paralysis","authors":"Dae Hyun Lim, Ju-Yeon Pyo, Yeong Ha Jeong, Byung Ho Jin, Kwang-Ryeol Kim","doi":"10.21129/nerve.2023.00374","DOIUrl":"https://doi.org/10.21129/nerve.2023.00374","url":null,"abstract":"This case report describes a 64-year-old female patient who presented to the emergency department with lower back pain, bilateral leg pain, and numbness. Magnetic resonance imaging revealed a mass-like lesion at the L2 level, which was surgically removed and was found to be a cellular schwannoma upon histopathological examination. The patient exhibited immediate postoperative improvement and was referred for rehabilitation. This case highlights the importance of considering cellular schwannoma as a possible diagnosis in patients with intradural extramedullary tumors causing compressive symptoms. Key words: Nerve sheath neoplasms; Neurilemmoma; Spinal cord neoplasms","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135730588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-17DOI: 10.21129/nerve.2023.00381
Tae-Hwan Park, Yunhee Choi, Tae-Shin Kim, Jun-Hoe Kim, Chang-Hyun Lee, Sum Kim, Young Rak Kim, Yong San Ko, Woon Tak Yuh, John M. Rhee, Kyoung-Tae Kim, Chun Kee Chung, Chi Heon Kim
Objective Mild to moderate stenosis at the adjacent level sometimes co-occurs with lumbar spondylolisthesis, but whether to include the adjacent level during surgery for the index level is a matter of debate. Spondylolisthesis causes anterior slipping of the vertebra and reduces the segmental angle at the index level, and the adjacent level may compensate for this change through hyperextension to maintain spinal balance. This study investigated the radiological changes and clinical outcomes of adjacent segment stenosis in patients with lumbar spondylolisthesis. Methods Forty consecutive patients (12 men and 28 women, age 66.6±10.4 years) underwent single-level oblique lumbar interbody fusion for L4-5 or L5-S1 spondylolisthesis. Lumbar central stenosis at the cranial adjacent segment was present in 16 patients (stenosis group) and absent in 24 patients (no-stenosis group). Clinical and radiological parameters were longitudinally compared between the stenosis and no-stenosis groups. Results Both groups showed similar and significant clinical improvement. The segmental angle at the index level significantly improved in both groups (p<0.05), but the segmental angle at the cranial adjacent segment significantly decreased only in the stenosis group (p<0.05). The spinal canal area at the adjacent level significantly improved only in the stenosis group (p<0.05). Conclusion Realigned spondylolisthesis may reduce hyperextension of the adjacent segment. If mild lumbar spinal stenosis is present at an adjacent level to spondylolisthesis, it may not be essential to include it in surgery. Key words: Lumbar vertebrae; Spinal fusion; Spinal stenosis; Spondylolisthesis
{"title":"The Influence of Spondylolisthesis Reduction on the Adjacent Lumbar Segment","authors":"Tae-Hwan Park, Yunhee Choi, Tae-Shin Kim, Jun-Hoe Kim, Chang-Hyun Lee, Sum Kim, Young Rak Kim, Yong San Ko, Woon Tak Yuh, John M. Rhee, Kyoung-Tae Kim, Chun Kee Chung, Chi Heon Kim","doi":"10.21129/nerve.2023.00381","DOIUrl":"https://doi.org/10.21129/nerve.2023.00381","url":null,"abstract":"Objective Mild to moderate stenosis at the adjacent level sometimes co-occurs with lumbar spondylolisthesis, but whether to include the adjacent level during surgery for the index level is a matter of debate. Spondylolisthesis causes anterior slipping of the vertebra and reduces the segmental angle at the index level, and the adjacent level may compensate for this change through hyperextension to maintain spinal balance. This study investigated the radiological changes and clinical outcomes of adjacent segment stenosis in patients with lumbar spondylolisthesis. Methods Forty consecutive patients (12 men and 28 women, age 66.6±10.4 years) underwent single-level oblique lumbar interbody fusion for L4-5 or L5-S1 spondylolisthesis. Lumbar central stenosis at the cranial adjacent segment was present in 16 patients (stenosis group) and absent in 24 patients (no-stenosis group). Clinical and radiological parameters were longitudinally compared between the stenosis and no-stenosis groups. Results Both groups showed similar and significant clinical improvement. The segmental angle at the index level significantly improved in both groups (p<0.05), but the segmental angle at the cranial adjacent segment significantly decreased only in the stenosis group (p<0.05). The spinal canal area at the adjacent level significantly improved only in the stenosis group (p<0.05). Conclusion Realigned spondylolisthesis may reduce hyperextension of the adjacent segment. If mild lumbar spinal stenosis is present at an adjacent level to spondylolisthesis, it may not be essential to include it in surgery. Key words: Lumbar vertebrae; Spinal fusion; Spinal stenosis; Spondylolisthesis","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135945179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-12DOI: 10.21129/nerve.2023.00311
Seung-Hoon Ji, Sung-Kyun Hwang
We report a rare case of cerebral aneurysmal subarachnoid hemorrhage (SAH) associated with Turner syndrome. A 34-year-old woman presented with aneurysmal SAH originating from a saccular aneurysm in the right anterior communicating artery. The patient underwent endovascular coil embolization of the aneurysm. The patient recovered favorably after surgery without any neurological deficits. She had previously been diagnosed with Turner syndrome, which was managed with medical treatment, including estrogen hormone replacement therapy. It is uncommon for a patient with Turner syndrome to present with aneurysmal SAH; nonetheless, aneurysmal SAH could be a clinical concern. Further investigations are needed to reveal the risk factors, vascular anatomy, and causative mechanisms of aneurysmal SAH in patients with Turner syndrome. Key words: Intracranial aneurysm; Subarachnoid hemorrhage; Turner syndrome; Estrogens
{"title":"A Case of Turner Syndrome Presenting as Aneurysmal Subarachnoid Hemorrhage","authors":"Seung-Hoon Ji, Sung-Kyun Hwang","doi":"10.21129/nerve.2023.00311","DOIUrl":"https://doi.org/10.21129/nerve.2023.00311","url":null,"abstract":"We report a rare case of cerebral aneurysmal subarachnoid hemorrhage (SAH) associated with Turner syndrome. A 34-year-old woman presented with aneurysmal SAH originating from a saccular aneurysm in the right anterior communicating artery. The patient underwent endovascular coil embolization of the aneurysm. The patient recovered favorably after surgery without any neurological deficits. She had previously been diagnosed with Turner syndrome, which was managed with medical treatment, including estrogen hormone replacement therapy. It is uncommon for a patient with Turner syndrome to present with aneurysmal SAH; nonetheless, aneurysmal SAH could be a clinical concern. Further investigations are needed to reveal the risk factors, vascular anatomy, and causative mechanisms of aneurysmal SAH in patients with Turner syndrome. Key words: Intracranial aneurysm; Subarachnoid hemorrhage; Turner syndrome; Estrogens","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135968958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-11DOI: 10.21129/nerve.2023.00325
Yong Min Lee, Chi Hyung Lee, Chang Hyeun Kim, Young Ha Kim, Soon Ki Sung, Dong Wuk Son, Sang Weon Lee, Geun Sung Song
Hypertrophic pachymeningitis (HP) is a rare type of inflammatory fibrosis characterized by diffuse thickening of the dura mater, which may cause a compressive effect or vascular compromise. Progressively worsening headache is the usual symptom, along with ataxia and various cranial nerve palsies. This article describes a rare case of HP after burr hole trephination for a chronic subdural hemorrhage (CSDH). A 64-year-old man was admitted to the emergency room with a headache that had started approximately 2 weeks prior. After the diagnosis of CSDH on imaging, burr hole trephination was performed. Six months later, the patient visited the hospital again with a headache. He was diagnosed with a recurrence of CSDH, and a craniotomy was performed. A solid subdural granuloma was suspected and a pathological examination revealed acute and chronic inflammation. Tissue biopsy and laboratory blood tests did not reveal any abnormalities. Three months later, he visited the hospital again with a severe headache. Magnetic resonance imaging showed no significant difference in the area of the previous operation; however, focal venous congestion and localized venous ischemic or inflammatory changes were observed in the tentorium. A craniotomy was performed for biopsy, and the dura mater was very thick. The pathology was diagnosed as HP. After taking steroids and immunosuppressive agents, the patient's symptoms improved. HP is a rare chronic inflammatory condition of the dura mater that causes neurological deficits. If the diagnosis is not definitively established based on an imaging examination, it should be made through a surgical biopsy. Steroid and immunosuppressive agents can improve the prognosis after diagnosis. Key words: Headache disorders; Hematoma, subdural, chronic; Hypertrophy; Immunosuppressive agents; Meningitis; Steroids
{"title":"A Rare Case of Hypertrophic Pachymeningitis after Surgery for Chronic Subdural Hemorrhage: A Case Report","authors":"Yong Min Lee, Chi Hyung Lee, Chang Hyeun Kim, Young Ha Kim, Soon Ki Sung, Dong Wuk Son, Sang Weon Lee, Geun Sung Song","doi":"10.21129/nerve.2023.00325","DOIUrl":"https://doi.org/10.21129/nerve.2023.00325","url":null,"abstract":"Hypertrophic pachymeningitis (HP) is a rare type of inflammatory fibrosis characterized by diffuse thickening of the dura mater, which may cause a compressive effect or vascular compromise. Progressively worsening headache is the usual symptom, along with ataxia and various cranial nerve palsies. This article describes a rare case of HP after burr hole trephination for a chronic subdural hemorrhage (CSDH). A 64-year-old man was admitted to the emergency room with a headache that had started approximately 2 weeks prior. After the diagnosis of CSDH on imaging, burr hole trephination was performed. Six months later, the patient visited the hospital again with a headache. He was diagnosed with a recurrence of CSDH, and a craniotomy was performed. A solid subdural granuloma was suspected and a pathological examination revealed acute and chronic inflammation. Tissue biopsy and laboratory blood tests did not reveal any abnormalities. Three months later, he visited the hospital again with a severe headache. Magnetic resonance imaging showed no significant difference in the area of the previous operation; however, focal venous congestion and localized venous ischemic or inflammatory changes were observed in the tentorium. A craniotomy was performed for biopsy, and the dura mater was very thick. The pathology was diagnosed as HP. After taking steroids and immunosuppressive agents, the patient's symptoms improved. HP is a rare chronic inflammatory condition of the dura mater that causes neurological deficits. If the diagnosis is not definitively established based on an imaging examination, it should be made through a surgical biopsy. Steroid and immunosuppressive agents can improve the prognosis after diagnosis. Key words: Headache disorders; Hematoma, subdural, chronic; Hypertrophy; Immunosuppressive agents; Meningitis; Steroids","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"197 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136209260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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