Pub Date : 2021-10-31DOI: 10.21129/nerve.2021.7.2.83
Hyeongyu Jang, M. Kang
Objective: Both spinal multiple sclerosis (SMS) and spinal intramedullary astrocytoma (SIA) are rare space-occupying lesions in the spinal cord and clinically show various myelopathy symptoms. Both clinical and imaging findings are similar and are easily misdiagnosed. This study is to clarify clinical and radiographic finding that could be helpful to differentiate SMS from SIA.Methods: We compared the demographic, clinical, and radiographic characteristics between the SIA and SMS groups. The SIA group (n=13) was diagnosed postoperatively with pathologic confirmation, and the SMS group (n=25) was composed of patients who have a lesion in the spinal cord and met the McDonald criteria for the diagnosis of multiple sclerosis (criteria revised in 2010).Results: Clinically, patients with SIA had a significantly longer symptom duration before the first visit than SMS (4.9±4.4 vs. 2.1±3.6 months, p=0.008). All persons with SIA showed progressive disease course, whereas 95.8% of persons with SMS showed remission (p<0.001). In contrast to SMS, the involvement of both halves of the spinal cord was more frequently observed in patients with SIA (p<0.001). In addition, fusiform dilation in the sagittal plane (p<0.001) or tumoral cyst (p=0.001) also significantly suggested SIA rather than SMS.Conclusion: Despite many limitations of this study, the present data demonstrated the clinical and imaging features helpful in distinguishing SIA from SMS. As with most tumors, SIA tends to show a slowly progressive clinical course without remission. Occupation of both halves of the spinal cord, fusiform dilation, or cysts was favoring radiographic factor for the SIA.
目的:脊髓多发性硬化症(SMS)和脊髓髓内星形细胞瘤(SIA)均为罕见的脊髓占位性病变，临床表现为多种脊髓病症状。临床和影像学表现相似，容易误诊。本研究旨在阐明临床和影像学表现，有助于鉴别SMS和SIA。方法:我们比较了SIA组和SMS组的人口学、临床和影像学特征。SIA组(n=13)术后病理确诊，SMS组(n=25)由脊髓有病变且符合McDonald多发性硬化症诊断标准(2010年修订标准)的患者组成。结果:在临床上，SIA患者首次就诊前的症状持续时间明显长于SMS患者(4.9±4.4 vs 2.1±3.6个月，p=0.008)。所有SIA患者病程进展，而95.8%的SMS患者病情缓解(p<0.001)。与SMS相比，SIA患者更常观察到双侧脊髓受累(p<0.001)。此外，矢状面梭状梭形扩张(p<0.001)或肿瘤囊肿(p=0.001)也明显提示SIA而非SMS。结论:尽管本研究有许多局限性，但目前的数据表明临床和影像学特征有助于区分SIA和SMS。与大多数肿瘤一样，SIA往往表现为缓慢进展的临床过程，没有缓解。脊髓双侧被占据、梭状扩张或囊肿是SIA的有利影像学因素。
{"title":"Differentiation between Spinal Intramedullary Astrocytoma and Spinal Multiple Sclerosis Using Clinical and Radiologic Factors","authors":"Hyeongyu Jang, M. Kang","doi":"10.21129/nerve.2021.7.2.83","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.83","url":null,"abstract":"Objective: Both spinal multiple sclerosis (SMS) and spinal intramedullary astrocytoma (SIA) are rare space-occupying lesions in the spinal cord and clinically show various myelopathy symptoms. Both clinical and imaging findings are similar and are easily misdiagnosed. This study is to clarify clinical and radiographic finding that could be helpful to differentiate SMS from SIA.Methods: We compared the demographic, clinical, and radiographic characteristics between the SIA and SMS groups. The SIA group (n=13) was diagnosed postoperatively with pathologic confirmation, and the SMS group (n=25) was composed of patients who have a lesion in the spinal cord and met the McDonald criteria for the diagnosis of multiple sclerosis (criteria revised in 2010).Results: Clinically, patients with SIA had a significantly longer symptom duration before the first visit than SMS (4.9±4.4 vs. 2.1±3.6 months, p=0.008). All persons with SIA showed progressive disease course, whereas 95.8% of persons with SMS showed remission (p<0.001). In contrast to SMS, the involvement of both halves of the spinal cord was more frequently observed in patients with SIA (p<0.001). In addition, fusiform dilation in the sagittal plane (p<0.001) or tumoral cyst (p=0.001) also significantly suggested SIA rather than SMS.Conclusion: Despite many limitations of this study, the present data demonstrated the clinical and imaging features helpful in distinguishing SIA from SMS. As with most tumors, SIA tends to show a slowly progressive clinical course without remission. Occupation of both halves of the spinal cord, fusiform dilation, or cysts was favoring radiographic factor for the SIA.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128725054","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 : 2021-10-31DOI: 10.21129/nerve.2021.7.2.110
Woowon Oh, Yeongu Chung, Jebeom Hong, Y. Won, P. Chung, M. Rho
A 76-year-old man presented with recurrent left side weakness for several months without a history of head trauma. Brain computed tomography revealed a subdural hematoma (SDH). The patient was diagnosed with a chronic SDH and empirically treated via burr hole trephination. However, the origin of SDH was eventually confirmed to be glioblastoma.
{"title":"Glioblastoma Presenting as Spontaneous Subdural Hematoma","authors":"Woowon Oh, Yeongu Chung, Jebeom Hong, Y. Won, P. Chung, M. Rho","doi":"10.21129/nerve.2021.7.2.110","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.110","url":null,"abstract":"A 76-year-old man presented with recurrent left side weakness for several months without a history of head trauma. Brain computed tomography revealed a subdural hematoma (SDH). The patient was diagnosed with a chronic SDH and empirically treated via burr hole trephination. However, the origin of SDH was eventually confirmed to be glioblastoma.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134431174","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 : 2021-10-31DOI: 10.21129/nerve.2021.7.2.114
Da Ham Kim, S. Noh
With recent advances in treatment technology, the mortality rate of spinal abscesses is decreasing. However, spinal abscesses are still unusual and difficult to treat. A 56-year-old woman presented with lower back pain and fever and chills that started two days before the visit. Initially, she showed lower limb extremity motor weakness. There was right focal acute pyelonephritis of the upper kidney portion with an associated complicated cyst on abdominal-pelvic computed tomography. Klebsiella pneumoniae was cultivated in blood and urine cultures. Spine magnetic resonance imaging with contrast enhancement was completed and the results showed epidural and subarachnoid space abscess formation in the whole lumbar space. The patient was treated with total laminectomy at L2-3 and laminotomy at L4-5 with epidural and subarachnoid abscess removal. After surgery, her back pain subsided enough that intravenous morphine was no longer needed. However, lower limb extremity motor weakness was not recovered. Antibiotics were administered to treat a potential cerebral nervous system infection for nine weeks. At the last follow-up, inflammation levels were normalized and the motor weakness in both legs was also normalized with active rehabilitation. This report described an epidural and subarachnoid abscess in a middle-aged woman due to urinary tract infection sepsis associated with acute pyelonephritis caused by Klebsiella pneumoniae. With proper surgery and adequate antibiotic treatment, the patient's symptoms improved significantly without any complications.
{"title":"Spinal Epidural and Subarachnoid Abscess Due to Acute Pyelonephritis in a 56-Year-Old Woman: A Case Report and Literature Review","authors":"Da Ham Kim, S. Noh","doi":"10.21129/nerve.2021.7.2.114","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.114","url":null,"abstract":"With recent advances in treatment technology, the mortality rate of spinal abscesses is decreasing. However, spinal abscesses are still unusual and difficult to treat. A 56-year-old woman presented with lower back pain and fever and chills that started two days before the visit. Initially, she showed lower limb extremity motor weakness. There was right focal acute pyelonephritis of the upper kidney portion with an associated complicated cyst on abdominal-pelvic computed tomography. Klebsiella pneumoniae was cultivated in blood and urine cultures. Spine magnetic resonance imaging with contrast enhancement was completed and the results showed epidural and subarachnoid space abscess formation in the whole lumbar space. The patient was treated with total laminectomy at L2-3 and laminotomy at L4-5 with epidural and subarachnoid abscess removal. After surgery, her back pain subsided enough that intravenous morphine was no longer needed. However, lower limb extremity motor weakness was not recovered. Antibiotics were administered to treat a potential cerebral nervous system infection for nine weeks. At the last follow-up, inflammation levels were normalized and the motor weakness in both legs was also normalized with active rehabilitation. This report described an epidural and subarachnoid abscess in a middle-aged woman due to urinary tract infection sepsis associated with acute pyelonephritis caused by Klebsiella pneumoniae. With proper surgery and adequate antibiotic treatment, the patient's symptoms improved significantly without any complications.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133615452","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 : 2021-10-31DOI: 10.21129/nerve.2021.7.2.57
I. Yang, Moon-Soo Han, Gwang-Jun Lee, Seul-Kee Lee, B. Moon, Jung-Kil Lee
Objective: We aimed to examine the long-term radiological and clinical outcomes after stand-alone anterior cervical discectomy and fusion (ACDF).Methods: In total, we enrolled 20 patients and 31 treated segments with degenerative cervical disease that underwent stand-alone ACDF with ≥60 months of follow-up. Segmental angle (SA), cervical sagittal alignment (CSA), subsidence, and fusion were evaluated. A visual analogue scale (VAS) and the neck disability index (NDI) were applied pre- and post-operatively and at the last follow-up.Results: Subsidence occurred in 9 (45%) patients and 15 segments (48.4%) at the last follow-up. The mean VAS and NDI scores had improved in both groups with and without subsidence. The mean SA at the last follow-up had significantly increased to 2.3°±8.5° in the subsidence group and to 1.7°± 5.2° degree in the non-subsidence group compared to the post-operative SA (p<0.001). The overall mean CSA at the last follow-up significantly increased overtime in both groups from the postoperative CSA (p=0.003). The fusion rate was 86.7% in the subsidence group and 81.3% in non-subsidence group. However, the difference in SA, CSA and fusion rates between the two groups were not statistically significant (p=0.119, 0.98, and 0.682, respectively).Conclusion: As a result of a long-term follow-up study after stand-alone ACDF, subsidence occurs to some extent. Still, it does not appear to significantly impact radiological and clinical outcomes if the clinician performs sufficient decompression of foramen during surgery. Subsidence seems to have a positive influence on the fusion rate.
{"title":"How Subsidence Affects Clinical and Radiological Outcomes after Stand-Alone Anterior Cervical Discectomy and Fusion on Patients with Degenerative Cervical Disease? A Long-Term Follow-Up Study","authors":"I. Yang, Moon-Soo Han, Gwang-Jun Lee, Seul-Kee Lee, B. Moon, Jung-Kil Lee","doi":"10.21129/nerve.2021.7.2.57","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.57","url":null,"abstract":"Objective: We aimed to examine the long-term radiological and clinical outcomes after stand-alone anterior cervical discectomy and fusion (ACDF).Methods: In total, we enrolled 20 patients and 31 treated segments with degenerative cervical disease that underwent stand-alone ACDF with ≥60 months of follow-up. Segmental angle (SA), cervical sagittal alignment (CSA), subsidence, and fusion were evaluated. A visual analogue scale (VAS) and the neck disability index (NDI) were applied pre- and post-operatively and at the last follow-up.Results: Subsidence occurred in 9 (45%) patients and 15 segments (48.4%) at the last follow-up. The mean VAS and NDI scores had improved in both groups with and without subsidence. The mean SA at the last follow-up had significantly increased to 2.3°±8.5° in the subsidence group and to 1.7°± 5.2° degree in the non-subsidence group compared to the post-operative SA (p<0.001). The overall mean CSA at the last follow-up significantly increased overtime in both groups from the postoperative CSA (p=0.003). The fusion rate was 86.7% in the subsidence group and 81.3% in non-subsidence group. However, the difference in SA, CSA and fusion rates between the two groups were not statistically significant (p=0.119, 0.98, and 0.682, respectively).Conclusion: As a result of a long-term follow-up study after stand-alone ACDF, subsidence occurs to some extent. Still, it does not appear to significantly impact radiological and clinical outcomes if the clinician performs sufficient decompression of foramen during surgery. Subsidence seems to have a positive influence on the fusion rate.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"127 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126795328","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 : 2021-10-31DOI: 10.21129/nerve.2021.7.2.117
Seung-Mo Hong, Keung Nyun Kim, S. Yi
We present a case report of very rare and unfamiliar disease named Tapia syndrome characterized by concomitant unilateral paralysis of the 10th and 12th cranial nerves. Symptoms include dysphonia, dysphagia, tongue deviation toward affected side. The syndrome occurs after orotracheal intubation. A case report of the patient; A 48-year-old Asian man, presented with both arm numbness and gait disturbance for 1 year. We planned laminoplasty of cervical 4, 5, 6, and 7. After the operation, he complained of hoarseness and difficulty in swelling. On his physical examinations, uvula and tongue deviation to right is detected. At 8 months after the surgery, his clinical symptoms and chief compliant about surgery had disappeared. The mechanism of the disease is unclear. Though the progress of the disease is benign, further evaluation to rule out other desperate disease like cerebral infarction is evitable.
{"title":"Tapia Syndrome after Cervical Laminoplasty: A Case Report and Literature Review","authors":"Seung-Mo Hong, Keung Nyun Kim, S. Yi","doi":"10.21129/nerve.2021.7.2.117","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.117","url":null,"abstract":"We present a case report of very rare and unfamiliar disease named Tapia syndrome characterized by concomitant unilateral paralysis of the 10th and 12th cranial nerves. Symptoms include dysphonia, dysphagia, tongue deviation toward affected side. The syndrome occurs after orotracheal intubation. A case report of the patient; A 48-year-old Asian man, presented with both arm numbness and gait disturbance for 1 year. We planned laminoplasty of cervical 4, 5, 6, and 7. After the operation, he complained of hoarseness and difficulty in swelling. On his physical examinations, uvula and tongue deviation to right is detected. At 8 months after the surgery, his clinical symptoms and chief compliant about surgery had disappeared. The mechanism of the disease is unclear. Though the progress of the disease is benign, further evaluation to rule out other desperate disease like cerebral infarction is evitable.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128686614","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 : 2021-10-31DOI: 10.21129/nerve.2021.7.2.36
Gwang Yoon Choi, Jinseo Yang, Y. Cho, H. Choi, Jinpyeong Jeon, S. Kang
Objective: This study aimed to assess the clinical applicability of magnetic resonance imaging (MRI) for the early diagnosis of common peroneal neuropathy (CPNe).Methods: Over three years, the authors have treated 58 patients with CPNe. All patients had clinical or neurophysiological confirmation of CPNe. Among them, 35 (60%) patients underwent axial knee MRI with a 1.5-Tesla scanner. These 35 patients were selected for study and were classified into three groups according to the time of examination after the occurrence of dropped foot―acute, subacute, and chronic onset groups. According to muscle appearances (normal, edematous change, and atrophy), we diagnosed them with CPNe, except for those with normal morphology. We evaluated the applicability of MRI in the diagnosis of CPNe compared to that of electromyography (EMG).Results: The 18, 11, and six cases were included in the acute, subacute, and chronic onset groups, respectively. In the acute onset group, three cases had normal muscle appearance, while 15 cases had edematous changes in the affected muscles. In the subacute onset group, eight cases had edematous changes, while three cases showed muscle atrophy. In the chronic onset group, six cases had muscle atrophy. CPNe could be diagnosed using MRI in about 91% (32/35) of all the cases. Excluding the chronologically chronic stage, diagnosis rate was approximately 89%(26/29) of all the cases. However, only in 27 cases (77%) denervation potentials were presented on EMG.Conclusion: According to our results, MRI is a helpful diagnostic modality, especially in the early stage of CPNe, and may lead to proper management.
{"title":"Applicability of Magnetic Resonance Imaging for Early Diagnosis of Common Peroneal Neuropathy","authors":"Gwang Yoon Choi, Jinseo Yang, Y. Cho, H. Choi, Jinpyeong Jeon, S. Kang","doi":"10.21129/nerve.2021.7.2.36","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.36","url":null,"abstract":"Objective: This study aimed to assess the clinical applicability of magnetic resonance imaging (MRI) for the early diagnosis of common peroneal neuropathy (CPNe).Methods: Over three years, the authors have treated 58 patients with CPNe. All patients had clinical or neurophysiological confirmation of CPNe. Among them, 35 (60%) patients underwent axial knee MRI with a 1.5-Tesla scanner. These 35 patients were selected for study and were classified into three groups according to the time of examination after the occurrence of dropped foot―acute, subacute, and chronic onset groups. According to muscle appearances (normal, edematous change, and atrophy), we diagnosed them with CPNe, except for those with normal morphology. We evaluated the applicability of MRI in the diagnosis of CPNe compared to that of electromyography (EMG).Results: The 18, 11, and six cases were included in the acute, subacute, and chronic onset groups, respectively. In the acute onset group, three cases had normal muscle appearance, while 15 cases had edematous changes in the affected muscles. In the subacute onset group, eight cases had edematous changes, while three cases showed muscle atrophy. In the chronic onset group, six cases had muscle atrophy. CPNe could be diagnosed using MRI in about 91% (32/35) of all the cases. Excluding the chronologically chronic stage, diagnosis rate was approximately 89%(26/29) of all the cases. However, only in 27 cases (77%) denervation potentials were presented on EMG.Conclusion: According to our results, MRI is a helpful diagnostic modality, especially in the early stage of CPNe, and may lead to proper management.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114829801","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 : 2021-10-31DOI: 10.21129/nerve.2021.7.2.121
B. Jung, S. Kim, Woo Jin Choe, S. Lim
Spinal cord hemangioblastoma (HBL) is a highly vascularized tumor that occurs sporadically or in relation to von Hippel-Lindau disease. Sporadic-type HBLs in the spinal cord usually present as single lesions that are potentially curable by complete surgical resection, with a low rate of recurrence. We report a case of a totally excised sporadic-type spinal cord HBL with multiple recurrences observed 10 years after surgery. Long-term follow-up may be necessary for spinal cord HBL, even in cases of complete resection.
{"title":"Possible Delayed Recurrence of Sporadic Spinal Hemangioblastoma after Complete Surgical Resection: A Case Report","authors":"B. Jung, S. Kim, Woo Jin Choe, S. Lim","doi":"10.21129/nerve.2021.7.2.121","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.121","url":null,"abstract":"Spinal cord hemangioblastoma (HBL) is a highly vascularized tumor that occurs sporadically or in relation to von Hippel-Lindau disease. Sporadic-type HBLs in the spinal cord usually present as single lesions that are potentially curable by complete surgical resection, with a low rate of recurrence. We report a case of a totally excised sporadic-type spinal cord HBL with multiple recurrences observed 10 years after surgery. Long-term follow-up may be necessary for spinal cord HBL, even in cases of complete resection.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127015880","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 : 2021-10-31DOI: 10.21129/nerve.2021.7.2.64
H. Yoon, Junghyeok Kim, D. Ryu, S. Yoon
Objective: Dual energy X-ray absorptiometry (DXA) is a standard tool for measuring the bone mineral density (BMD), but it sometimes provides inaccurate results. In contrast, quantitative computed tomography (QCT) measures the BMD more accurately by directly measuring the trabecular bone. This study examined the factors that cause the discrepancy between DXA and QCT with advanced spinal imaging.Methods: The medical records of 59 patients who underwent DXA, QCT, and a lumbar spine magnetic resonance imaging (MRI) were reviewed retrospectively. The following values were measured on plain radiographs, computed tomography, and MRI: lumbar lordosis, segmental scoliosis, compression fracture, spondylosis, abdominal aortic calcification, facet joint degeneration, and Modic change. The significant parameters contributing to the discordance results between DXA and QCT were evaluated by logistic regression analysis.Results: QCT identified osteoporosis in 43 patients (72.88%). DXA identified 15 osteoporotic patients (25.42%). Of the 44 patients not diagnosed with osteoporosis by DXA, 30 patients (68.18%) were diagnosed with osteoporosis by QCT. Multivariate logistic regression analysis showed that the result of DXA might be overestimated by a degenerated facet joint (odds ratio [OR] 4.58; 95% confidence interval [CI], 1.1-19.07) and measurements at a fracture site (OR, 1.63; 95% CI, 1.23-2.15).Conclusion: DXA might miss a diagnosis of osteoporosis. Facet joint hypertrophy due to degeneration revealed a stronger association with the overestimation of the BMD by DXA than the formation of osteophytes at the vertebral body. Therefore, the results of DXA should be interpreted carefully, considering the possibility of interruption.
{"title":"What Causes the Discrepancy between Quantitative Computed Tomography and Dual Energy X-Ray Absorptiometry?","authors":"H. Yoon, Junghyeok Kim, D. Ryu, S. Yoon","doi":"10.21129/nerve.2021.7.2.64","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.64","url":null,"abstract":"Objective: Dual energy X-ray absorptiometry (DXA) is a standard tool for measuring the bone mineral density (BMD), but it sometimes provides inaccurate results. In contrast, quantitative computed tomography (QCT) measures the BMD more accurately by directly measuring the trabecular bone. This study examined the factors that cause the discrepancy between DXA and QCT with advanced spinal imaging.Methods: The medical records of 59 patients who underwent DXA, QCT, and a lumbar spine magnetic resonance imaging (MRI) were reviewed retrospectively. The following values were measured on plain radiographs, computed tomography, and MRI: lumbar lordosis, segmental scoliosis, compression fracture, spondylosis, abdominal aortic calcification, facet joint degeneration, and Modic change. The significant parameters contributing to the discordance results between DXA and QCT were evaluated by logistic regression analysis.Results: QCT identified osteoporosis in 43 patients (72.88%). DXA identified 15 osteoporotic patients (25.42%). Of the 44 patients not diagnosed with osteoporosis by DXA, 30 patients (68.18%) were diagnosed with osteoporosis by QCT. Multivariate logistic regression analysis showed that the result of DXA might be overestimated by a degenerated facet joint (odds ratio [OR] 4.58; 95% confidence interval [CI], 1.1-19.07) and measurements at a fracture site (OR, 1.63; 95% CI, 1.23-2.15).Conclusion: DXA might miss a diagnosis of osteoporosis. Facet joint hypertrophy due to degeneration revealed a stronger association with the overestimation of the BMD by DXA than the formation of osteophytes at the vertebral body. Therefore, the results of DXA should be interpreted carefully, considering the possibility of interruption.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"273 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124515456","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 : 2021-10-31DOI: 10.21129/nerve.2021.7.2.71
Ga-On Park, U. Choi, K. Kim, Jeong-Yoon Park, D. Chin, Keun-Su Kim, Yong-Eun Cho
Objective: This study aimed to compare the radiographic and clinical outcomes between sacral alar iliac (SAI) screw fixation and conventional iliac (CI) screw fixation with a particular focus on the rate of reoperation, surgical site infection (SSI), sacroiliac joint pain, instrument failure, and screw prominence.Methods: Patients who underwent sacropelvic fixation in the authors’ institution from June 2011 to May 2017 were retrospectively investigated. Forty-three patients with SAI screw fixation and 25 with CI screw fixation were included. Preoperative patient and surgical characteristics and postoperative outcomes and complications were analyzed between the SAI and CI groups. Radiographic parameters were analyzed before and after surgery.Results: Lumbosacral fusion rates showed no statistically significant difference between the SAI group and CI groups (90.7% vs. 92.0%, p=0.878). The SAI group showed a significantly good result with regard to SSI compared to the CI group (0% vs. 16%, p=0.016), but had a significantly higher rate of distal screw fracture than the CI group (16.3% vs. 0%, p=0.042).Conclusion: The SAI screw fixation technique could achieve good outcomes of pain relief, deformity correction, and lumbosacral fusion rate with relatively lower complications such as the rates of reoperation, SSI, and screw prominence as compared to the CI screw fixation technique. However, distal instrument failure was observed more frequently in the SAI group, requiring further biomechanical studies.
目的:本研究旨在比较骶髂翼(SAI)螺钉固定与传统髂(CI)螺钉固定的影像学和临床结果，特别关注再手术率、手术部位感染(SSI)、骶髂关节疼痛、器械失效和螺钉突出。方法:回顾性调查2011年6月至2017年5月在笔者所在机构行骶盆腔固定手术的患者。43例采用SAI螺钉固定，25例采用CI螺钉固定。分析SAI组和CI组的术前和手术特点、术后结局和并发症。分析手术前后影像学参数。结果:腰骶融合率SAI组与CI组比较差异无统计学意义(90.7% vs 92.0%， p=0.878)。与CI组相比，SAI组在SSI方面表现出明显良好的结果(0%比16%，p=0.016)，但远端螺钉骨折率明显高于CI组(16.3%比0%，p=0.042)。结论:与CI螺钉固定技术相比，SAI螺钉固定技术在疼痛缓解、畸形矫正、腰骶融合率等方面具有较好的效果，且并发症如再手术率、SSI、螺钉突出率等相对较低。然而，在SAI组中观察到的远端器械失效更为频繁，需要进一步的生物力学研究。
{"title":"Complication Profiles Associated with Sacral Alar Iliac Screw Fixation in Patients with Adult Spinal Deformity: A Comparative Analysis to the Conventional Iliac Screw Fixation","authors":"Ga-On Park, U. Choi, K. Kim, Jeong-Yoon Park, D. Chin, Keun-Su Kim, Yong-Eun Cho","doi":"10.21129/nerve.2021.7.2.71","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.71","url":null,"abstract":"Objective: This study aimed to compare the radiographic and clinical outcomes between sacral alar iliac (SAI) screw fixation and conventional iliac (CI) screw fixation with a particular focus on the rate of reoperation, surgical site infection (SSI), sacroiliac joint pain, instrument failure, and screw prominence.Methods: Patients who underwent sacropelvic fixation in the authors’ institution from June 2011 to May 2017 were retrospectively investigated. Forty-three patients with SAI screw fixation and 25 with CI screw fixation were included. Preoperative patient and surgical characteristics and postoperative outcomes and complications were analyzed between the SAI and CI groups. Radiographic parameters were analyzed before and after surgery.Results: Lumbosacral fusion rates showed no statistically significant difference between the SAI group and CI groups (90.7% vs. 92.0%, p=0.878). The SAI group showed a significantly good result with regard to SSI compared to the CI group (0% vs. 16%, p=0.016), but had a significantly higher rate of distal screw fracture than the CI group (16.3% vs. 0%, p=0.042).Conclusion: The SAI screw fixation technique could achieve good outcomes of pain relief, deformity correction, and lumbosacral fusion rate with relatively lower complications such as the rates of reoperation, SSI, and screw prominence as compared to the CI screw fixation technique. However, distal instrument failure was observed more frequently in the SAI group, requiring further biomechanical studies.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123963913","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 : 2021-10-31DOI: 10.21129/nerve.2021.7.2.99
Sung Kyu Song, Jong-myung Jung, W. Kim, Sang Gu Lee, Y. Ahn, Seong Son, B. Yoo
Cervical artificial discs (CADs) are a surgical option in selected patients with cervical spinal disc degeneration. Although CADs have been available for many years, concerns persist regarding long-term safety, durability, and implant-related failure. We report a case of nucleus herniation of a Mobi-C implant without trauma, which is a rare complication. Two years after implantation of a Mobi-C implant, a 47-year-old man presented with acute paraplegia without a history of trauma. On cervical magnetic resonance imaging, a T2-high signal intensity lesion was noted in the ventral aspect of the spinal cord at the T1-2 level. During emergent surgery, nucleus herniation of the Mobi-C was detected. After surgery, the patient could walk without assistance. Posterior herniation of the Mobi-C nucleus without trauma is a rare complication that should be considered in surgical planning and follow-up.
{"title":"Acute Paraplegia Due to Nucleus Herniation of a Mobi-C Implant without Trauma: Case Report of a Rare Complication","authors":"Sung Kyu Song, Jong-myung Jung, W. Kim, Sang Gu Lee, Y. Ahn, Seong Son, B. Yoo","doi":"10.21129/nerve.2021.7.2.99","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.99","url":null,"abstract":"Cervical artificial discs (CADs) are a surgical option in selected patients with cervical spinal disc degeneration. Although CADs have been available for many years, concerns persist regarding long-term safety, durability, and implant-related failure. We report a case of nucleus herniation of a Mobi-C implant without trauma, which is a rare complication. Two years after implantation of a Mobi-C implant, a 47-year-old man presented with acute paraplegia without a history of trauma. On cervical magnetic resonance imaging, a T2-high signal intensity lesion was noted in the ventral aspect of the spinal cord at the T1-2 level. During emergent surgery, nucleus herniation of the Mobi-C was detected. After surgery, the patient could walk without assistance. Posterior herniation of the Mobi-C nucleus without trauma is a rare complication that should be considered in surgical planning and follow-up.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"2008 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116939249","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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