Purpose
We aimed to evaluate the feasibility of 3D broadband inversion-recovery-prepared ultrashort echo-time (3D IRP UTE) imaging for assessing ossification of the posterior longitudinal ligament ...(OPLL).
Materials and methods
The study consisted of 25 consecutive patients with cervical OPLL 13 women, 12 men; mean age 66.3 (47–84) years who underwent CT, 3T conventional MR, and 3D IRP UTE imaging studies. Two readers independently assessed the 3D IRP UTE images for the type (mixed, continuous, circumscribed, segmental) and distribution of OPLL. All readers consensually assessed the diagnostic certainty of OPLL on conventional MR and 3D IRP UTE images by using a 3-point scale system. Interobserver and intermodality agreement was assessed by κ statistics. A Wilcoxon signed-rank test was used to evaluate the difference of diagnostic certainty between conventional MR and 3D IRP UTE imaging.
Results
Interobserver and intermodality agreements were good (
κ
= 0.73) and excellent (
κ
= 0.81) for the OPLL type, and excellent (
κ
= 0.85) and good (
κ
= 0.76) for the assessment of the distribution of OPLL, respectively. The mean level of the diagnostic certainty of OPLL was significantly higher for 3D IRP UTE than conventional MR imaging (
p
= 0.002).
Conclusion
3D IRP UTE imaging may be useful for assessing OPLL.
Background: A halo vest is an immobilization device widely used to stabilize the cervical spine. Pain and infection at the skull pin insertion site are common complications, but skull perforation is ...rare, and most published studies are case reports. This study aimed to identify risk factors for skull perforation by comparing patients who did and did not develop perforation.Methods: Overall thickness and the thicknesses of the internal and external laminae of the skull at the skull pin insertion sites were measured on cranial computed tomography scans of 66 patients fitted with a halo vest. The results were compared between patients who did and did not develop perforation.Results: Four patients developed perforations. All patients with perforation were older women, and their external and internal laminae were significantly thinner than those of patients who did not develop perforation.Conclusion: The reported causes of skull pin perforation include infection around the pin, osteoporosis, and an enlarged frontal sinus. However, most patients with perforation in the present study were older women, and the cause was the thinning of the external and external laminae.
Introduction: Meningiomas and schwannomas are common intradural–extramedullary spinal tumors. Because of their different origins, they necessitate different surgical procedures, which makes ...preoperative diagnosis important.Methods: In this study, clinical and imaging data for 62 patients diagnosed with either meningioma or schwannoma across multiple institutions were analyzed.Results: The average age of patients was older (67.6 vs. 58.9 years), and the frequency of females was higher (72% vs. 46%) for meningioma than for schwannoma. Meningiomas were mostly found in the thoracic region (84%), whereas schwannomas were commonly located in the lumbar region (54%). For each tumor type, specific radiological findings were identified. For meningiomas, findings included the ginkgo leaf sign (GLS) (sensitivity 58%, specificity 100%), oval shape (sensitivity 84%, specificity 63%), dural tail sign (DTS) (sensitivity 75%, specificity 100%), and intertumoral calcification (sensitivity 39%, specificity 100%). Combining GLS and DTS greatly improved sensitivity to 89% (specificity 100%). For schwannomas, specific findings included a lobule shape (sensitivity 25%, specificity 95%), dumbbell shape (sensitivity 54%, specificity 100%), and cystic changes (sensitivity 54%, specificity 97%).Conclusions: GLS may be a specific radiological feature for meningiomas and can aid in diagnosis when combined with DTS. Understanding these distinct radiological characteristics is valuable for preoperative differential diagnosis of intradural–extramedullary spinal tumors.
A retrospective analysis of a prospective, non-randomized cohort dataset.
To cross-sectionally examine the prevalence of sarcopenia and the association between spine-pelvic deformity and skeletal ...muscle volume loss and ectopic fat infiltration into lumbar paravertebral muscles (PVMs) in patients who underwent lumbar surgery.
Muscle quality deterioration has been considered the main pathology of sarcopenia, reducing muscle strength directly. The qualitative deterioration as well as volume loss in PVM, which contributes significantly to core body extension, might cause aging-related spine deformity.
In total, 184 patients were included. Sarcopenia was diagnosed at baseline, and all patients underwent whole-body X-ray. The amount of fat in lumbar PVM was evaluated with the Goutallier classification in magnetic resonance imaging findings. The expression of adipogenesis- and atrophy-promoting factors in PVM was evaluated with quantitative polymerase chain reaction.
In total, 36.1% of adults aged ≥60 years were diagnosed with sarcopenia. The values of skeletal muscle indexes of the limb and trunk were inversely correlated with the sagittal vertical axis, pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI-LL) values. The PT and PI-LL were greater, PVM area was smaller, and Goutallier grade was greater in sarcopenic adults than in non-sarcopenic older adults. Additionally, the PVM area correlated with the LL value, and Goutallier's grade correlated with the PT and PI-LL values. Moreover, the amount of ectopic fat in PVMs inversely correlated with skeletal muscle indexes. The expression levels of atrophy gene-1 and muscle ring-finger protein-1 did not differ between the groups and did not correlate with the PVM area. In contrast, the expression of Pparg and Cebpa was upregulated in sarcopenic older adults, where it correlated with Goutallier's grade.
The volume loss of skeletal muscle, including lumbar PVM, and ectopic fat infiltration into the PVM, may cause the lumbo-pelvic deformity.Level of Evidence: 3.
Abstract Background Upper cervical spine instability is one of the most critical orthopedic problems in patients with Down syndrome. However, arthrodesis of the upper cervical spine in these patients ...can be very difficult to achieve and has a high complication rate because of mental retardation and accompanying various medical conditions of the vital organs. Even now, surgeries in such patients, especially pediatric cases, are challenging and the optimal operative procedure remains unsettled. The purpose of this study was to report 2 cases of pediatric atlantoaxial instability due to Down syndrome in which posterior occipito-axial fixation with C2 laminar screws was performed. Methods Case 1 was a girl aged 6 years 10 months who had atlantoaxial rotatory fixation with os odontoideum. Atlantoaxial rotatory fixation was incompletely reduced by halo traction, and it was not maintained without halo-ring and -vest fixation. Posterior occipito-axial fixation with bilateral C2 laminar screws was then performed. Case 2 was a boy aged 10 years 7 months who had atlantoaxial subluxation with os odontoideum. He also had incomplete quadriplegia, so he could neither walk nor have a meal by himself. Posterior occipito-axial fixation with right C2 pedicle and left C2 laminar screws was then carried out. Results In case 1 bone union was obtained at 3 months after surgery and the patient's symptoms were resolved. In case 2 bone union was obtained at 3 months after surgery and the paralysis was improved. Conclusions/level of evidence In cases of atlantoaxial instability due to Down syndrome, symptomatic patients often present between ages 5 and 15 years and mental retardation interferes with postoperative cervical immobilization. C2 laminar screws can be safely applied for the pediatric axis and biomechanically accomplished rigid fixation. The C2 laminar screw is one of the most useful options to achieve stability of the pediatric atlantoaxial complex without the risk of vertebral artery injuries (level IV case series).
Ureteral injury during lateral lumbar interbody fusion (LLIF) is uncommon. However, it is a serious complication that may require additional surgery should it occur. The objective of this study was ...to evaluate whether there was any change in the position of the left ureter between preoperative biphasic contrast-enhanced CT scanned in the supine position and intraoperative scanning in the right lateral decubitus position after stent placement, to assess the risk of ureteral injury in the actual surgical position.
The position of the left ureter scanned with the O-arm navigation system with the patient in the right lateral decubitus position and its position on preoperative biphasic contrast-enhanced CT images scanned with the patient in the supine position were investigated comparing their positions at the L2/3, L3/4, and L4/5 levels.
The ureter was located along the interbody cage insertion trajectory in 25 of 44 disc levels (56.8%) in the supine position, but in only 4 (9.5%) in the lateral decubitus position. The proportion of patients in whom the left ureter was located lateral to the vertebral body (along the LLIF cage insertion trajectory) at each level was 80% in the supine position and 15.4% in the lateral decubitus position at the L2/3 level, 53.3% in the supine position and 6.7% in the lateral decubitus position at the L3/4 level, and 33.3% in the supine position and 6.7% in the lateral decubitus position at the L4/5 level.
The proportion of patients in whom the left ureter was located on the lateral surface of the vertebral body when the patient was in the actual surgical position (lateral decubitus position) was 15.4% at the L2/3 level, 6.7% at the L3/4 level, and 6.7% at the L4/5 level, suggesting that caution is required during LLIF surgery.
To compare the efficacy of 2-octylcyanoacrylate (Dermabond; Ethicon Inc) with standard suture repair in the management of cervical laminoplasty. Fourty-five patients were enrolled in this study. ...Twenty-two patients were using Dermabond, and 23 were repaired using standard suture. All patients underwent surgery in 2010 and were observed three months or more after operation. Operation time, prone position time, incision length, intraoperative blood loss, days of drain and gauze removal and times to replace the gauze were examined. There were no adverse events in both groups. Significant difference in operation and prone position time, intraoperative blood loss, days of drain removal were not observed. The average days required for gauze removal using Dermabond was 6.73 days, which was significantly less than that required for suture repair (11.87 days) (p<0.05). And the average number of times to replace the gauze using Dermabond was 3.86, which was significantly less than that required for suture repair (5.22 times) (p<0.05). In the management of cervical laminoplasty, Dermabond is an effective repair technique.
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