Search

Abstract Background Meningioma is the second most common intradural extramedullary tumor, following schwannoma. Meningioma is primarily categorized as benign World Health Organization grade 1, but clear cell meningioma is grade 2 of the intermediate malignant category. Clear cell meningiomas are rare, accounting for less than 1% of all meningioma tumors. There is no previous report of multiple intraspinal clear cell meningiomas without dural attachment. Case presentation A 27-year-old Asian male patient presented with lower right extremity pain, and had undergone tumor resection for intracranial clear cell meningioma 7 years previously, with re-resection and radiotherapy for local tumor recurrence at our hospital’s department of neurosurgery being carried out 4 years previously. No recurrence was observed since then. Preoperative lumbar magnetic resonance imaging showed two tumors at the L1 and L4 levels, both mimicking schwannoma with well-defined margins, no dural tail sign and homogeneous internal contrast. Intraoperative findings on tumor resection showed two tumors contiguous with the right L2 and L5 roots, which were not attached to the dura mater, similar to a schwannoma. After gross total resection, the postoperative pathology revealed no nuclear SMARCE1 antibody staining. The patient was diagnosed with clear cell meningioma. The patient’s postoperative course went well, with no symptoms of nerve dropout and no recurrence 2 years after surgery. In this case, both lumbar lesions were well demarcated and spherical in shape, occurring with single roots. Tumor characteristics suggested a primary rather than a metastatic lesion. Clear cell meningioma is characterized by a SMARCE1 mutation and is different from other types of meningiomas. Conclusion To the best of our knowledge, this is the first report of multiple intraspinal clear cell meningiomas without dural attachment at the lumbar spine after resection of intracranial clear cell meningioma. We speculate that the two tumors were de novo lesions on the basis of the features of the tumors, although they were detected 7 years after the resection of intracranial clear cell meningioma.

Abstract Background Ectopic gas in the graft is occasionally encountered upon follow-up computed tomography (CT) after anterior cervical corpectomy and fusion (ACCF). However, most cases lack inflammatory responses and manifestations of infection. Although the clinical significance of ectopic gas in the graft has not yet been established, to the best of our knowledge, no previous studies have described ectopic gas in the graft after ACCF. This study evaluated ectopic gas in the fibular graft upon follow-up CT after ACCF. Methods We reviewed 112 patients who underwent ACCF and follow-up CT, with a minimum follow-up period of 3 years. CT images were retrospectively reviewed to confirm the presence of ectopic gas in the graft and bone fusion. Bone fusion was defined as follows: mobility less than 2 mm between spinous processes on the flection-extension radiograph or a bone bridge on CT images. Results Of the 112 patients, 30 (27%) patients had ectopic gas in the fibular grafts. Among them, ectopic gas was initially observed 3 months after surgery (early onset) in 23 (77%) patients and 6 months after surgery (late-onset) in the remaining seven (23%) patients. Upon the latest follow-up CT, ectopic gas more frequently remained in late-onset (4/7, 57%) rather than in early-onset (3/23, 13%) cases (p = 0.033). Bone fusion was not observed when CT images exhibited ectopic gas in the graft, whereas ectopic gas was not observed when CT images exhibited bone fusion. Conclusion Ectopic gas in the fibular graft was observed at both early and late-onset after ACCF; late-onset gas remained significantly. The remaining gas was strongly associated with pseudoarthrosis; therefore, pseudoarthrosis should be considered when ectopic gas in the graft is observed on CT images.

Backgrounds: For the surgical treatment of lumbar canal stenosis (LCS) due to spinal epidural lipomatosis (SEL), several studies have reported direct decompression, including fat debulking. However, none of these studies have mentioned indirect decompression for SEL. Here we report two cases in which indirect decompression with lateral interbody fusion (LIF) was effective in treating LCS due to SEL. Case description: Case 1 involves a 71-year-old male with LCS due to SEL at the L3/4 and L4/5 levels without a history of steroid usage. Case 2 involves a 60-year-old male with LCS due to SEL at the L2/3, L3/4, and L4/5 levels, who had been medicated with prednisolone (2.5 mg/day) and methotrexate (6 mg/week) for the treatment of remitting seronegative symmetrical synovitis with pitting edema syndrome. After oblique lateral interbody fusion and posterior fusion with percutaneous pedicle screw, the patients’ symptoms disappeared immediately. Postoperative magnetic resonance imaging showed that the epidural fat had been successfully stretched, and the dura was decompressed. Conclusions: Indirect decompression with LIF could be a new surgical option for treating LCS due to SEL.

The authors reported a 58-year-old male who suffered from severe low back pain due to kyphoscoliosis associated with congenital contractural arachnodactyly (CCA), a subset of Marfan syndrome. Posterior spinal corrective fusion surgery from T8 to the pelvis with pedicle subtraction osteotomy at L4 was conducted. Because of long upper extremities due to CCA, we had no choice but to keep his shoulders abducted 90°, horizontal flexed 30°, and elbow flexed 120° with the conventional arm table during the surgery. Immediately after the surgery, he complained of numbness on the lateral aspect of his right forearm, difficulty of elbow flexion, and supination. Postoperative upper arm magnetic resonance imaging revealed evidence of coracobrachialis, brachialis, and biceps brachii myositis resulted from denervation by musculocutaneous nerve. We diagnosed his symptoms as postoperative isolated musculocutaneous neuropathy (MCNP) based on physical and radiological findings. Weakness and numbness began to be resolved 1.5 months after the surgery. Active motion of the elbow started to recover two months after the surgery and completely recovered six months postoperatively. The potential cause of our patient’s pathology was regarded to be intraoperative malposition of the abnormal long arms. In conclusion, we reported a case of isolated MCNP after thoracolumbar spine surgery under prone position, which is extremely rare and not well known among surgeons. Therefore, spine surgeons should take care of arm position and joint angle even though prone surgery to prevent MCNP, particularly in the patient with long arm span because of Marfanoid.

Background: Although many complications of the spinal implant have been reported previously, to the best of our knowledge, this is the first report on a delayed implant complication of the ilium, leading to buttock pain and aggravated scoliosis. Case description: A 78-year-old woman underwent transforaminal lumbar interbody fusion with pedicle screws at the L4–L5 level at another institution. Preoperative symptoms, left leg pain, disappeared soon after surgery. However, 6 months post surgery, she experienced severe pain in her left buttock and sacroiliac joint area, which was treated only at our pain clinic. Based on our initial consultation 5 years after the operation, her plain radiography findings showed a 29° convex left-sided scoliosis spanning from the L1–L5. Computed tomography scan revealed apparent iliac bone erosion at the point of contact with the left-side screw head and rod at L5. The patient had painful scoliosis owing to implant irritation. Soon after the removal of the left implant, the pain was relieved and the degree of scoliosis decreased to 17°. Conclusion: This study reports the presence of an unexpected complication caused by pedicle screw fixation at the L4–L5 level. Although the implant was far from the iliac bone, at the L4–L5 fusion, it could cause erosion of the bone after the progression of L3–L4 and L5–S1 disk degeneration and aggravate scoliosis. Neurosurgeons should be aware that patients may present with buttock pain and unprecedented scoliosis by hardware irritation.

Aim: Spinal cord injury in elderly populations has increased in recent years. This study aimed to investigate the pathology, severity, efficacy of the surgery, and complications of cervical spinal cord injury in extremely elderly patients aged >80 years. Methods: Sixty-three patients who underwent surgical treatment for cervical spinal cord injury were enrolled in this retrospective multicenter study. Forty patients were aged