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Spinal tuberculosis causes severe complications like neurological and spinal deformity which may lead to respiratory distress, costo-pelvic impingement, paraplegia and consequent reduction in the quality and longevity of life. The aim of the present treatment is to avoid the consequence of neural complications and gain near-normal spine. Mechanical factor causes pathological fracture or dislocation of an affected vertebral body. Surgical decompression ensues further instability. Reconstruction of spinal column by pedicle screw and rod provide stability and prevents secondary neural damage and deformity thereby helps in early mobilization. Prospective study was done to evaluate the results in 20 cases of spinal tuberculosis in thoracolumbar region associated with neurological deficit. We operated our cases (12 males and 8 females) by posterolateral decompression, fusion and stabilization by pedicle screw and rod along with antitubercular drug treatment. All patients were with neurological deficit, single level involvement and 10 to 30 degree of mild kyphosis. After surgery, kyphosis improved from 20.7 ± 5.5 degrees to 12.5 ± 3.9 degree. Bony fusion was in 65.0% cases. Neurological improvement and pain subsided in all the patients.

A 61-year-old male presented with a 2-year history of increasing back pain that particularly worsened when standing and walking. He complained of back pain and kyphotic deformity for more than 30 years. His medical history was non-significant other than spinal tuberculosis. He had no history of trauma and corrective surgery for kyphosis. The physical examination showed rigid kyphosis in the thoracolumbar region. Active and passive low back range of motion was limited and …

Background Extrarenal nephroblastomatosis is a rare entity which occurs in retroperitoneum and inguinal region predominantly. Here we report two cases of primary extrarenal nephroblastomatosis of Han Chinese in Asian in unusual locations, one is located in testis and paratestis, and the other is paraspinal cord. Case presentation Patient 1 was a 19-month-old boy with a hard and nodular mass adherent to the left testis in inguinal region. Patient 2 was a 9-month-old boy with a 1 × 0.7 × 0.4 cm mass in spinal canal at the midline thoracolumbar region. Histological examinations of the two patients after operations revealed extrarenall nephroblastomatosis with multiple nephrogenic foci, composed of immature glomeruli, tubules and blastemal cells.Then the patients were closely monitored without adjuvant chemotherapy, and has been alive and well without any recurrence for >6 months. Conclusions Most nephrogenic rests remain subclinical, and thus, complete excision of the lesion with conservative treatment is recommended. Otherwise, nephrogenic rests are close associated with Wilms tumor and regular follow-up is required to ensure early detection of malignant transformation.

A lesão medular é incapacitante, irreversível e de custo econômico e social elevado. Neste estudo, objetivou-se padronizar um modelo de lesão medular, que produza paraplegia, com o uso de cateter e avaliar histologicamente a efetividade da lesão para estudos com terapia celular. Foram realizadas as lesões medulares em ratos Wistar, utilizando-se o cateter Fogarty n.3 e compressão na região toracolombar (T8-T9) durante 5 minutos. Foram estudados três grupos: grupo A, animais controle sem lesão medular; grupo B, animais submetidos à lesão, utilizando-se 50µL de compressão; grupo C, animais submetidos à lesão, utilizando-se 80µL de compressão. Foi realizada avaliação motora pela aplicação da escala BBB, antes da compressão, após recuperação anestésica, 24 e 72 horas depois da compressão e sete dias após a compressão. Após o sétimo dia da lesão, os animais foram submetidos à eutanásia, foi feita a retirada da medula espinhal, fígado e rins e realizada a análise histológica com a coloração hematoxilina-eosina. A mortalidade variou entre os grupos, com 0% no grupo A, 38,5% no B e 48% no C. Nesses dois últimos grupos, a causa da morte foi edema pulmonar neurogênico, confirmado clínica e histologicamente. As medulas espinhais histologicamente apresentaram diferentes graus de edema, congestão vascular e hemorragia, enquanto que os fígados e os rins apresentaram diferentes graus de congestão vascular e necrose. Em relação à recuperação dos movimentos, no grupo A, verificou-se 100% de escore 21; no B, 25% de escore 21; 37,5% de escore 11; e 37,5% de escore 0; enquanto, no grupo C, verificou-se 100% de escore 0. Conclui-se que o procedimento realizado utilizando-se 80µL de solução salina para preencher o balão do cateter foi mais eficiente, apesar de maior mortalidade, pois apresentou maior porcentagem de animais com lesão completa (paraplegia). Spinal cord injury is disabling, irreversible and with high economic and social cost. This study aimed to standardize a model of spinal cord injury to induce paraplegia, with a catheter and to evaluate the effectiveness of the histological lesion for further studies with cell therapy. Cord lesions were performed in Wistar rats using the Fogarty catheter n.3 and compression in the thoracolumbar region (T8-T9) for 5 minutes. We studied three groups: A control group without spinal cord injury, B group subjected to 50?L compression injury, C group with animals subjected to 80?L compression injury. Motor evaluation was performed by applying the BBB scale, before compression, after recovery from anesthesia, 24 and 72 hours after compression and 7 days after compression. At the seventh day after injury, the animals were euthanized. The spinal cord, liver and kidneys were removed and a histological analysis was performed with hematoxylin-eosin staining. Mortality varied among groups, it was 0% in group A, 38.5% in group B and 48% in group C. In the latter two groups the cause of death was neurogenic pulmonary edema, clinically and histologically confirmed. Histologically the spinal cord showed different degrees of edema, hemorrhage and vascular congestion, while the liver and kidneys showed different degrees of vascular congestion and necrosis. Regarding movement recovery, in group A it was found a 100% score 21, in group B 25% of score 21, 37.5% score 11 and 37.5% of score zero, whereas in group C there was a 100% of score zero. It is concluded that the procedure performed using 80?L of saline to fill the balloon catheter was more efficient because, although the higher percentage of mortality, it induced a higher percentage of animals with complete injury (paraplegia).

WOS: 000346501700007 PubMed: 25031846 Introduction: The aim of this study was to report surgical strategies and clinical outcomes for thoraco-lumbar intradural lipomas. Intraspinal lipomas are rare congenital histologically benign neoplasms, which account for less than 1% of all spinal cord tumors. These tumors are most frequently found in the lumbosacral area as components of a dysraphic state, however, intramedullary lipomas are not associated with spina bifida or cutaneous malformations and have only been described as isolated cases among spinal lipomas, where the thoracolumbar region is rarely affected. Case Presentation: Three patients with thoracolumbar intradural lipomas were admitted to our clinic at different points of time. Partial resections and debulking of the tumors were achieved with the guidance of an operating microscope. We performed laminectomies or laminoplasties, for tumor resections. Discussion: Postoperatively, the patients demonstrated significant clinical improvements. In this manuscript we presented our surgical experiences for intraspinal lipomas.

Spinal cord diseases or injuries can cause dysfunction of the sensory and locomotor systems. Segmentation of the spinal cord provides measures of atrophy and allows group analysis of multi-parametric MRI via inter-subject registration to a template. All these measures were shown to improve diagnostic and surgical intervention. We developed a framework to automatically segment the spinal cord on T2-weighted MR images, based on the propagation of a deformable model. The algorithm is divided into three parts: first, an initialization step detects the spinal cord position and orientation by using the elliptical Hough transform on multiple adjacent axial slices to produce an initial tubular mesh. Second, a low-resolution deformable model is iteratively propagated along the spinal cord. To deal with highly variable contrast levels between the spinal cord and the cerebrospinal fluid, the deformation is coupled with a contrast adaptation at each iteration. Third, a refinement process and a global deformation are applied on the low-resolution mesh to provide an accurate segmentation of the spinal cord. Our method was evaluated against a semi-automatic edge-based snake method implemented in ITK-SNAP (with heavy manual adjustment) by computing the 3D Dice coefficient, mean and maximum distance errors. Accuracy and robustness were assessed from 8 healthy subjects. Each subject had two volumes: one at the cervical and one at the thoracolumbar region. Results show a precision of 0.30 ± 0.05 mm (mean absolute distance error) in the cervical region and 0.27 ± 0.06 mm in the thoracolumbar region. The 3D Dice coefficient was of 0.93 for both regions.

We report on an uncommon type of complex dumbbell schwannoma involving the thoracolumbar region, which was successfully managed with unilateral hemilaminectomy using a modified posterior approach. A 19-year-old male patient presented with one-year history of low back pain radiating to the lower limbs, limping of two month-history, and hesitancy of micturition of 15-day duration. Clinically, a diagnosis of conus-cauda lesion was suspected. Findings of the X-ray and magnetic resonance imaging of the dorsolumbar spine were suggestive of a complex dumbbell schwannoma, extending from the lower part of the T11 level to the upper part of the L1 vertebrae left to the spinal cord, with extension through the intervertebral foramina to the paraspinal region on the left side. A modified posterior approach with unilateral laminectomy was used for complete removal of the tumor. The histological diagnosis was schwannoma. The patient had minimal pain postoperatively, he was mobilized on the third day without the need for any external support. At one year follow-up, he had normal motor and sensory functions in the lower limbs., Bu yazıda, torakolomber bölgeyi tutan ve modifiye posterior yaklaşım ve tek taraflı hemilaminektomi ile başarılı bir şekilde tedavi edilen, nadir türde bir dumbel şıvanom olgusu sunuldu. On dokuz yaşındaki erkek hasta, bir yıldır var olan ve alt ekstremiteye yayılan bel ağrısı, iki aydır süren topallama ve 15 gündür var olan, idrar çıkarmada duraklama yakınmalarıyla başvurdu. Klinik olarak hastada konus-kauda lezyonundan şüphelenildi. Dorsolomber omurganın radyografi ve manyetik rezonans ile incelenmesi, oldukça karmaşık bir dumbel şıvanom ortaya çıkardı. Lezyon, T11 düzeyinin aşağısından, omuriliğin soluna doğru, L1 omurlarının üst kısmına ve intervertebral foramina boyunca sol taraftaki paraspinal bölgeye kadar uzanıyordu. Tümörün tümüyle çıkarılması için, modifikasyonlu posterior yaklaşımla tek taraflı laminektomi uygulandı. Histopatolojik tanı şıvanom olarak bildirildi. Hastanın ameliyattan sonra hafif ağrı dışında bir sorunu olmadı, üçüncü günde herhangi bir destek olmaksızın yürütülmeye başlandı. Bir yıllık izleminde alt ekstremitelerin motor ve duyu fonksiyonları normal bulundu.

Existing reports concerning intervertebral disc disease (IVDD) have focused almost exclusively on dogs, although a small number of individual case reports of IVDD of cats has been published. The medical records of six cats with IVDD were reviewed. Radiographic studies confirmed narrowed intervertebral disc spaces, mineralised intervertebral discs, and one or more extradural compressive lesions of the spinal cord in each cat. All disc extrusions were located in the thoracolumbar region. Surgical decompression of the spinal cord was achieved in all cats by means of hemilaminectomy and removal of compressive extradural material confirmed to be degenerative disc material. Good to excellent neurological recovery was noted in five of the six cats included in this report. Based on this review, it appears that IVDD of cats has many similarities to IVDD of dogs, and that healthy cats with acute intervertebral disc extrusion(s) respond favourably to surgical decompression of the spinal cord.

Study Design. Ex vivo biomechanical study using osreoporotic cadavetic vertebral bodies. Objective. To determine the association between the volume of compent injected during percutaneous vertebroplasty and the restoration of strength and stiffness in osteoporotic vertebral bodies, two investigational cements were studied: Orthocomp (Orthovita, Malvern, PA) and Simplex 20 (Simplex P with 20% by weight barium sulfate content: Stryker-Howmedica-Osteonics, Rutherford, NJ). Summary of Background Data. Previous biomechanical studies have shown that injections of 8-10 mL of cement during vertebroplasty restore or increase vertebral body strength and stiffness; however, the doseresponse association between cement volume and restoration of strength and stiffness is unknown. Methods. Compression fractures were experimentally created in 144 vertebral bodies (T6-L5) obtained from 12 osteoporotic spines harvested from female cadavers. After initial strength and stiffness were determined, the vertebral bodies were stabilized using bipedicular injections of cement totaling 2, 4, 6, or 8 mL and recompressed, after which post-treatment strength and stiffness were measured. Strength and stiffness were considered restored when post-treatment values were not significantly different from initial values. Results. Strength was restored for all regions when 2 mL of either cement was injected. To restore stiffness with Orthocomp, the thoracic and thoracolumbar regions required 4 mL, but the lumbar region required 6 mL. To restore stiffness with Simplex 20, the thoracic and lumbar regions required 4 mL, but the thoracolumbar region required 8 mL. Conclusion. These data provide guidance on the cement volumes needed to restore biomechanical integrity to compressed osteoporotic vertebral bodies.

A 48-year-old male presented with progressive leg weakness. Magnetic resonance imaging and computed tomography myelography showed an extradural arachnoid cyst extending from the T-12 to L-2 levels in the thoracolumbar region. The cyst was confirmed at surgery and completely removed. This surgical intervention achieved improvement in the neurological symptoms.

The Quantec Spinal Imaging System (QSIS) is a raster stereography used to measure three-dimensional trunk images. The Q angle, a coronal plane measurement generated by the Quantec Spinal Imaging System (QSIS), was compared with the Cobb angle in assessment of scoliosis curve magnitude. One hundred forty-nine patients with idiopathic scoliosis were evaluated using both the Quantec system and plane radiographs. The Cobb and Q angles demonstrated significant correlation in the thoracic region (r = 0.65, p < 0.05), lumbar region (r = 0.63, p < 0.05), and in the thoracolumbar region (r = 0.70, p < 0.05). The difference between the Q and Cobb angles was small when the Cobb angle was

Neaas A.: Clinical Aspects of Surgical Treatment of Thoracolumbar Disc Disease in Dogs. A Retrospective Study of 300 Cases. Acta Vet. Brno 1999, 68: 121–130. The clinical records of 300 dogs with thoracolumbar disc disease treated by decompressive surgery at the Clinic of Surgery and Orthopedics at University of Veterinary and Pharmaceutical Sciences in Brno during a four year period (April 1994 through March 1998) were reviewed. The breed, age and sex predisposition, the frequency of disc extrusion at each intervertebral disc space in thoracolumbar region of spine, and the location of extruded disc material relative to the spinal cord were recorded. The number of patients with multiple disc herniations was also recorded. Dogs were grouped by clinical signs of disease into five groups (I, II, III, IVA, IVB and IVC grades). Recovery rates depending on the preoperative neurological grade of spinal injury and duration of clinical signs were compared. Patients were observed at least 9 months after surgery. All dogs were treated by hemilaminectomy without prophylactic fenestration of other disc spaces. The results of treatment in ten dogs with grade II involvement were excellent in 80% of these dogs, very good in 10%, and fair in 10%. The results of treatment in 68 dogs with grade III involvement were excellent in 80.88% of these patients, very good in 8.82 %, and fair in 10.29%. The results of treatment in 111 dogs with grade IV A involvement in which decompression was performed within 48 hours of the onset of clinical signs were excellent in 71.17% of these patients, very good in 12.61%, fair in 14.42%, and poor in 1.80%. The results of treatment in 56 dogs with grade IV A involvement in which decompression was performed later than 48 hours after onset of paraplegia were excellent in 46.43%, very good in 25.00%, fair in 17.87%, and poor in 10.70%. Hemilaminectomy was performed in thirty-one dogs with severe neurological dysfunction (group IV B) within 48 hours after onset of paraplegia. Outcome of the surgery was excellent in 22.58% of these patients, very good in 6.45%, fair in 48.39%, and poor in 22.58%. The results of treatment in 5 dogs with grade IV C involvement were excellent in 40% of these patients, and fair in 60%. Nineteen dogs died in the perioperative or early postoperative period and thus were lost to follow-up. Recurrence of neurological deficits in the remaining group of 281 clinical patients was assessed. The recurrence rate observed from 9 to 51 months after surgery, was 14.59 % (41 cases). Fourteen dogs had a recurrence of paraparesis (grade II and III) and twenty-seven dogs had paraplegia (grade IV) 1 to 30 months (mean 10.27 ± 7.25 months) after surgery. In all 41 cases cause of the recurrence was extrusion of other disc.

Sirs: Spinal subarachnoid hemorrhage (SAH) acounts for less than 1% of SAHs. Cerebral complications are uncommon and moderate in severity. We report on a 30year old woman suffering from severe cerebral vasospasms, without subarachnoid blood in successive cranial CT scans, due to spinal SAH caused by a ruptured solitary spinal aneurysm of unknown etiology. The patient suffered from a graft-versus-host reaction of her transplanted kidney. Under immunosuppression, she developed recurrent pneumonias and a septicemia with unknown germ that were treated by intravenous antibiotics. In the further course, she suddenly presented with headache, back pain and progressive behavioural disturbances. Cranial CT at this time was normal. Three lumbar punctures revealed a hemorrhagic CSF that was considered to be artificially bloody. Because of increasing paraparesis and rectal incontinence, the patient was referred to our clinic one week later. On admission, she was in poor clinical condition with reduced consciousness, no speech production, nuchal rigidity and paraplegia lasting for more than 24 hours. Cranial CT was normal, whereas cranial MRI showed bilateral MCA-infarction on diffusionweighted MRI (Fig. 1A). Spinal MRI revealed a ventrally located intraspinal circular tumour at the level of the twelfth thoracic vertebra with an intradural T1-hyperintensive signal in the thoracolumbar canal (Fig. 1B). Suboccipital puncture yielded a hemorrhagic CSF (2540 cells per ll). Conventional panangiography revealed a solitary aneurysm (8 · 15 mm) originating from the descending branch of the anterior spinal artery at the level of the twelfth thoracic vertebra (Fig. 1C) as well as generalised, severe cerebral vasospasms. Despite immediate triple-Hand nimodipine-therapy, CT 12h later demonstrated large bilateral MCAinfarction, but was still without any cerebral SAH (Fig. 1D). Because of the infavorable prognosis, palliative treatment was carried out until death due to a pneumogenic sepsis 23 days later. To date, 20 cases of spinal SAH due to a rupture of isolated spinal aneurysms have been reported [1–2, 4–16]. Of the eight reported patients with thoracolumbar aneurysms, all had an acute onset of pain in the thoracolumbar region [1, 8, 11, 13, 15]. Three also had paraparesis [1, 8]. Six of the eight patients were treated surgically [8, 11, 13, 15] whilst the other two had a conservative treatment [1]. All patients recovered either without or with minor neurological deficits. The authors found two dissecting aneurysms [8], an inflammation within the vessel wall in two cases [1, 11] and no evident etiology in the other four reports [1, 8, 13, 15]. In our patient, general autopsy did not reveal any underlying systemic (e.g. polyarteriitis nodosa, connective tissue disorder, syphilis), cerebral or further spinal vascular pathology. Since the SAH was related in timing to systemic infection in the context of immunosuppression, the aneurysm may result from a local inflammation. Morphologically, inflammatory aneurysms are characterised by proliferation of the tunica intima and media as well as inflammatory infiltrates. Infectious agents may be detected within the vessel wall [4, 11]. However, the aneurysm in our patient only yielded a prominent fibroblastic proliferation without inflammatory infiltrates (Fig. 2). Additional analysis of blood and CSF samples did not contain any germs and all serological tests were negative. Thus the inflammatory etiology remains speculative. In summary, we present the case of a young woman who suffered from symptomatic cerebral vasospasms due to spinal SAH caused by a ruptured solitary spinal aneurysm. Pathogenesis of cerebral vasospasm is unclear, but is most probably due to a distant inflammatory response caused by the subarachnoid blood [3]. Although there have been a few R. Surges AE M. Schubert AE C. Weiller A. Hetzel AE W.-D. Niesen (&) Dept. of Neurology University Clinics of Freiburg Breisacherstr. 64 79106 Freiburg, Germany Tel.: +49-761/270-5157 Fax: +49-761/270-5328 E-Mail: wolf-dirk.niesen@uniklinikfreiburg.de

Coverage of midline posterior wounds presents a challenge to the reconstructive surgeon, especially when spinal stabilization hardware has been present and exposed in the wound. Most commonly those wounds that involve the mid to upper thoracic spine have been covered by latissimus dorsi muscle or musculocutaneous flaps. Lower midline wounds, especially in the thoracolumbar region, have needed more complex means of coverage. These have included reversed latissimus dorsi flaps, free flaps, extended intercostal flaps, or fasciocutaneous rotation flaps. We have utilized a far simpler and effective muscle flap: the paraspinous muscle flap. We have raised paraspinous muscle flaps bilaterally and have been able to cover a number of difficult wounds. The wounds were presented by 8 patients with exposed Harrington rods, 3 patients with cerebrospinal fluid leaks, and 1 patient with exposed spinous processes. The wounds in 5 of these 12 patients were in the upper thoracic region, where a latissimus flap was utilized as an additional layer of muscle coverage. The other seven patients had wounds in the lower midline region below the potential reach of the latissimus dorsi. In the latter patients the only flaps employed were paraspinous muscle flaps. We had only one failure in all patients, which involved a recurrent cerebrospinal fluid leak in which there was no decompression of the cerebrospinal fluid pressure utilized in the immediate postoperative period to protect the dural repair. In that instance, a leak recurred. This paper presents the method of flap elevation and the results of our series.

STUDY DESIGN A case report of aggressive multilevel Charcot spinal arthropathy treated with staged spinal instrumentation. OBJECTIVES To report an unusual case of Charcot spinal arthropathy, given the rapidity of progression and extent of tissue destruction, and present the results of successful spinal instrumentation and stabilization. SUMMARY OF BACKGROUND DATA Charcot spinal arthropathy in the long-standing paraplegic patient is more commonly seen in those who have undergone prior spinal surgery and is usually restricted to 2 spinal levels. METHODS A 36-year-old amateur weight lifter with T6 complete paraplegia presented with lower thoracic back pain, a kyphotic deformity of the thoracolumbar region, and gross spinal instability on transferring. Imaging revealed extensive bony destruction from T10-T12 and complete absence of spinal tissue over the affected levels. Staged anterior and posterior spinal instrumentation from T3 to L4 was performed. RESULTS Spinal stabilization was achieved, and the patient was pain free and able to resume light training at 6-month follow-up. CONCLUSIONS We would advise a high index of suspicion of Charcot arthropathy in the active paraplegic patient presenting with back pain caudal to their sensory level. Staged spinal instrumentation is an effective treatment for multilevel Charcot spinal arthropathy.

Primary osteosarcoma of the spine is rare. The reported prevalence of osteosarcoma of spinal origin is less than 3 per cent of all osteosarcomas1,2,7; Shives et al., for example, reported such a lesion in only twenty-seven of 1122 patients who had a primary osteosarcoma. We believe that en bloc resection with a wide margin is the ideal treatment for any osteosarcoma; however, this procedure is very difficult to perform for an osteosarcoma of the spine because of the proximity of the spinal cord and the major vessels. Because it is difficult to excise the spinal tumor completely7,9, the prognosis after treatment of an osteosarcoma of the spine continues to be poor compared with that after treatment of an osteosarcoma in an extremity. We report the case of a patient who was managed successfully with total en bloc spondylectomy10,11 for a primary osteosarcoma of the spine involving the eleventh thoracic through second lumbar vertebral levels. A sixteen-year-old boy was seen because of a four-month history of stiffness and severe pain in the thoracolumbar region of the back. Physical examination demonstrated tenderness in the area of the posterior elements of the eleventh and twelfth thoracic and first lumbar vertebrae, without neurological deficit. Plain radiographs showed increased bone density at the level of the twelfth thoracic vertebra and diffuse sclerotic changes in the paravertebral soft tissues at the levels of the eleventh thoracic through second lumbar vertebrae (Figs. 1-A and 1-B). The computerized tomography scan demonstrated that the tumor included the entire twelfth thoracic vertebra as well as segments of the eleventh thoracic vertebra. There was extensive paravertebral and epidural involvement in the region of the eleventh thoracic through first lumbar vertebrae as well as bilateral invasion of the paraspinous …

Restoration of normal micturition in SCI patients is a major goal in neuro-urology. The ideal therapy would be to achieve repair of the injured spinal cord, but this is not feasible at the present time. Thus, other procedures have been deployed, including intermittent catheterization, electrical stimulation of the sacral ventral roots, continence diversion and external sphincterotomy [1–3]. Unfortunately, these approaches have hardly led to satisfactory outcomes in the majority of SCI cases. Recently, Xiao et al. reported a series of experimental and clinical studies attempting to establish a “skin-central nervous system (CNS)-bladder” reflex pathway to trigger bladder contraction [4–6]. However, this technique was useful only in the cases of spastic bladder incurred by supraconal injuries. Clinically, fracture-dislocation of the spinal column was most commonly witnessed in the thoracolumbar region (T12/L1), This is more likely to result in damage to the spinal cone and bladder center, triggering hypotonia and decreased bladder contractile strength. This study was performed in an attempt to demonstrate that restoration of autonomic micturition in the atonic bladder by re-establishment of afferent and efferent nerve pathways is achievable.

Background Most information about spinal arachnoid diverticula (SADs) in dogs has been retrieved from relatively small case series. The aim of this study was to describe this disease in a larger number of dogs. Objectives Description of the signalment, clinical presentation, and imaging findings of a large number of dogs with SADs. Animals One hundred and twenty-two dogs with SADs. Methods Retrospective case series study. All medical records were searched for a diagnosis of SAD. The diagnosis was made based on myelography, computed tomography myelography (CT-m), or magnetic resonance imaging (MRI). Results In the 122 dogs, 125 SADs were identified. Sixty-five were located in the cervical region and 60 in the thoracolumbar region. A higher body weight was significantly associated with a cervical localization of the SAD (P

In the thoracolumbar region, between 7% and 30% of spinal fusion failures are at risk for pseudarthrosis. From a biomechanical perspective, the nonconformity of the intervertebral graft to the endplate surface could contribute to pseudarthrosis, given suboptimal stress distributions. The objective of this study was to quantify the effect of endplate-graft conformation on endplate stress distribution, maximum Von Mises stress development, and stability. The study design used an experimentally validated finite element (FE) model of the L4–L5 functional spinal unit to simulate two types of interbody grafts (cortical bone and polycaprolactone (PCL)-hydroxyapatite (HA) graft), with and without endplate-conformed surfaces. Two case studies were completed. In Case Study I, the endplate-conformed grafts and nonconformed grafts were compared under without posterior instrumentation condition, while in Case Study II, the endplate-conformed and nonconformed grafts were compared with posterior instrumentation. In both case studies, the results suggested that the increased endplate-graft conformity reduced the maximum stress on the endplate, created uniform stress distribution on endplate surfaces, and reduced the range of motion of L4–L5 segments by increasing the contact surface area between the graft and the endplate. The stress distributions in the endplate suggest that the load sharing is greater with the endplate-conformed PCL-HA graft, which might reduce the graft subsidence possibility.

Study design A retrospective study to review the results of unstable thoracolumbar burst fractures managed with casting or bracing and early ambulation in neurologically healthy patients. Objectives To determine the clinical outcome of patients with unstable burst fractures of the thoracolumbar spine treated without surgery, and to identify any variables that may adversely influence the final outcome. Summary of background data The management of unstable fractures of the thoracolumbar spine as described by Bedbrook involves a period of recumbency for 6-8 weeks followed by gradual mobilization. Newer techniques of surgical stabilization of the fracture and decompression of the neural elements have become popular because immediate stability of the spine is created and because the need for prolonged bedrest and hospitalization is eliminated. There have been only three reports in the literature describing the nonoperative management of these fractures with early mobilization; some authors believe that this is appropriate only if the posterior column is intact. The results reported in the literature of nonoperative management of thoracolumbar burst fractures have indicated that this is an effective method of management. Methods A retrospective review of 26 patients with unstable burst fractures in the thoracolumbar region (T11-L2) was performed; follow-up evaluation was obtained from 24 patients. Clinical follow-up examination was performed by the use of a questionnaire in which the patients were asked to rate their pain, ability to work, ability to perform in recreational activities, and their overall satisfaction with treatment. Results Mean follow-up time for the 24 patients was 34.3 months. Mean duration of hospitalization was 8.2 days; those patients who did not have injuries other than their spine fracture had a mean hospitalization time of 5.9 days. Kyphotic deformity could be corrected with hyperextension casting but tended to recur during the course of mobilization and healing. No correlation was found between kyphosis and clinical outcome. At final follow-up evaluation, 19 patients (79%) had little or no pain; 18 patients (75%) had returned to work; 18 (75%) stated that they had little or no restrictions in their ability to work, and 16 (67%) stated that they had little or no restrictions in their ability to participate in recreational activities. Only one patient (4%) reported being dissatisfied with the initial nonoperative treatment of his spine fracture. Ten patients were found to have evidence of spinous process widening on plain films; there was no significant difference in the clinical or radiographic outcome of these 10 patients when compared with the 14 others who did not have interspinous widening. Conclusions Nonoperative management of thoracolumbar burst fractures with hyperextension casting or bracing was proven to be a safe and effective method of treatment in selected patients. Clinical results were favorable; no neurologic deterioration was observed; hospitalization times were minimized, and patient satisfaction was high. The authors do not believe that ligamentous injury of the posterior column is a contraindication to nonoperative management of thoracolumbar burst fractures.

Presentation of Case A 21-year-old woman was admitted to the hospital because of thoracolumbar pain. The patient had been well until 17 weeks earlier, when she began to have pain in the midline thoracolumbar region of the spine, with radiation to the right flank, accompanied by nocturnal fever. The pain was aggravated by coughing, sneezing, straining, and recumbency and was not relieved by acetaminophen. Fourteen weeks before admission she came to this hospital. Her temperature was 38°C. The physical examination was normal except for tenderness in the right costovertebral angle and a narrow introitus that prevented a digital examination. The . . .

We experienced two cases of extradural arachnoid cysts in the thoracolumbar region.Case 1: A 13-year-old female suffered from low back pain and progressive weakness of her lower limbs. MRI and myelogram showed a cystic lesion located in the posterior part of the spinal canal which was compressing the spinal cord at the Th12-L3 level. Cine MRI revealed turbulence in the cyst and spinal fluid flow between the subarachnoid space and cyst. We confirmed that the extradural arachnoid cyst communicated with the subarachnoid space. After extirpation of the cyst and closure of the communicating fissure, complete motor recovery was seen and the patient's low back pain disappeared.Case 2: A 65-year-old female suffered from low back pain and was unable to walk due to palsy of her lower limbs. Although an arachnoid cyst at the Th11-L2 level was suspected from MRI and myelogram, neither turbulence in the cyst nor communication flow was seen in tine MRI. Fluid aspiration improved the palsy of her lower limbs, however MRI taken 3 days later revealed accumulation of fluid and the palsy exacerbated after 3 weeks. Surgery was performed, at which time it was found that the arachnoid cyst communicated with the subarachnoid space. The cyst was extirpated and the connecting pedicle ligated. Complete motor recovery was seen 3 months after surgery.

Split notochord syndrome represents an extremely rare and pleomorphic form of spinal dysraphism characterized by a persistent communication between the endoderm and the ectoderm, resulting in splitting or deviation of the notochord. It manifests as a cleft in the dorsal midline of the body through which intestinal loops are exteriorized and even myelomeningoceles or teratomas may occur at the site. A rare variant was diagnosed on autopsy of a 23+4-week-old fetus showing a similar dorsal enteric fistula and midline protruding intestinal loops in thoracolumbar region. The anteroposterior radiograph showed a complete midline cleft in the vertebral bodies from T11 to L5 region, and a split in the spinal cord was further confirmed by ultrasonography. Myelomeningocele was erroneously reported on antenatal ultrasound. Thus, awareness of this rare anomaly is necessary to thoroughly evaluate the cases of such spinal defects or suspected myelomeningoceles.

We present a retrospective study of 15 cases with severe posttuberculous kyphosis of thoracolumbar region that underwent posterior vertebral column resection. From 2004 to 2009, 15 consecutive patients with posttubercular kyphotic deformity underwent posterior vertebral resection osteotomy. Six subjects were females and nine were males with an average age of 35.8 years (range 20–60 years) at the time of surgery. None of the patients had neurological deficits. The mean preoperative visual analogue scale was 8.7 (range 3–9), and the average preoperative Oswestry Disability Index was 46.5 (range 40–56). The average duration of postoperative follow-up was 36.1 ± 10.7 months (range 24–62 months). The number of vertebra resected was 1.3 (range 1–2) on average. There were ten patients with one-level osteotomy and five patients with two-level osteotomy. The average operation time was 446.0 ± 92.5 min (range 300–640 min) with an average blood loss of 1,653.3 ± 777.9 ml (range 800–3000 ml). The focal kyphosis before surgery averaged 92.3 ± 8.9° (range 74–105°), and the kyphotic angle decreased to 34.5 ± 8.7° on average after the surgical correction. The average kyphotic angle at the last follow-up was 36.9 ± 8.5°, loss of correction was 2.4 ± 1.4° on average. All patients postoperatively received bony fusion within 6–9 months. Our results showed that although posterior vertebral resection is a highly technical procedure, it can be used safely and effectively in the management of severe posttuberculous kyphosis. It is imperative that operations be performed by an experienced surgical team to prevent operation-related complications.

The experience at Istituto Rizzoli with 366 primary bone tumors of the spine focuses on the criteria for planning and treatment. An accurate preoperative evaluation by standard radiograph, computerized tomography scan, and magnetic resonance imaging allow the classification of benign lesions as latent (not requiring treatment), active (curettage), or aggressive (curettage plus adjuvants or marginal resection). The malignant lesions are classified as intracompartmental or extracompartmental (both low and high grade). Wide resection is attempted, but seldom is feasible. An angiographic study of the spinal cord is compulsory for lesions located in the thoracolumbar region. The value of embolization is enhanced, primarily in highly vascular lesions. An accurate preoperative study of the vital parameters of the patient, together with a continuous intraoperative monitoring, is mandatory.

In this paper we describe a method for the continuous infusion of putative repair-enhancing substances into the rat spinal cord subarachnoid space, thereby allowing investigation of the process of naturally occurring and graft assisted repair of the spinal cord. Solutions are delivered into the rat CSF from an osmotic mini-pump via a purpose-made fine-silicone catheter. Under general anaesthesia a T13 to L2 laminectomy is performed to expose the dura covering the spinal cord. The osmotic mini-pump is placed in a subcutaneous pouch in the left thoracolumbar region with the silicone catheter looping forward in the subcutaneous plane before entering the subarachnoid space through a durotomy in the rostral extent of the exposed dura. A technique of fixation has been developed which prevents migration, disconnection or kinking of the mini-pump and catheter assembly. Dye infusion, post-mortem and histological studies have been used to validate the method and its reliability.

The aim of this study was to identify the prevalence of proximal junctional kyphosis (PJK) in degenerative lumbar scoliosis (DLS) following long instrumented posterior spinal fusion, and to search for predictable risk factors for the progression of junctional kyphosis. In total 98 DLS patients with a minimum 2-year follow-up were reviewed prospectively. According to the occurrence of PJK at the last follow-up, patients were divided into 2 groups: PJK group and non-PJK group. To investigate risk values for the progression of PJK, 3 categorized factors were analyzed statistically: patient characteristics—preoperative data of age, sex, body mass index (BMI), bone mineral density (BMD) were investigated; surgical variables—the most proximal and distal levels of the instrumentation, the number of instrumented levels; pre- and postoperative radiographic parameters include the scoliotic angle, sagittal vertical axis, thoracic kyphosis, thoracolumbar junctional angle, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope. PJK was developed in 17 of 98 patients (17.3%) until to the final follow-up and were enrolled as the PJK group, and 81 patients without PJK at final follow-up were enrolled as the non-PJK group. There was no statistically significant difference between the 2 groups in age at operation (P = 0.900). The patient's sex was excluded in statistical analysis because of the predominance of female patients. There were statistically significant difference between the 2 groups in BMI ([25.5 ± 1.7] kg/m2 in the PJK group and [23.6 ± 1.9] kg/m2 in the non-PJK group, P 25 kg/m2, osteoporosis, and UIV at thoracolumbar junction were independently associated with PJK. In conclusion, osteoporosis, obesity, and UIV at thoracolumbar junction are risk factors for the development and progression of PJK in DLS patients following long instrumented posterior spinal fusion. Antiosteoporosis treatment extends the fusion level above the thoracolumbar region and controlling body weight before and after surgery could provide opportunities to reduce the rate of PJK and to improve therapeutic outcomes.

Background Vertebral fractures are the hallmark of bone fragility and are frequently present in patients with ankylosing spondylitis (AS). For treating rheumatologists, it is important to know which patients already have vertebral fractures and which patients are at risk to develop new fractures. Limited longitudinal data are available concerning the development of new vertebral fractures in AS. Objectives To investigate the prevalence and incidence of radiographic vertebral fractures and the association with patient characteristics, clinical assessments, and medication use in a large prospective cohort of patients with ankylosing spondylitis (AS) in daily clinical practice. Methods Consecutive AS patients from the Groningen Leeuwarden AS (GLAS) cohort with baseline and 2-year lateral radiographs of the thoracic and lumbar spine were included. Radiographs were scored for vertebral fractures by two readers according to the method of Genant et al . Vertebral fractures were defined as ≥20% reduction in vertebral height. Severity of fractures were divided into mild (20–25% reduction), moderate (25–40% reduction), and severe (>40% reduction) fractures. Differences in baseline characteristics were explored between patients with and without radiographic vertebral fractures. Results Of 292 included AS patients, 70% were male, 82% HLA-B27+, mean age was 43±13 years, median symptom duration 16 (IQR: 8–25) years, and mean BASDAI 5.3±2.2. Radiographic vertebral fractures were present in 59 (20%) patients at baseline. During 2 years of follow-up, 15 (6%) patients developed new vertebral fractures and 7 (2%) showed an increase in severity of existing fractures. Most fractures were mild and located in the mid-thoracic and thoracolumbar region of the spine. The presence of vertebral fractures was significantly associated with older age, higher BMI, longer smoking duration, larger occiput-to-wall distance, more spinal radiographic damage, and lower hip BMD. Occiput-to-wall distance was identified as an independent risk factor for prevalent vertebral fractures; 44% of the patients with hyperkyphosis (occiput-to-wall distance ≥10 cm) had vertebral fractures. The development of new or progressive vertebral fractures was also associated with older age and low BMD. Patients using NSAIDs at baseline showed less prevalent (18% vs. 31%) and incident (5% vs. 17%) vertebral fractures than patients without NSAIDs. Conclusions In this large AS cohort in daily clinical practice, radiographic vertebral fractures were frequently present, especially in older patients with more advanced disease, low hip BMD, and a less healthy lifestyle. Interestingly, NSAID use was associated with a reduced vertebral fracture risk. Acknowledgement The GLAS cohort was supported by an unrestricted grant from Pfizer. Pfizer had no role in the design, conduct, interpretation, or publication of this study. Disclosure of Interest F. Maas: None declared, A. Spoorenberg Grant/research support from: Abbvie, Pfizer, UCB, Consultant for: Abbvie, Pfizer, MSD, UCB, Novartis, B. van der Slik: None declared, E. van der Veer: None declared, E. Brouwer Grant/research support from: Pfizer, H. Bootsma: None declared, R. Bos Grant/research support from: Pfizer, F. Wink Consultant for: Abbvie, S. Arends Grant/research support from: Pfizer

Spinal fractures are common in the thoracolumbar region. Assessment of fracture instability is often made from fracture patterns seen on plain radiographs or CT scans. The purpose of this in vitro study was to correlate three-dimensional flexibility to each fracture type, i.e., endplate, wedge, and brust. Ten fresh cadaveric human spine specimens (T11-L1) were incrementally impacted in a high-speed trauma apparatus until a fracture occurred. All fractures were produced by the same mechanism (axial compression/flexion load). The occurrence of a fracture was monitored by lateral radiographs of the specimen, whose canal was lined with 1.6-mm steel balls. After each impact, the specimen was studied for its flexibilily in flexion, extension, left and right lateral bindings, and left and right axial rotations. The flexibility was determined in response to the application of maximum pure moments of 7.5 Nm. Each moment was applied individually and in three load cycles. Parameters of neutral zone (NZ) and range of motion (ROM) were computed. Average flexion-extension ROM (and NZ) for intact, endplate, wedge, and burst fracture were respectively, 12.7° (1.3°), 13.9° (1.7°), 19.2° (3.2°), 22.0° (6.0°). The average lateral bending ROM (NZ) were 12.6° (1.2°), 13.6° (1.9°), 19.1° (3.7°), 27.2° (9.8°). The average axial rotation ROM (NZ) were 4.7° (0.4°), 6.1° (0.7°), 7.1° (1.0°), 12.9° (3.1°). The highest instability (fracture/intact motion) was seen in the axial rotation NZ in all three fracture types: 3.2, 5.4, and 14.7, respectively, for the endplate, wedge, and brust fractures. The average kinetic energy and force necessary to produce endplate, wedge, and burst fractures were 57, 84, 104 Nm, and 4.8, 6.5, 6.3 kN, respectively.

IntroductionVCR is the most suitable osteotomy for rigid angular kyphosis especially if the correction needed is high. The prospective cohort study assessed the efficacy of Posterior Vertebral Column Resection (PVCR) in management of Fixed Angular Kyphosis (FAK).Patients and MethodsThirteen cases of FAK managed by PVCR in Assiut University Hospital and followed up for a mean of 20.31 (12–48) months. Seven cases (53.8%) were females and six cases were males, the mean age was 13.77 years. Eleven cases were congenital (84.6%) and two cases were post tuberculous. Five cases (38.5%) affected the thoracic region, six cases (46.2%) affected thoracolumbar region and two cases (15.4%) affected lumbar region. VAS, ODI, SRS-22, and neurology together with local kyphotic angle were compared pre, post and at last follow up visit. One case suffered progressive paraplegia.ResultsFive osteotomies were at L1; four at D11, and one osteotomy at D10, D12, L2 and L3. The VAS improved from 6.57 ± 2.14 to 1.29 ± 0.75 (p = 0.001...

Unsuccessful recognition of the origin of testicular pain and a high failure rate of surgical interventions lead to poor outcomes, psychologic distress, and increased costs of care. A frequently overlooked cause of testicular and buttock pain is irritation of the T10-L1 sensory nerve roots, the genitofemoral nerve, and the ilioinguinal nerve. We present the case of a 36-year-old policeman with a 5-year history of back pain and testicular pain of unknown origin. Physical examination of the thoracolumbar region revealed that active movement provoked the patient's buttock symptoms, and local mobility restrictions were present in the thoracolumbar region. A central disk protrusion at T12-L1 was noted on upper lumbar spine magnetic resonance imaging, which supports dysfunction of this region. The diagnosis of thoracolumbar stiffness led to implementation of passive and active mobilization of that region and to specific hip stretching and strengthening exercises. After a course of direct and guided physical therapy, the patient attained complete symptom resolution. The patient returned to full work duties as a police officer and resumed his full recreational activity. The excellent outcome achieved in managing this patient was attributed to identifying the origin of referred pain from the thoracolumbar junction.

We report two patients with ventral schwannoma in the thoracolumbar region manifesting as low back pain with or without paraparesis. In both patients magnetic resonance imaging (MRI) revealed a heterogeneously-enhanced intradural extramedullary mass in the thoracolumbar region. The tumors were successfully removed via the posterior approach. Their histology was consistent with schwannoma. Postoperative MRI showed no evidence of a tumor in either patient. Spinal schwannomas are common benign intradural extramedullary spinal neoplasms; most arise from the dorsal- and very few from the anterior roots. A literature review revealed that ventral schwannomas, including giant tumors as in the one from case 2 in our study, affect mainly the cervical region, and most are surgically addressed via the posterior approach. Careful handling of the spinal cord is mandatory for satisfactory surgical results.

The use of minimally invasive techniques in thoracoscopically assisted procedures allows the reconstruction of the anterior column after vertebral fractures of the thoracolumbar region with reduced approach morbidity. Further indications are secondary reconstruction after malalignment and nonunion and resection of tumour and metastasis. After resection of the destroyed discs and vertebra, vertebral body replacement together with an angle-stable double-rod instrumentation results in a biomechanical stable anterior column. The aims of this procedure are: reconstruction and stabilization of the anterior column, decompression of the spinal canal, resection of destroyed discs, restoration of the sagittal alignment, early functional treatment and reduced comorbidity by using the minimally invasive approach.

Callithrix jacchus (common marmoset) is regularly used in biomedical research, including for studies involving the skeleton. To support these studies, skeletons of healthy animals that had been euthanized for reasons not interfering with skeletal anatomy were prepared. The marmoset dental formula 2I-1C-3P-2M of each oral quadrant is atypical for New World monkeys which commonly possess a third molar. Seven cervical, 12–13 thoracic, 7–6 lumbar, 2–3 sacral and 26–29 caudal vertebrae are present, the thoracolumbar region always comprising 19 vertebrae. A sigmoid clavicle connects the scapula with the manubrium of the sternum. Depending on the number of thoracic vertebrae, 4–5 sternebrae are located between the manubrium and xiphoid process. Wide interosseous spaces separate the radius from the ulna, and the tibia from the fibula. A small sesamoid bone is inserted in the m. abductor digiti primi longus at the medial border of the carpus, a pair of ovoid sesamoid bones is located at the palmar/plantar sides of the trochleae of each metapodial bone, and round fabellae articulate with the proximal surfaces of the femoral condyles. Male marmosets possess a small penile bone. Both the front and hind feet have five digits. The hallux possesses a flat nail, whereas all other digits present curved claws. Interestingly, a central bone is present in both the carpus and tarsus. This study provides a description and detailed illustrations of the skeleton of the common marmoset as an anatomical guide for further biomedical research.

Study Design. Case report. Objectives. To report a rare case of purely extradural spinal meningioma in a patient with previous history of malignant disease and to discuss the potential pitfalls in differential diagnosis and treatment of intraspinal extramedullary masses. Summary and Background Data. Spinal meningiomas located purely in the extradural space are rare, and they may easily be confused with malignant neoplasms that are much more common in this location. Methods. An asymptomatic intraspinal extramedullary mass in the thoracolumbar region was detected by magnetic resonance imaging in a 75-year-old woman with previous history of malignant disease. Results. The purely extradural lesion was completely excised via a dorsal approach. The intraoperative and postoperative histologic examination revealed a meningioma. The patient is symptom free 18 months after surgery without radiologic recurrence. Conclusion. Extradural spinal meningiomas may mimic metastatic disease. Attention needs to be drawn to this dangerous preoperative and intraoperative misinterpretation, which may easily entail an inadequate therapy. Intraoperative histology is mandatory for optimal surgical decision-making.

Suboptimal placements of pedicle screws may lead to neurological and vascular complications. Computer-assisted image guidance has been shown to improve accuracy in spinal instrumentation. Checking the accuracy of the navigation system during pedicle screw placement is fundamental. We describe a novel technique of using continuous accuracy check of the navigation system during O-arm-based neuronavigation to instrument the thoracolumbar region. Forty thoracic and 42 lumbar screws were inserted in 12 patients. The Mirza evaluation system was used to evaluate the accuracy of the inserted screws. There was no neurological injury and no need to reposition any screw. The accuracy of the screws placement was excellent. Our technique of continuous at will operational accuracy check of the neuronavigation system is associated with extreme accuracy of screw placement, no need to bring a patient back to the operating room to reposition a pedicle screw, and with excellent outcome.

Injuries to the thoracic and lumbar spine occur in 6.3% of all trauma patients (Holmes, Acad Emerg Med 8:866–872, 2001). The great majority of those injuries are due to blunt trauma. Spinal cord injury occurs in 1.3% of trauma patients (Holmes, Acad Emerg Med 8:866–872, 2001). Fractures occur most commonly in the thoracolumbar region (T10-L2) as it is the most mobile part of the thoracic and lumbar spine. Severe burst-type fractures of the vertebral body can render the spine unstable and puts the cord at risk for injury by the protruding fragments.

To investigate characteristic clinical and radiological features of extradural arachnoid cysts (EDACs) in the thoracolumbar region, a retrospective review of medical records and imaging studies was performed. EDACs are well known but relatively rare lesions in the thoracolumbar spinal canal. The most common site is the lower thoracic spine, and it may cause neurological symptoms by compressing the spinal cord or nerve root. In this study, the pathogenesis, symptomatology, diagnostic approach, and surgical management of EDACs will be discussed. We studied 14 consecutive patients who were surgically treated for EDACs in the thoracolumbar region at our institute between March 2000 and January 2011. The history, clinical presentations, image findings, operative findings, and surgical outcomes of these patients were retrospectively analyzed. The mean follow-up period was 28 months (range: 6–72 months). Progressive motor weakness was the predominant symptom in all patients. Nine patients had radicular leg pain and back pain in the thoracolumbar area. On MRI, the cyst compressed the dural sac and spinal cord posteriorly typically with bilateral foraminal extensions. On radiological study, a communication point with the subarachnoid was hardly observed. The surgical treatment of EDACs included complete resection of the walls and closing the communicating point with the subarachnoid space. All patients showed excellent outcomes according to Odom’s criteria without recurrence. One CSF leakage and one postoperative hematoma were noted. Thoracolumbar EDAC patients presented paraparesis and leg pain. Complete excision and closing the communicating point with the subarachnoid space were the choices of treatment, and the outcomes were favorable.

Few studies quantify spinal posture behaviour at both the thoracolumbar and lumbar spinal regions. This study compared spontaneous spinal posture in 50 asymptomatic participants (21 males) during three conditions: 10-min computer task in sitting (participants naïve to the measure), during their perceived ‘correct’ sitting posture, and standing. Three-dimensional optical tracking quantified surface spinal angles at the thoracolumbar and lumbar regions, and spinal orientation with respect to the vertical. Despite popular belief that lordotic lumbar angles are ‘correct’ for sitting, this was rarely adopted for 10-min sitting. In 10-min sitting, spinal angles flexed 24(7–9)deg at lumbar and 12(6–8)deg at thoracolumbar regions relative to standing (P < 0.001). When participants ‘corrected’ their sitting posture, their thoracolumbar angle −2(7)deg was similar to the angle in standing −1(6)deg (P = 1.00). Males were flexed at the lumbar angle relative to females for 10-min sitting, ‘correct’ sitting and standing, but showed no difference at the thoracolumbar region. Refereed/Peer-reviewed

The aim of this study was to outline the clinicoradiological features of central nervous system (CNS) tuberculoma, and highlight the importance of early treatment. We conducted a retrospective analysis between 1999 and 2008. Clinicoradiological, pathological and follow-up data of 23 patients were reviewed and analysed. The mean age at presentation was 30.3 years (range = 17–43 years), and the average disease duration at presentation was six months (range = 1–19 months). The tuberculoma location in the cohort was: thoracic region (10 patients); cervical region (six), cervicothoracic region (three); thoracolumbar region (one); and intracranial (six); three patients (13%) had multiple lesions. Nineteen (82.6%) and 15 (65.2%) patients had sensory-motor and bowel/bladder involvement, respectively. Two patients presented with headache and consciousness disturbance, and two patients had a history of pulmonary Koch’s disease. Five patients had a history of tuberculous meningoencephalitis, and one patient had a history of enlarged cervical lymph nodes. Twenty-one patients underwent surgery, and two received conservative treatment; all patients received anti-tuberculosis therapy for 18 months. Seventeen of the 21 surgical patients and both conservatively managed patients achieved improved neurological function (with Karnofsky Performance Scale scores of 90–100). Patients presenting at an advanced disease stage had a poorer outcome. CNS tuberculoma is a benign condition with a good prognosis and effective therapy options. Enhanced brain and spine MRI should be performed to ensure the diagnosis is not missed. Early surgical decompression is recommended for intramedullary tuberculoma. Craniotomy is indicated for patients with intracranial hypertension, while more conservative therapy is appropriate for patients who have intracranial tuberculomas without intracranial hypertension.

This paper reports a segmental analysis of the lateral spinal radiographs of 37 children referred to hospital in a school screening study of 4,890 school children aged 12–13 years. On each lateral radiograph a line was drawn along the posterior surface of each vertebral body from T5-L5 and the angle of this line from the vertical was recorded. After measuring the scoliosis curve (Cobb) angle and using conventional criteria for diagnosis, three groups of patients are defined, namely, 1) a control group (average scoliosis curve angle (Cobb) of 5°, n = 14), 2) a group with lumbar curves (average Cobb angle 21°, n = 7), and 3) a group with thoracic curves (average Cobb angle 19 degrees, n = 10). Individual lateral spinal profiles are also analyzed. The findings show: (1) In the control group, there are different degrees of vertical backward tilt (declivity) from T7–L3, with a maximum tilt at T12 (mean 26°). The most vertical vertebrae are T6 and L4, with forward tilting (proclivity) at each of (T5 and L5.2) In the lumbar curve group, the segmental sagittal tilt is not significantly different from that in the control group. The mean declivity at T12 is 25°. (3) In the thoracic curve group, the segmental sagittal tilt is significantly less than that in the control group at each of T10–L1. The mean declivity at T12 is 17°. A more vertical T12 is associated with a larger Cobb angle. (4) The individual sagittal spinal profiles of the thoracic curve group (but no other group) show lordosis in the region of the lateral spinal curve (scoliosis) and a kyphotic angulation at an average of three vertebrae below the apical vertebrae of the scoliosis curve. (5) It is suggested that as a thoracic lordoscoliosis develops, the appearance of a kyphotic angulation in the thoracolumbar and upper lumbar spine is determined by the compressibility of each disc in relation to the length of the articular processes at the corresponding level. Where the combination of disc weakness to facet length is most adverse, forward flexion occurs, as in a spinal fracture, to produce the kyphotic angulation. © 1992 Wiley-Liss, Inc.

Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and developed massive rebleeding on the third day following initial evacuation of hematoma. This case illustrates that a patient with routine normal coagulation profile and adequate hemostasis can still harbor platelet dysfunction (in present case due to polycythemia) and later on can manifest as rebleeding and neurological deterioration.

We retrospectively studied the cases with tuberculous spondylitis of thoracolumbar region with two or more levels of involvement that underwent posterior instrumentation and fusion and anterior fusion with titanium mesh following anterior decompression using simultaneous successive posterior–anterior–posterior surgery. Among all patients with tuberculous spondylitis accompanied by medium or severe kyphosis, 20 patients who underwent simultaneous successive decompression, fusion and instrumentation with posterior–anterior–posterior surgery between 1999 and 2004 were included in the study. Patients were evaluated for fusion formation and neurological and functional status. Kyphosis angles were measured at early and long-term follow-up. Antituberculosis chemotherapy was initiated in all patients and continued for 9 months; initially as quadruple therapy for 3 months, and then as triple therapy. Average follow-up period was 52.7 months (range 37–94). Solid fusion was achieved in all patients. All patients returned to their previous occupation; 75% (15 subjects) with mild pain or no pain and 15% (3 subjects) with major limitations. There were 11 patients with neurological deficit, 9 of these achieved complete neurological recoveries. Regarding kyphosis angle, an average 35.1° correction (84.8%) was obtained in postoperative period (p < 0.001) and there was no significant correction loss during the follow-up period (p < 0.05). There were no grafts or instrumentation-related stabilization problems. In subjects with tuberculous spondylitis with involvements at two or more levels accompanied by medium and severe kyphosis, decompression, fusion and instrumentation by simultaneous successive posterior–anterior–posterior surgery is an effective and safe management method for effective kyphosis correction with high fusion rates.

Background In healthy adolescents normal back shape asymmetry, here termed truncal asymmetry (TA), is evaluated by higher and lower subsets of BMI. The study was initiated after research on girls with adolescent idiopathic scoliosis (AIS) showed that higher and lower BMI subsets discriminated patterns of skeletal maturation and asymmetry unexplained by existing theories of pathogenesis leading to a new interpretation which has therapeutic implications (double neuro-osseous theory). Methods 5953 adolescents age 11–17 years (boys 2939, girls 3014) were examined in a school screening program in two standard positions, standing forward bending (FB) and sitting FB. The sitting FB position is thought to reveal intrinsic TA free from back humps induced by any leg-length inequality. TA was measured in both positions using a Pruijs scoliometer as angle of trunk inclinations (ATIs) across the back at each of three spinal regions, thoracic, thoracolumbar and lumbar. Abnormality of ATIs was defined as being outside 2 standard deviations for each age group, gender, position and spinal region, and termed severe TA. Results In the sitting FB position after correcting for age,relatively lower BMIs are statistically associated with a greater number of severe TAs than with relatively higher BMIs in both girls (thoracolumbar region) and boys (thoracolumbar and lumbar regions). The relative frequency of severe TAs is significantly higher in girls than boys for each of the right thoracic (56.76%) and thoracolumbar (58.82%) regions (p = 0.006, 0.006, respectively). After correcting for age, smaller BMIs are associated with more severe TAs in boys and girls. Discussion BMI is a surrogate measure for body fat and circulating leptin levels. The finding that girls with relatively lower BMI have significantly later menarche, and a significant excess of TAs, suggests a relation to energy homeostasis through the hypothalamus. The hypothesis we suggest for the pathogenesis of severe TA in girls and boys has the same mechanism as that proposed recently for AIS girls, namely: severe TAs are initiated by a genetically-determined selectively increased hypothalamic sensitivity (up-regulation, i.e. increased sensitivity) to leptin with asymmetry as an adverse response to stress (hormesis), mediated bilaterally mainly to the growing trunk via the sympathetic nervous system (leptin-hypothalamic-sympathetic nervous system (LHS) concept). The putative autonomic dysfunction is thought to be increased by any lower circulating leptin levels associated with relatively lower BMIs. Sympathetic nervous system activation with asymmetry leads to asymmetries in ribs and/or vertebrae producing severe TA when beyond the capacity of postural mechanisms of the somatic nervous system to control the shape distortion of the trunk. A test of this hypothesis testing skin sympathetic responses, as in the Rett syndrome, is suggested.

Minimally invasive spine surgery is evolving rapidly. Compared with the traditional posterior approach with long and wide exposure, the minimally invasive approach offers significant advantages in treating patients with spine trauma.

SUMMARY: Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive para- or tetraplegia. They most commonly affect elderly men and are classically found in the thoracolumbar region. The AV shunt is located inside the dura mater close to the spinal nerve root where the arterial blood from a radiculomeningeal artery enters a radicular vein. The increase in spinal venous pressure leads to decreased drainage of normal spinal veins, venous congestion, and the clinical findings of progressive myelopathy. On MR imaging, the combination of cord edema, perimedullary dilated vessels, and cord enhancement is characteristic. Therapy has to be aimed at occluding the shunting zone, either by superselective embolization with a liquid embolic agent or by a neurosurgical approach. Following occlusion of the fistula, the progression of the disease can be stopped and improvement of symptoms is typically observed.

Embryofetoscopy is an endoscopic technique that enables direct visualization and morphologic study of embryos during the first trimester and allows a selective tissue sample to be obtained. We describe an early missed abortion in the first trimester, apparently without cause according to findings at ultrasound. Embryofetoscopy revealed a remarkable dorsal cystic formation covered by a blood clot in the thoracolumbar region of the spine, suggestive of meningocele or myelomeningocele. A selective tissue biopsy specimen of the cystic lesion demonstrated meningeal tissue such as a meningocele. Embryofetoscopy in missed abortion could provide information about the causes of severe defects in embryo development so that parents can be effectively advised insofar as future pregnancies.

Spinal meningoceles are protrusions or expansions of one or more layers of the thecal sac through a canal or foramen of the spinal column in which there is a defect. They are frequently found in a posterior location with the dysraphic vertebrae over the thoracolumbar region. Spinal meningoceles are most commonly observed at birth and constitute approximately 10% of all patients with spina bifida [1, 2]. Although non-dysraphic anterior, lateral, and anterolateral meningoceles in the cervical, thoracic, and lumbar spine are very rare and frequently characterized by the absence of a congenital defect of the vertebrae, they are usually associated with neurofibromatosis 1 (NF-1) or Marfan’s syndrome [1, 2, 3, 4, 5, 6, 7, 8]. However, anterior lumbosacral meningoceles are a rare form of spinal dysraphism because of a bony defect. Their embryologic origin remains unclear, although there are several hypotheses [2]. Thoracic and/or lumbosacral spinal levels are the most common, with cervical localization being very rare [5, 6, 7, 9, 10, 11].