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Tuberculous spondylitis has become relatively rare in recent years. Furthermore, the incidence of tuberculous spondylitis involving the atlas and axis comprises only 0.3% of all tuberculous spondylitis. We successfully treated a patient with tuberculous spondylitis of the atlas and axis without pulumonary lesion.A 29-year-old female, suspected of a cervical disc hernia, was refered to us because conservative treatment induced little improvement. She had symptoms indicating cervical tuberculous spondylitis, such as febricula, malaise, neck pain, headache, and dysphagia. Serological exams indicated acute inflammation (ESR: 95mm/h, CRP: 4.6mg/dl). Roentgenograms of her chest and cervical spine did not show any pathological findings. However, CT revealed the pathological fracture of the atlas and MRI revealed fluid collection around the atlanto-axial region and middle thoracic spine. Needle aspiration of cervical lesion was performed under CT guide. Tuberculous infection was determined using the PCR method. Clinical symptoms subsided and ESR and CRP were reduced to normal range 4 weeks after the start of antituberculous medications. After 14 weeks, we confirmed thebone union of the pathological fracture of the atlas and disappearance of the abscess by MRI.

We report a case of intraspinal enterogenous cyst complaining of chest pain and gait disturbance. A 43-year-old male experienced chest pain 7 years ago when driving over bumps and swallowing something. I schemic heart disease was initially suspected, but no abnormality was detected by detailed examination. These symptoms subsided with antidepressant drugs.He experienced chest pain again which did not subside with the antidepressant drugs, and gait disturbance started. Magnetic resonance imaging (MRI) and myelogram showed a cystic lesion located in front of the cervicothoracic spinal canal, and which oppressed the cord severely to the posterior. Neither turbulence in the cyst nor communication flow between the cyst and subarachnoid space was seen in cine MRI.Tumor was resected by the posterior approach. After resection, pathological study revealed the mass to be an enterogenous cyst. The symptoms disappeared after surgery, and no tumor recurrence was seen by MRI for 6 months after surgery.

We reviewed the surgical results of 18 patients suffering from thoracic myelopathy caused by ossification of the yellow ligament (OYL) and investigated the factors affecting postoperative results. The percentage of clinical recovery, which was calculated from the JOA score before and after surgery, averaged 54.9%. Factors investigated were age at surgery, delay of surgery after onset of symptoms, JOA score before surgery and percentage of narrowing of spinal canal calculated from CT myelography. Correlation between percentage of clinical recovery and these factors were analyzed. There was a significant negative correlation between the percentage of clinical recovery and delay of surgery. No significant correlation was found between the other factors. Therefore, we recommend early diagnosis and early surgery without delay.

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.

Two surgical cases of os odontoideum in spondyloepiphyseal dysplasia (SED) tarda were reported. The first case was a 34-year-old male suffering from intractable neck pain with bilateral numbness in his hands due to myelopathy. The radiogram demonstrated atlantoaxial subluxation and invagination of the posterior arch of C1 into the foramen magnum.CT-myelogram showed the spinal cord to be compressed between the posterior arch of C1 and the base of the odontoid process. The second case was a 28-year-old male who developed tetraplesia after falling down. His radiogram demonstrated posterolateral atlantoaxial subluxation.In both cases, the posterior arch of C1 was located close to the foramen magnum and was unable to be reduced downward. Both cases required occipitocervical fusion using a fan-like rod. We experienced two cases of SED congenita with similar radiological findings to SED tarda. Narrowing of the atlanto-occipital interval and loss of motion were also seen in SED congenita experienced previously. Their finding may be characteristic of case with os odontoideum in SED.The first case achieved a good recovery after surgery, however, the second case remained tetraplegic.

We reviewed 19 patients with cervical myelopathy treated with anterior decompression and fusion. Etiology of cervical myelopathy was cervical disc herniation (CDH) in 13 patients and cervical spondylosis (CSM) in 6. Clinical recovery rate (%) was calculated from preoperative cervical myelopathy score (JOA) and the score at follow-up. Correlation between the clinical recovery rate and MRI findings (area and flatness at the narrowest part of the spinal cord), age at surgery, duration of myelopathy and pre-operative clinical score were analyzed separately in the CDH and CSM groups. Clinical recovery rate averaged 69% in the CDH group and 75% in the CSM group. In the CDH group, average clinical recovery rate in patients younger than 60 years was 80 and in patients over 60 years was 60. There was a significant negative correlation between the clinical recovery rate and age at surgery (p

We experienced three cases of spinal vascular disorders showing negative angiographic findings.Case 1: A 15-year-old female had two paraplegic attacks with spontaneous remission after the first attack. Intraspinal hemorrhage was speculated because of a chronological change in her MR imaging. Two selective angiographies did not reveal any pathological findings. Surgery was done after the second attack which had resulted in severe paraplegia. Intraspinal hemorrhage without any abnormal vessels was found and was evacuated. Paraplegia improved markedly.Case 2: A 28-year-old female showed staggering gait due to a deep sensation disturbance. Case 3: A 34-year-old female developed numbness in her left lower extremity. In both cases, a spinal vascular disorder was strongly suspected by MR imaging, but selective angiography did not reveal any positive findings.Possible reasons why selective angiography failed to show any pathological findings include the failure to hit feeder arteries, no arterial component in the vascular disorder and a vascular disorder that was too small to detect.Spinal vascular disorders may show a similar clinical course to multiple sclerosis. Using sequential MR imaging and MR imaging enhanced with Gd-DTPA, intraspinal hemorrhage can be distinguished from multiple sclerosis.

We reviewed clinical and radiological results of five patients with lower lumbar burst fractures treated by pedicle screws. All patients achieved successful union of the fracture with good alignment and improved their neurological deficits as well as reducing their low back pain. Posterior decompression with reduction of the prolapsed fracture fragment in the spinal canal was useful for treating patients who underwent surgery within four weeks from the time of injury. It may be possible to preserve the lower disc segment in Dennis type B fractures by using posterolateral fusion of the upper disc segment only. To achieve earlier mobility, and reduce the period of bed-rest required, anterior strut grafting may be needed in patients with a burst fracture whose spinal bodies and upper and lower discs are severely destroyed including those with Dennis type D fractures.

We report 20 cases (11 males, 9 females) who were operated upon between 1985 and 1993 for treatment of intradural spinal cord tumors using the posterior approach. The age of patients at surgery ranged from 8 to 70 years. They were followed up from 2 months to 6 years and 3 months (mean 2 years and 3 months).On MRI, posterior shift of the spinal cord was observed after tumor removal in 4 cases with intramedullary tumors, in one case with extramedullary tumor, and in one case with an arachnoid cyst. However, no cases with cauda equina tumors showed posterior shift. The dorsal tissue behind the shifted spinal cord was enhanced by gadolinium in a case with positive Lhermitte sign. Cine MRI revealed that the posteriorly shifted spinal cord stopped the cerebrospinal fluid flow in 4 cases. These results suggested that the posteriorly shifted cord resulted from adhesion of the spinal cord to the arachnoid membrane or the dura.

Preoperative radiological findings and surgical results of 13 bidirectional anterior and posterior atlantoaxial subluxation (AAS) cases and 11 unidirectional anterior AAS cases were compared. Bidirectional AAS showed more angular instability of the atlantoaxial joint than anterior AAS (p

Malignant lymphoma originating in the spine is a rare occurrence, however differential diagnosis from eosinophilic granuloma or pyogenic spondylitis is often difficult because of inflammatory manifestations clinically and pathologically, A 48-year-old house wife with Th9 lymphoma was diagnosed as eosinophilic granuloma pathologically after biopsy and anterior simultaneous vertebral body fusion, However, paraplegia ensued one month after surgery, so that palliative posterior decompression was performed.A 6-year-old girl with Th5 lymphoma had been treated by antibiotics presumably as pyogenic spondylitis. Although emergency biopsy and anterior vertebral fusion was performed as a result of impending paralysis, chemotherapy with regimen of Ki-1 lymphoma ameliorated the desease and the paralysis.Chemotherapy upon malignant lymphoma is mandatory and often effective, however, in the spinal lesion, surgical intervension is inevitable if the paralysis is impending.

Clinical results following treatment for spinal infections in nine patients were evaluated. Three children and one adult who showed only slight disc space narrowing and slight erosion of vertebral endplate radiologically were successfully treated only by administration of antibiotics. Five adults who showed advanced vertebral destruction required surgery in order to reduce the infection. Two of these five cases, who showed neurological compromise with severe cervical kyphosis, were successfully treated with Luque SSI, anterior debridement and iliac bone grafting.Children and adults with minimum radiological changes respond well to antibiotic administration. Adults with advanced radiological changes and neurological compromise can be successfully treated with posterior instrumentation and anterior bone grafting not only sufficient for correction of kyphosis but also for rigid fixation.