Thoracic Intraspinal Synovial Cyst Causing Myelopathy: A Case Report

Intraspinal synovial cysts are commonly found in the lumbar spine and occur less commonly in the cervical spine. Occurrence of a cyst in the thoracic spine causing myelopathy is extremely rare. We report here the radiological findings of a case of a thoracic intraspinal synovial cyst that caused myelopathy at the T2-3 level with an accompanying review of the clinical literature.

Chronic Lumbar Epidural Hematoma in a Patient Suffering With Spondylolytic Spondylolisthesis at the L4-5 Level: A Case Report

Nontraumatic spinal epidural hematoma (SEH) is a rare condition and the exact cause of the hemorrhage in SEH has never been established. However, there have been a few recent reports on some types of the epidural hematoma with a detectable origin of hemorrhage. We encountered a case of chronic SEH in a patient who had spondylolytic spondylolisthesis, which is also a rare condition to be associated with SEH. We report here on the radiologic findings of a case of chronic epidural hematoma in a patient who had spondylolytic spondylolisthesis at the L4-5 level, and we include a review of the related literatures.

Lumbar Internal Disc Derangement in Patients with Chronic Low Back Pain: Diagnostic Value of the MR Imaging Findings as Compared with Provoked Discography as the Standard

PURPOSE: The aim of this study was to evaluate the diagnostic value of the MR Imaging findings with provoked discography used as the standard for painful lumbar disc derangement. MATERIALS AND METHODS: Two hundred patients (412 discs), (age range: 21-77 years), with chronic low back pain underwent MRI and provoked discography. We evaluated the MRI T2-WI findings such as disc degeneration, high-Intensity zones and endplate abnormalities. Subsequently, provocative discography was independently performed with using MR imaging, and a painful disc was defined when moderate to severe and concordant pain was provoked. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the MRI findings with using provoked discography as the standard. RESULTS: 400 discs showed abnormal findings such as disc degeneration, HIZ and endplate abnormalities on the T2-WI images. 12 discs showed normal findings. HIZ or endplate abnormalities were always combined with disc degeneration. The prevalence of each findings were disc degeneration (400 discs: 97.1%), HIZ (111 discs: 26.9%), type I endplate abnormalities (34 discs: 8.3%), type II endplate abnormalities (75 discs: 18.2%), the combined findings of HIZ and type I endplate abnormalities (2 discs: 0.5%) and the combined findings of HIZ and type II endplate abnormalities (7 discs: 1.7%). The disc degeneration showed high sensitivity (99.5%) and low specificity (5.0%), so only the NPV (91.7%) was significant, and not the PPV (47.8%). Each findings of HIZ (sensitivity, 36.5%; specificity, 81.4%; PPV, 63.18%; NPV, 59.5%), type I endplate abnormalities (11.0%, 94.1%, 61.8% and 54.8%, respectively), type II endplate abnormalities (19.8%, 83.2%, 50.7% and 54.3%, respectively), the combined findings of HIZ and type I endplate abnormalities (0.5%, 99.6%, 50.0% and 53.4%, respectively) and the combined findings of HIZ and type II endplate abnormalities (26.0%, 99.1%, 71.4% and 53.8%, respectively) show high specificity, but low sensitivity, so the PPV and NPV were also not significant. CONCLUSION: For diagnosing painful lumbar disc derangement, the MR imaging findings seem to be inadequate as predictive factors when provoked discography was used as the standard.

En Plaque Meningioma in Thoracic Spine: Case Report

Spinal en plaque meningioma is rarely found in the spinal canal, although lateral sphenoid wing meningioma displays a propensity for growth en plaque. We encountered a case of completely circumferential spinal en plaque meningioma, which is an even rarer condition. Herein, we report the CT & MRI findings along with a review of the related literature.